Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury

Abstract

Objective To investigate the feasibility and safety and, to a lesser extent efficacy, of inspiratory muscle training (IMT) for patients with acute complete cervical or thoracic spinal cord injury (SCI). Design Prospective, observational pilot study comprising a series of case reports. Setting Tertiary care, public hospital. Participants Seven adult subjects with an acute complete cervical or thoracic SCI. Interventions Participants received IMT as soon as their respiratory condition was stable. A high-resistance, low-repetition program of IMT using a POWERbreathe KH1 device was instituted. Training comprised 3-6 sets of 6 breaths, commenced at 50% maximum inspiratory pressure with the training load progressively increased. Outcome measures Feasibility (number of sessions when the criteria to participate in IMT were met/not met), safety (symptoms and physiological stability) before, during and after IMT sessions and efficacy (lung function) were measured. Results There were 50 sessions in total where participants met the criteria to receive IMT, with a mean (range) of 7.1 (3-11) IMT sessions per participant delivered over 10.7 (4-17) days. IMT was feasible, with all 50 planned sessions of IMT able to be delivered, and safe, with stable physiological parameters and no adverse symptoms or events recorded before, during or after IMT. Maximal inspiratory pressure increased for four participants and forced vital capacity increased for three participants over the duration of their IMT sessions. Conclusion A high-resistance, low-repetition program of IMT was feasible and safe in adults with an acute complete cervical or thoracic SCI whose respiratory status was stable. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN 12614000975695).

Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial

“…The work performed by the active group was significantly higher and supports the progressive training paradigm was suitable to achieve a training effect for inspiratory muscles, however ineffective for expiratory. Recent pilot studies investigating progressive RMT36 37 also showed this training paradigm to be feasible and effective in people with tetraplegia. The frequency of the training was supervised twice daily and labour intensive.…”

Effect of 4 weeks resistive inspiratory muscle training on respiratory functions in patients with tetraplegia during in-patient rehabilitation

“…Another recent study by (McDonald and Stiller, 2019), also supported the very fact that a highresistance, low-repetition program of the IMT was both feasible and safe in an earlier stage post-SCI than has previously been documented and quoted that further study is required to demonstrate the ef icacy of IMT when instituted during the acute phase post-SCI. The main limitations of this study were the small sample size and uncontrolled design clearly limiting the generalizability of the results.…”

“…There is dearth of evidence supporting use of RIMT in tetraplegics patients within the acute phase of SCI, because the majority of studies conducted upto now which have concluded that inspiratory muscle training improves lung functions in tetraplegic patients have included patients one month post-SCI (Postma et al, 2014) and those studies conducted on SCI subjects within the irst month of injury have supported use of RIMT, but have advocated that further research needs to be carried out in this patient population because of pitfalls in these studies (McDonald and Stiller, 2019).…”

Respiratory physiotherapy techniques used in patients with neurological disease

“…V případě oslabení mimických svalů, kdy pacient není schopen obemknout náustek ústy, lze využít i obličejovou masku. Na lůžkách intenzivní péče je možnost nasadit trenažér Threshold PEP/IMT na tracheostomickou kanylu (Neumannová, Kolek, 2012 Cílem terapie, tedy cvičení s pomůckou Threshold IMT, je zvýšit sílu nádechových svalů pro eliminaci dušnosti v klidu, při mluvení a při fyzické zátěži (McDonald, Stiller, 2019;Pinto, de Carvalho, 2013). Posilování výdechových svalů pomocí trenažéru Threshold PEP může zlepšit mobilitu bronchiální sekrece a usnadnit expektoraci koaktivací výdechových svalů.…”