The effects of the neck stabilization exercise on the muscle activity of trunk respiratory muscles and maximum voluntary ventilation of chronic stroke patients.

BACKGROUND: Unstable neck posture, muscle imbalance, and segmental instability can cause neck pain and decrease the respiratory function. OBJECTIVE: To examine effects of a neck stabilization exercise on respiratory muscle activity and maximal voluntary ventilation (MVV) in patients with a chronic stroke. METHODS: A total of 40 patients with a chronic stroke participated in this study. They were randomly divided into two groups (20 in each group). However, ten patients dropped out of the experiment (5 in each group). The experimental group (n= 15) performed a 15-minute neck stabilization exercise and a 15-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. The control group (n= 15) completed a 30-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. Exercises were conducted for 30 minutes a day, five times a week, for a total of six weeks. Activities of major respiratory muscles and MVV were measured before and after the experiment. RESULTS: Both the experimental group and the control group showed significant difference in activities of major respiratory muscles and MVV before and after the experiment (p< 0.05). The experimental group showed a significantly higher increase compared to the control group (p< 0.05). CONCLUSIONS: The application of a combination of a neck stabilization exercise and a breathing retraining exercise to patients with a chronic stroke can increase activity of respiratory muscles and MVV.

Respiratory muscle training positively affects vasomotor response in young healthy women.

Vasomotor response is related to the capacity of the vessel to maintain vascular tone within a narrow range. Two main control mechanisms are involved: the autonomic control of the sympathetic neural drive (global control) and the endothelial smooth cells capacity to respond to mechanical stress by releasing vasoactive factors (peripheral control). The aim of this study was to evaluate the effects of respiratory muscle training (RMT) on vasomotor response, assessed by flow-mediated dilation (FMD) and heart rate variability, in young healthy females. The hypothesis was that RMT could enhance the balance between sympathetic and parasympathetic neural drive and reduce vessel shear stress. Thus, twenty-four women were randomly assigned to either RMT or SHAM group. Maximal inspiratory mouth pressure and maximum voluntary ventilation were utilized to assess the effectiveness of the RMT program, which consisted of three sessions of isocapnic hyperventilation/ week for eight weeks, (twenty-four training sessions). Heart rate variability assessed autonomic balance, a global factor regulating the vasomotor response. Endothelial function was determined by measuring brachial artery vasodilation normalized by shear rate (%FMD/SR). After RMT, but not SHAM, maximal inspiratory mouth pressure and maximum voluntary ventilation increased significantly (+31% and +16%, respectively). Changes in heart rate variability were negligible in both groups. Only RMT exhibited a significant increase in %FMD/SR (+45%; p<0.05). These data suggest a positive effect of RMT on vasomotor response that may be due to a reduction in arterial shear stress, and not through modulation of sympatho-vagal balance.

Short-Term Effects of Normocapnic Hyperpnea and Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study.

OBJECTIVE: The aim of the study was to evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in patients with chronic obstructive pulmonary disease. DESIGN: The study used a randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 d/wk) of either normocapnic hyperpnea (group 1, n = 12) or sham maneuvers (group 2, n = 10) in addition to individualized cycle training and abdominal, upper, and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation, maximal inspiratory, and expiratory pressures, and 6-min walking distance. RESULTS: After training, a significant improvement was found only for group 1 in respiratory muscle endurance time (by 654 [481] secs versus 149 [216] secs for group 2, P = 0.0108) and maximal inspiratory (group 1: from 81.2 [21.9] cmH2O to 107.6 [23.0] cmH2O, P = 0.018 versus group 2: from 75.4 [13.8] cmH2O to 81.3 [18.9] cmH2O, P = 0.139). The difference between groups for 6-min walking distance, maximum voluntary ventilation, and expiratory pressures was not significant. CONCLUSIONS: Short-term normocapnic hyperpnea training added to standard exercise, compared with exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in patients with chronic obstructive pulmonary disease.

Respiratory muscle training on pulmonary and swallowing function in patients with Huntington's disease: a pilot randomised controlled trial.

