Avaliação da força muscular respiratória emindivíduos com síndrome de down / Evaluation of respiratory muscle strength in individuals havingDown syndrome

Em consequência das alterações musculares, decorrentes do quadro de hipotonia generalizada, encontradas nos indivíduoscom síndrome de Down (SD), esses desenvolvem também alterações na força muscular respiratória (FMR). Assim, oobjetivo do estudo foi avaliar a FMR de indivíduos com SD. Trata-se de um estudo do tipo transversal, realizado na Associaçãode Pais e Amigos dos Excepcionais (APAE) de município do interior de São Paulo. Foram avaliados 20 voluntários,divididos em dois grupos, sendo 10 indivíduos não sindrômicos e 10 indivíduos com diagnóstico de SD, com idade entre18 e 35 anos, de ambos os gêneros. A avaliação da FMR foi realizada com um manovacuômetro analógico, por meio dasmedidas da pressão inspiratória máxima (PIMáx) e da pressão expiratória máxima (PEMáx). Para a análise estatística, foiutilizado o programa Bioestat versão 5.3. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk. Logo após,foram utilizados testes de comparação para duas amostras independentes (teste t de Student e Mann-Whitney), adotandonível de significância de 5%. Na comparação entre os grupos estudados, pode-se constatar diferença significativa daPIMáx (p= 0,0011) e da PEMáx (p= 0,0002), sendo que menores valores de FMR foram obtidos no grupo de indivíduos comSD (PIMáx: -109±49,49 x -29,50±9,07) e (PEMáx: 127±44,06 x 45,50±10,11). Portanto, indivíduos com SD apresentamredução da FMR. Acredita-se que estes indivíduos se beneficiariam de um programa de reabilitação, incluindo fisioterapiarespiratória, minimizando assim, possíveis complicações respiratórias.

As a result of muscle changes caused by the generalized hypotonia found in individuals with Down syndrome (DS), thesesubjects develop changes in respiratory muscle strength. The objective of the study was to assess respiratory muscle strength(RMS) of individuals having DS. Thus, the objective of the study was to evaluate the respiratory muscle strength (RMS) inindividuals with DS. It was cross-sectional study, conducted at the Association of Parents and Friends of Exceptional (APFE)of countryside of São Paulo. 20 volunteers were evaluated, divided into two groups, 10 non-syndromic individuals and10 individuals diagnosed with DS, aged between 18 and 35 years, of both genders. The evaluation of RMS was performedby an analog manometer through which were measured maximal inspiratory pressures (MIP) and maximum expiratorypressures (MEP). For data analysis, were used the BioEstat version 5.3. Data normality was verified by the Shapiro-Wilktest. After, comparison tests were used for two independent samples (Student’s t and Mann-Whitney tests), adopting asignificance level of 5%. When comparing both groups, we can find a significant difference in MIP (p= 0.0011) and MEP(p= 0.0002), and lower RMS values were obtained in the group of individuals with DS. SD (MIP: -109±49.49 x -29.50±9.07)and (MEP: 127±44.06 x 45.50±10.11) Therefore, individuals with Down syndrome have decreased RMS. It is believed thatthese individuals would benefit from a rehabilitation program, including physiotherapy, thus minimizing possible respiratorycomplications.

Avaliação da força muscular respiratória emindivíduos com síndrome de down / Evaluation of respiratory muscle strength in individuals havingDown syndrome

Em consequência das alterações musculares, decorrentes do quadro de hipotonia generalizada, encontradas nos indivíduoscom síndrome de Down (SD), esses desenvolvem também alterações na força muscular respiratória (FMR). Assim, oobjetivo do estudo foi avaliar a FMR de indivíduos com SD. Trata-se de um estudo do tipo transversal, realizado na Associaçãode Pais e Amigos dos Excepcionais (APAE) de município do interior de São Paulo. Foram avaliados 20 voluntários,divididos em dois grupos, sendo 10 indivíduos não sindrômicos e 10 indivíduos com diagnóstico de SD, com idade entre18 e 35 anos, de ambos os gêneros. A avaliação da FMR foi realizada com um manovacuômetro analógico, por meio dasmedidas da pressão inspiratória máxima (PIMáx) e da pressão expiratória máxima (PEMáx). Para a análise estatística, foiutilizado o programa Bioestat versão 5.3. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk. Logo após,foram utilizados testes de comparação para duas amostras independentes (teste t de Student e Mann-Whitney), adotandonível de significância de 5%. Na comparação entre os grupos estudados, pode-se constatar diferença significativa daPIMáx (p= 0,0011) e da PEMáx (p= 0,0002), sendo que menores valores de FMR foram obtidos no grupo de indivíduos comSD (PIMáx: -109±49,49 x -29,50±9,07) e (PEMáx: 127±44,06 x 45,50±10,11). Portanto, indivíduos com SD apresentamredução da FMR. Acredita-se que estes indivíduos se beneficiariam de um programa de reabilitação, incluindo fisioterapiarespiratória, minimizando assim, possíveis complicações respiratórias.(AU)

