Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria – a prospective randomized trial

Abstract

Objective: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. Design: Prospective, randomized controlled trial. Setting: Tertiary hospital. Participants: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. Intervention: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. Main outcome measures: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. Results: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. Conclusions: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria. Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis

“…The subgroup analysis by type of intervention showed a slightly greater effect in the pooled of the studies that performed only IMT [ES= 0.89 (95% CI: 0.19 to 1.58; I 2 = 66.3%, p = 0.018)] compared with the IMT/EMT subgroup [ES= 0.38 (95% CI: 0.06 to 0.69; I 2 = 0.0%, p = 0.650)]. The FVC was analysed in nine studies [19,23,25,27,29,32,34,36,37]. The pooled ES was 0.32 (95% CI: 0.06 to 0.58; I 2 = 0.0%, p = 0.507) ( Figure 3).…”

“…When the studies were removed one by one, the pooled ES analysis showed a loss of statistical significance when the study of NJ Jung et al [26] was removed. Dyspnea was evaluated in five studies [19,21,29,33,37]; due to the limited number of studies, the subgroup analysis by type of RMT exercise was not performed. The pooled ES of RMT interventions on dyspnea was 0.47 (95% CI: −0.30 to 1.23; I 2 = 77%, p = 0.002) (Figure 8), showing a positive trend of improvement which was not statistically significant.…”

“…The pooled ES of RMT interventions on dyspnea was 0.47 (95% CI: −0.30 to 1.23; I 2 = 77%, p = 0.002) (Figure 8), showing a positive trend of improvement which was not statistically significant. The MBI [19,23,29] and BBS [23,24,27] were only evaluated in three studies. In both, the RMT interventions did not show a statistically significant improvement (MBI: 0.22 (95% CI: −0.31 to 0.75; I 2 = 37.6%, p = 0.201; and BBS: 0.06 (95% CI: −0.37 to 0.49; I 2 = 0.0%, p = 0.953).…”

“…Equally, MEP was analysed in seven studies [19][20][21]28,30,31,37], and only one of these performed exclusively IMT exercises [37]; thus, the overall ES was 0.55 (95% CI: 0.12 to 0.98; I 2 = 71.9%, p = 0.002) ( Figure 5). The MIP was examined in nine studies [19][20][21][22]28,30,31,35,37], and obtained a pooled ES= 0.84 (95% CI: 0.44 to 1.24; I 2 = 69.2%, p = 0.001) ( Figure 6); three of these studies performed only IMT exercises [22,35,37], and six studies carried out both IMT and EMT exercises, showing statistically significant improvements for both groups of interventions. Sensitivity analyses for all pulmonary function variables showed that the pooled ES estimates were not significantly modified in magnitude or direction when individual study data were removed from the analysis one at a time.…”

Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial

“…Improving rehabilitation training at this stage can help a lot to restore swallowing function as much as possible 24 . Previous study 25 has pointed out that it is rather difficult to evaluate the recovery of neurological function after stroke, and rehabilitation training at the initial stage can restore and alleviate the symptoms of dysphagia in most patients. The results of this present study have indicated that capsaicin combined with ice stimulation is beneficial to the recovery of swallowing function in patients with dysphagia after stroke, which is an easy and convenient intervention to improve the prognosis of patients with dysphagia.…”