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PurposeThe purpose of this study is to investigate how respiratory muscle strength correlates to cough capacity in patients with respiratory muscle weakness.Materials and MethodsForty-five patients with amyotrophic lateral sclerosis (ALS), 43 with cervical spinal cord injury (SCI), and 42 with Duchenne muscular dystrophy (DMD) were recruited. Pulmonary function tests including forced vital capacity (FVC) and respiratory muscle strength (maximal expiratory pressure, MEP; maximal inspiratory pressure, MIP) were performed. The correlation between respiratory muscle strength and cough capacity was analyzed.ResultsIn the SCI group, FVC in a supine position (2,597 ± 648 mL) was significantly higher than FVC in a sitting position (2,304 ± 564 mL, p < 0.01). Conversely, in the ALS group, FVC sitting (1,370 ± 604 mL) was significantly higher than in supine (1,168 ± 599 mL, p < 0.01). In the DMD group, there was no statistically significant difference between FVC while sitting (1,342 ± 506 mL) and FVC while supine (1,304 ± 500 mL). In addition, the MEP and MIP of all three groups showed a significant correlation with peak cough flow (PCF) (p < 0.01, Pearson's correlation analysis). In the SCI group, MIP was more closely correlated with PCF, while in the ALS and DMD groups, MEP was more closely correlated with PCF (p < 0.01, multiple regression analysis).ConclusionTo generate cough flow, inspiratory muscle strength is significantly more important for SCI patients, while expiratory muscle function is significantly more important for ALS and DMD patients.

The greater the MIC VC difference, the greater the PCF, and, thereby, the ability to expel airway mucus and avert respiratory complications. The lower the VC, the greater the percent increase in MIC and the greater the percent increase in assisted PCF. Maximal insufflations are extremely important to increase PCF for patients with neuromuscular conditions who have VCs of < 1500 ml.

Study design: Prospective single centre study. Objectives: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. Setting: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. Methods: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. Results: All three assisted cough methods showed a significantly higher value than the unassisted method (Po0.001). The VC correlated with the voluntary cough capacity and the MIP (R ¼ 0.749) correlated more significantly with the VC than the MEP (R ¼ 0.438) (Po0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (Po0.001). Conclusions: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n = 32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 ± 586 mL) was higher than that of VCs (1474 ± 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 ± 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 ± 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 ± 49 L/min) and volume assisted PCF (VPCF; 252 ± 45 L/min) (F = 66.13, p < 0.001). MIP (34 ± 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 ± 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.

Duchenne muscular dystrophy usually affects males. However, females are also affected in rare instances. Approximately 8% of female Duchenne muscular dystrophy (DMD) carriers are manifesting carriers and have muscle weakness to some extent. We investigated the clinical features of 3 female patients with dystrophinopathy diagnosed by clinical, pathological, and genetic studies at our neuromuscular disease clinic. The onset age of manifesting symptoms varied (8-28 years). Muscle weakness grade varied as follows: patient 1 showed asymmetrical bilateral proximal upper and lower extremities weakness, patient 2 showed asymmetrical bilateral upper extremities weakness similar to scapulohumoral muscular dystrophy, and patient 3 had only bilateral asymmetric proximal lower extremities weakness. Two patients had familial histories of DMD (their sons were diagnosed with DMD), but the 1 remaining patient had no familial history of DMD. The serum creatine kinase level was elevated in all patients, but it was not correlated with muscular weakness. An electromyography study showed findings of myopathy in all patients. One patient was diagnosed with a DMD carrier by a muscle biopsy with an immunohistochemical stain (dystrophin). The remaining 2 patients with familial history of DMD were diagnosed by multiplex ligation-dependent probe amplification (MLPA). There were inconsistent clinical features in the female carriers. An immunohistochemical analysis of dystrophin could be useful for female carrier patients. Also, multiplex ligation-dependent probe amplification is essential for the diagnosis of a manifesting female carrier DMD in female myopathic patients because conventional multiplex PCR could not detect the duplication and is less accurate compared to MLPA.

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