As a result of muscle changes caused by the generalized hypotonia found in individuals with Down syndrome (DS), thesesubjects develop changes in respiratory muscle strength. The objective of the study was to assess respiratory muscle strength(RMS) of individuals having DS. Thus, the objective of the study was to evaluate the respiratory muscle strength (RMS) inindividuals with DS. It was cross-sectional study, conducted at the Association of Parents and Friends of Exceptional (APFE)of countryside of São Paulo. 20 volunteers were evaluated, divided into two groups, 10 non-syndromic individuals and10 individuals diagnosed with DS, aged between 18 and 35 years, of both genders. The evaluation of RMS was performedby an analog manometer through which were measured maximal inspiratory pressures (MIP) and maximum expiratorypressures (MEP). For data analysis, were used the BioEstat version 5.3. Data normality was verified by the Shapiro-Wilktest. After, comparison tests were used for two independent samples (Student’s t and Mann-Whitney tests), adopting asignificance level of 5%. When comparing both groups, we can find a significant difference in MIP (p= 0.0011) and MEP(p= 0.0002), and lower RMS values were obtained in the group of individuals with DS. SD (MIP: -109±49.49 x -29.50±9.07)and (MEP: 127±44.06 x 45.50±10.11) Therefore, individuals with Down syndrome have decreased RMS. It is believed thatthese individuals would benefit from a rehabilitation program, including physiotherapy, thus minimizing possible respiratorycomplications.(AU)

Pulmonary Function after Weight Loss in Obese Women Undergoing Roux-en-Y Gastric Bypass: One-Year Followup.

Introduction. Obesity is a condition that causes damage to the respiratory function. However, studies have demonstrated that weight loss due to bariatric surgery has resulted in a huge improvement on some lung volumes, but controversy still persists regarding the behavior of the respiratory muscle strength and IRV (inspiratory reserve volume). Objective. To evaluate the effect of weight loss, after 1 year of the Roux-en-Y gastric bypass surgery (RYGB), on the lung volumes and the respiratory muscle strength in obese women. Methods. 24 obese women candidates were recruited for RYGB. Lung volumes (spirometry) and respiratory muscle strength were evaluated in preoperative period and one year after surgery. Results. There was a significant increase in some lung volumes. However, when examining the components of the VC (vital capacity) separately, an increase in ERV (expiratory reserve volume) and reduction of IRV were observed. Moreover, a statistically significant reduction in the values of respiratory muscle strength was recorded: MIP (maximal inspiratory pressure) and MEP (maximal expiratory pressure). Conclusion. Weight loss induced by bariatric surgery provides an increase in some lung volumes of obese women, but reduction in IRV. Additionally, there was also a reduction in the respiratory muscle strength.

Estimulação diafragmática elétrica transcutânea na paralisia diafragmática após cirurgia cardíaca / Transcutaneous electrical diaphragmatic stimulation in diaphragmatic paralysis after cardiac surgerys

Relata-se o caso de paciente mulher, 37 anos, com paralisia diafragmática (PD) após cirurgia cardíaca (CC)que realizou fisioterapia respiratória após a alta e, devido à dispneia, recebeu estimulação diafragmática elétrica transcutânea (EDET). Foram avaliados: volume corrente(VC), volume minuto (VM), frequência respiratória (FR),pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx) e radiografia torácica (RT), sendo possível observar a influência da EDET na função pulmonar em paciente com PD. Houve aumento do VC, PImáx e PEmáx; diminuição da FR e VM. A RT mostrou resolução parcial da PD¸ o que confirma a eficácia daEDET na restauração da força e volumes pulmonares frente à PD após CC.

The case study reports on a woman, 37, with diaphragmatic paralysis (DP) after cardiac surgery (CS)who underwent physiotherapy after discharge because of dyspnea and received transcutaneous electrical diaphragmatic stimulation (TEDS). The following were evaluated: tidal volume (TV), minute volume (MV),respiratory rate (RR), maximal inspiratory pressure(MIP), maximal expiratory pressure (MEP) and chest radiography (CR). There was an increase in the TV, MIP and MEP, with a decrease in the RR and MV. The CR showed partial resolution of the DP, which confirms the efficacy of TEDS for restoring lung strength and volumes when DP is present after CS.

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion.

OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group). MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure--maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

Silicone-ring Roux-en-Y gastric bypass in the treatment of obesity: effects of laparoscopic versus laparotomic surgery on respiration.

BACKGROUND: The objective of this study was to compare the effects of silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy versus that accomplished by laparotomy on pulmonary function. METHODS: A total of 26 women (body mass index (BMI) 35-49 kg/m(2)) were studied candidates for silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy (LG; n = 13) and laparotomy (or open surgery (OG); n = 13). Smokers, patients having lung disease, and those unable to carry out the tests properly were excluded. The physical therapy was standardized for both the groups. Respiratory evaluation was carried out during the preoperative period and on the second postoperative day by using spirometry and other tests that evaluated respiratory muscle strength and diaphragmatic mobility. Pain was evaluated by the visual analog scale on the second postoperative day. The statistical analysis was carried out with parametric or nonparametric tests, depending on the distribution of variables, considering p < 0.05 as statistically significant. RESULTS: Patients were similar with respect to age, BMI, and waist-to-hip ratio. A decrease in all variables was observed for both the groups in the postoperative period, although this decrease was less pronounced in the LG group. Pain intensity was also lower in the LG group. The length of hospital stay was 2 days, and there were no pulmonary complications. CONCLUSION: As there were no differences in the incidence of pulmonary complications and the length of hospital stay between the groups, the results showed that silicone-ring Roux-en-Y gastric bypass carried out by laparoscopy caused less pain and impairment of pulmonary function in the postoperative period.