OBJECTIVE: To examine the effects of 4-month of respiratory muscle training on pulmonary and swallowing function, exercise capacity and dyspnoea in manifest patients with Huntington's disease. DESIGN: A pilot randomised controlled trial. SETTING: Home based training program. PARTICIPANTS: Eighteen manifest Huntington's disease patients with a positive genetic test and clinically verified disease expression, were randomly assigned to control group (n=9) and training group (n=9). INTERVENTION: Both groups received home-based inspiratory (5 sets of 5 repetitions) and expiratory (5 sets of 5 repetitions) muscle training 6 times a week for 4 months. The control group used a fixed resistance of 9 centimeters of water, and the training group used a progressively increased resistance from 30% to 75% of each patient's maximum respiratory pressure. MAIN MEASURES: Spirometric indices, maximum inspiratory pressure, maximum expiratory pressure, six minutes walk test, dyspnoea, water-swallowing test and swallow quality of life questionnaire were assessed before, at 2 and 4 months after training. RESULTS: The magnitude of increases in maximum inspiratory (d=2.9) and expiratory pressures (d=1.5), forced vital capacity (d=0.8), forced expiratory volume in 1 second (d=0.9) and peak expiratory flow (d=0.8) was substantially greater for the training group in comparison to the control group. Changes in swallowing function, dyspnoea and exercise capacity were small (d ≤ 0.5) for both groups without substantial differences between groups. CONCLUSIONS: A home-based respiratory muscle training program appeared to be beneficial to improve pulmonary function in manifest Huntington's disease patients but provided small effects on swallowing function, dyspnoea and exercise capacity.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients.

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 +/- 7.3 years and an average body mass index (BMI) of 47.4 +/- 6.5 K/m(2) were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP + TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Entrenamiento muscular en paciente traqueostomizado: a propósito de un caso / Respiratory muscle training in tracheostomized patient: a case report

Se presenta el caso de una niña de 14 años portadora de Síndrome de Escobar, trastorno congénito caracterizado por alteraciones musculoesqueléticas, entre ellas escoliosis, que determinan una alteración ventilatoria restrictiva, similar a la presentada por pacientes neuromusculares. La Paciente está traqueostomizada con soporte ventilatorio en su domicilio. Se plantea un programa de Rehabilitación Respiratoria con Entrenamiento Físico general y de la musculatura específica inspiratoria. Este entrenamiento específico es realizado con una válvula Threshold IMT® con una carga de un 30 por ciento de la fuerza generada, medida a través de la Presión Inspiratoria Máxima. En un corto período presentó una mejoría significativa de su valor basal en un 42 por ciento. Es interesante destacar la factibilidad de entrenar pacientes con traqueostomía.

Rehabilitación respiratoria en pediatría / Pulmonary rehabilitation in children

La rehabilitación respiratoria se ha consolidado como parte fundamental del manejo y tratamiento de muchos enfermos pulmonares crónicos en edad adulta. La literatura reporta constante información de los múltiples beneficios que tiene el ejercicio practicado de manera sistemática, tanto en sujetos enfermos como sanos, sean estos niños o adultos; siempre considerando una acabada evaluación inicial que permita detectar aquellos en quienes el ejercicio produzca efectos deletéreos en su salud. En nuestro país, el concepto de rehabilitación respiratoria en pediatría está escasamente desarrollado. Sólo existen esfuerzos aislados, que solucionan problemas individuales y no colectivos. El Programa Nacional de Asistencia Ventilatoria no Invasiva en Domicilio (AVNI), es probablemente el primer esfuerzo sistemático en aplicar los principios de la rehabilitación pulmonar en pediatría, en donde un equipo trans-disciplinario le ofrece a los pacientes pediátricos portadores de una patología neuromuscular un enfoque integral que mejore su condición de calidad de vida. Este artículo resume algunos conceptos en torno a los principios de entrenamiento muscular en niños, el concepto de presión inspiratoria y la introducción de válvulas de entrenamiento.

Fuerza máxima del diafragma en la EPOC: estimulación magnética cervical frente a la clásica maniobra de inhalación forzada / Determination of maximal diaphragm strength in Chronic Obstructive Pulmonary Disease: cervical magnetic stimulation ersus traditional sniff maneuver

Objetivo: La estimulación magnética del diafragma es una técnica que permite evaluar la fuerza de este músculo. Dado que obvia la necesidad de colaboración del paciente, va extendiendo progresivamente su aplicación clínica. El objetivo del presente estudio ha sido comparar esta técnica de estimulación con la clásica de inhalación voluntaria forzada (sniff) en un grupo de pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Pacientes y métodos: Se estudió a 16 pacientes varones con EPOC de moderada a grave (valor medio ± desviación estándar del volumen espiratorio forzado en el primer segundo del 35 ± 15% del valor de referencia). En todos ellos se obtuvo la presión máxima del diafragma (expresión de la fuerza contráctil del músculo) por maniobras de inhalación voluntaria máxima y de estimulación cervical magnética. Resultados: Se observó una relación moderada entre ambas técnicas, siendo los valores obtenidos con estimulación de aproximadamente un 20% de los obtenidos con la maniobra voluntaria (97 ± 27 y 22 ± 7 cmH2O, respectivamente). La técnica de estimulación mostró unos coeficientes de variabilidad intraindividual del 12 ± 7%, e interindividual del 33 ± 6%, muy similares a los del método de inhalación. El análisis cualitativo de la técnica de estimulación para el diagnóstico de debilidad muscular mostró una elevada sensibilidad (89%), con escasos falsos negativos. Por el contrario, su especificidad fue muy baja (43%), con una tasa relativamente elevada de sobrediagnósticos. La eficacia de la predicción resultó globalmente aceptable (69%). Conclusiones: La técnica de estimulación magnética cervical se muestra como una buena opción clínica para descartar debilidad del diafragma, con indicación sobre todo en pacientes con poca capacidad de comprensión o incapacidad de colaboración

