Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients

Abstract

Cervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4–8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.

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“…Articles were included if they (a) specifically stated that the respiratory interventions were not supervised or (b) provided evidence of a logbook or training diary. Four publications met all inclusion criteria (Table 1) [ [24][25][26][27].…”

“…The authors determined that these highly trained athletes already possessed high pulmonary function and thus did not experience further improvement [24]. The less fit patients studied by Shin et al experienced significant improvements in FVC in the seated (23%) and supine (26%) positions, as well as in peak cough flow (PCF) (28%) [27]. The significant improvements in pulmonary function measured during expiratory maneuvers are especially interesting because the HEP intervention used by these inpatients focused heavily on IMT [27].…”

“…One hundred-seventeen individuals in these four publications completed a variant of RMT as a home exercise program (HEP). The largest study, enrolling 104 participants, was conducted in a tertiary hospital but patients were instructed to complete the IMT-based HEP on their own with a weekly check-in [ 27 ]. All other studies appeared to have participants training in their homes and reporting compliance with a training log or diary [ 24 – 26 ].…”

“…The Repecki case study and the Leatham et al publication described similar study interventions, with participants completing both an IMT HEP and a weekly or bi-weekly community fitness class [ 25 , 26 ]. The patients included in the article by Shin and colleagues were instructed on a multistep program including glossopharyngeal breathing, IMT with an incentive spirometer, and air stacking [ 27 ]. While the athletes in the study conducted by Gee et al completed RMT, by jointly performing both IMT and expiratory muscle training (EMT) [ 24 ].…”

“…Similar to the interventions detailed in this collection of RMT studies, the outcomes reported in these four studies were varied. Two of the four studies provided respiratory-based results [ 24 , 27 ], while the community-based program studies reported positive findings in functional outcomes including the T-shirt Test, Timed Transfer Test, hand held dynamometry, and Modified Functional Reach [ 25 , 26 ]. The wheelchair athletes saw significant improvement in maximal inspiratory pressure (MIP) (40%), maximal expiratory pressure (MEP) (25%) and peak expiratory flow rate (PEF) (9%), while forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) did not change significantly (1.6 and 1.5%, respectively) [ 24 ].…”