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group). MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure - maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28 percent in the inspiratory muscle training group, whereas it was 47 percent in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica / Comparison between incentive spirometry and expiratory positive airway pressure on pulmonary function after bariatric surgery

O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês) e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por ideolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m2, submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias). Foram divididas em dois grupos, GI – grupo inspirômetro (n=13) e GE, grupo EPAP (n=15). A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corrente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório...

The aim of this study was to compare the effect of expiratory positive airwaypressure (EPAP) and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m2, undergoing laparoscopic gastric bypass surgery (hospitalized for two days) were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion prior to, and on the second post-operative day. Before surgery patients were divided into two groups, SG – spirometer group (n=13), and EG – EPAP group (n=15). Motor physical therapy was standardized for both groups; respiratory therapy (both modalities) started on the day of surgery, in 15-minute sessions. Post-operative results showed similar reduction, in both groups, in the values of vital capacity, forced vital capacity, maximum voluntary ventilation, and inspiratory reserve volume. No changes were found in tidal volume values in SG, neither in expiratory reserve volume in EG. Diaphragmatic and thoracoabdominal motion were less harmed in SG. After bariatric surgery thus incentive spirometry had better effect in maintaining tidal volume, as well as on diaphragmatic and thoracoabdominal motion; while EPAP proved more efficient in re-establishing expiratory reserve volume in the postoperative period...

The impact of obesity on pulmonary function in adult women.

INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m(2) who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m(2). Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 +/- 3.89 years and a mean BMI of 41.1 +/- 3.46 kg/m(2), and the non-obese group presented a mean age of 23.9 +/- 2.97 years and a mean body mass index of 21.91 +/- 1.81 kg/m(2). There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 +/- 0.47 L vs. 1.87 +/- 0.42 L), a lower expiratory reserve volume (0.52 +/- 0.32 L vs. 1.15 +/- 0.32 L), and a maximal voluntary ventilation (108.5 +/- 13.3 L/min vs. 122.6 +/- 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation.

The impact of obesity on pulmonary function in adult women

INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m² who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m². Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 ± 3.89 years and a mean BMI of 41.1 ± 3.46 kg/m², and the non-obese group presented a mean age of 23.9 ± 2.97 years and a mean body mass index of 21.91 ± 1.81 kg/m². There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 ± 0.47 L vs. 1.87 ± 0.42 L), a lower expiratory reserve volume (0.52 ± 0.32 L vs. 1.15 ± 0.32 L), and a maximal voluntary ventilation (108.5 ± 13.3 L/min vs. 122.6 ± 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation.

Eletroestimulação diafragmática transcutânea em indivíduos saudáveis / Transcutaeous diaphragmatic electrostimulation in healthy individuals

O objetivo deste estudo foi avaliar a influência da EDT na função diafragmática em 20 mulheres jovens e saudáveis, divididas em dois grupos de 10, sendo um controle e outro experimental. A EDT foi realizada com o Phrenix Dualpex, cuja intensidade no grupo controle foi a mínima, para promover sensação de formigamento e no experimental, a suficiente para promover contração visível e palpável do diafragma. Foram avaliadas as medidas de PImax e PEmax, volume corrente (VC), volume minuto (VM), capacidade inspiratória (CI), capacidade vital (CV) e freqüência respiratória (FR), antes e após dez sessões de 30 minutos de EDT. Os resultados no grupo controle não foram significativos. No experimental, os resultados foram significativos para PImax , VC , VM e CI (p < 0,05). Para os valores da PEmax, CV e FR (p > 0,05) não revelaram diferença significativa. Podemos concluir que a EDT se mostrou efetiva na melhora da performance do músculo diafragma desses indivíduos.

The objective of this study was to evaluate the influence of transcutaneous diaphragmatic electrostimulation (TDE) in the function of the diaphragmatic muscle in 20 female young and healthy that were divided into two groups of 10, namely the control group and the study group. The equipment used to apply the TDE was Phoenix Dualpex, and the intensity applied to the control group was just enough to cause a tingling sensation, enough intensity was applied to promote a visible and palpable contraction of the diaphragm. PImax and PEmax, the current volume (CV), minute volume (MV), inspiratory capacity (IC) and vital capacity (VC), the respiratory frequency (RF) before and after ten 30-minute DTE sessions were evaluated. The results in the control group were no statistically significant. To the study group, the results showed a statistically significant difference for PImax , CV, MV and IC (p < 0.05). The PEmax, VC and RF did not show statistically significant differences. We can conclude that TDE was effective in the performance improvement of the diaphragm muscle.