Objective: Magnetic stimulation of the diaphragm allows its strength to be assessed. The clinical applications of this technique are becoming more widespread given that the patient's cooperation is not required. The aim of the present study was to compare this inhalation technique with traditional voluntary forced inspiration (sniff test) in a group of patients with chronic obstructive pulmonary disease (COPD). Patients and methods: Sixteen men with moderate-to-severe COPD were studied (mean [SD] forced expiratory volume in 1 second, 35% [15%] of the reference value). For all patients, the maximal transdiaphragmatic pressure (a measure of the contractility of the muscle) was determined at peak inspiration and during cervical magnetic stimulation. Results: A moderate correlation between measurements with the 2 techniques was observed. The value obtained with stimulation was approximately 20% of that obtained with the sniff maneuver (22 [7] cm H2O vs 97 [27] cm H2O, respectively). The stimulation technique yielded an intraindividual coefficient of variability of 12% (7%) and an interindividual one of 33% (6%). Very similar values for these coefficients were obtained with the sniff maneuver. Qualitative analysis of the stimulation technique showed it to have a high sensitivity (89%) for diagnosing muscle weakness, with few false negatives. In contrast, specificity was very low (43%), and false positives for muscle weakness were relatively common. The overall effectiveness of the prediction was acceptable (69%). Conclusions: Cervical magnetic stimulation appears to be a good clinical option for ruling out diaphragm weakness. It is particularly indicated in patients with limited capacity for understanding instructions or those unable to cooperate

Inspiratory muscle training in patients with Duchenne muscular dystrophy.

PURPOSE: The aim of this study was to assess the usefulness of a specific inspiratory muscle training in Duchenne muscular dystrophy (DMD). PATIENTS AND METHODS: Fifteen patients with DMD started 6 months of training the inspiratory muscles and 15 patients served as a control group. Pulmonary and inspiratory muscle function parameters were assessed 3 months before and at the beginning of training, in the first and third month of training, at the end, and 6 months after its cessation. Maximal sniff assessed esophageal and transdiaphragmatic pressure values served as indices for global inspiratory muscle strength and diaphragmatic strength, respectively. Inspiratory muscle endurance was assessed by the length of time a certain inspiratory task could be maintained. RESULTS: In 10 of the 15 patients, respiratory muscle function parameters improved significantly after 1 month of training. Further improvements were to be seen after 3 and after 6 months. Even 6 months after the end of training, those effects remained to a large extent. In the other five patients, there was no such improvement after 1 month of training, which was therefore discontinued. All these five patients had vital capacity values of less than 25 percent predicted and/or PaCO2 values of more than 45 mm Hg. The 15 control patients had no significant change in their respiratory muscle function parameters. CONCLUSION: We conclude that a specific inspiratory muscle training is useful in the early stage of DMD.

The effects of inspiratory resistive training on respiratory muscle function in patients with muscular dystrophy.

The effects of inspiratory resistive training on respiratory muscle function was evaluated in 11 patients with Duchenne, limb-girdle, and facio-scapulo-humeral (FSH) type muscular dystrophy. Muscle training consisted of breathing against an inspiratory resistance for two 15-minute sessions each day while at home. Following 6 weeks of training, there were significant increases in the maximum resistance that could be tolerated for at least 5 minutes (P < 0.01) and also in the maximum duration that ventilations equal to 30%, 50%, 70%, and 90% of the maximum voluntary ventilation could be sustained (P < 0.05). In six patients who trained for an additional 6-week period, respiratory muscle endurance increased even further. The degree of improvement in respiratory muscle endurance was positively correlated with baseline vital capacity (r = 0.84, P < 0.05) and maximal inspiratory pressure (r = 0.76, P < 0.05). Spirometry, functional residual capacity, and maximal inspiratory and expiratory pressures were not affected by training. We conclude that inspiratory resistive training improves respiratory muscle endurance in muscular dystrophy patients. Improvement in respiratory muscle function may serve to delay the onset of respiratory complications in patients with muscular dystrophy.