Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level

Mateus, Sérgio Ricardo Menezes; Beraldo, Paulo Sérgio Siebra; Horan, Thomas A.

doi:10.1038/sj.sc.3101998

Cited by 29 publications

(15 citation statements)

References 21 publications

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“…Our study suggests that inspiratory muscle training at low loads has a positive effect in quadriplegic patients, since the initial values were lower than those predicted, whereas those obtained after 8 weeks of training were higher than the baseline values and showed no significant differences in relation to the predicted values, suggesting a trend towards normality after the specific training. These lower baseline values are in accordance with the findings of a study (23) showing that quadriplegic patients with injuries to the upper cervical spine (at C4 or C5) presented with the lowest values of MIP, MEP and FVC. It is important to note that the protocol that we used (low load muscle training) is an easy-to-perform exercise, which favors adherence to treatment.…”

Section: Discussionsupporting

confidence: 81%

Treinamento de músculos inspiratórios em pacientes com quadriplegia

et al. 2010

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Objective: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. Methods: Eight quadriplegic patients (7 males and 1 female) with injury to the lower cervical spine (segments C4-C7) were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30% of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. Results: In comparison with the mean baseline value, there was an increase in MIP, measured in the sitting position, at weeks 4 and 8 (−83.0 ± 18.9 cmH 2 O vs. −104.0 ± 19.4 cmH 2 O and −111.3 ± 22.7 cmH 2 O). There was an increase in MEP, also in the sitting position, at week 4 (from 36.8 ± 8.1 to 42.6 ± 8.8 cmH 2 O). There was an improvement in FVC at week 4 (from 2.1 ± 0.8 to 2.5 ± 0.6 L, representing an increase of 24 ± 22%). Although there was an increase in endurance (sitting) at week 8, the difference was not significant in comparison with the baseline value (29.8 ± 21.0 vs. 35.9 ± 15.5 min, an increase of 173 ± 233%). Conclusions: Quadriplegic patients can benefit from training at low loads (30% of MIP), which can improve inspiratory muscle strength, FVC and expiratory muscle performance.Keywords: Respiratory mechanics; Quadriplegia; Breathing exercises. ResumoObjetivo: Determinar se o treinamento de músculos inspiratórios pode aumentar a força e endurance desses músculos em pacientes com quadriplegia. Métodos: Oito pacientes quadriplégicos (7 homens e 1 mulher) com lesão medular cervical entre C4 e C7 foram submetidos ao treinamento de músculos inspiratórios utilizando-se um resistor de carga linear ajustado em 30% da PImáx. As sessões de treinamento foram realizadas com os pacientes sentados 5 vezes por semana por 8 semanas. Tempo de endurance, PImáx, PEmáx e CVF foram medidos antes do treinamento e nas semanas 4 e 8. Resultados: Em comparação ao valor basal médio, houve um aumento da PImáx, mensurada na posição sentada, nas semanas 4 e 8 (−83,0 ± 18,9 cmH 2 O vs. −104,0 ± 19,4 e −111,3 ± 22,7 cmH 2 O). Houve aumento da PEmáx, também na posição sentada, na semana 4 (de 36,8 ± 8,1 a 42,6 ± 8,8 cmH 2 O). Houve uma melhora na FVC na 4ª semana (de 2,1 ± 0,8 a 2,5 ± 0,6 L, representando um incremento de 24 ± 22%).O tempo de endurance (sentado) não apresentou um aumento significativo entre o momento basal e a semana 8 (29,8 ± 21,0 min vs. 35,9 ± 15,5 min; aumento de 173 ± 233%). Conclusões: Pacientes com quadriplegia podem se beneficiar com o treinamento com baixas cargas (30% da PImáx), com melhora da força dos músculos inspiratórios, CVF e efetividade dos músculos expiratórios.

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Section: Discussionsupporting

confidence: 81%

Treinamento de músculos inspiratórios em pacientes com quadriplegia

et al. 2010

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“…However, various factors can influence MIP and MEP results, (4)(5)(6)(7) and the value of MIP as an index of inspiratory power has been questioned. …”

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confidence: 99%

“…(2,3) The traditional investigations used in SCI patients are spirometry and determination of lung volumes. However, various factors can influence MIP and MEP results, (4)(5)(6)(7) and the value of MIP as an index of inspiratory power has been questioned. (6) One alternative is determination of sniff nasal inspiratory pressure (SNIP).…”

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confidence: 99%

“…Measurements of MIP were obtained near residual volume, whereas those of MEP were obtained near total lung capacity. (7,15) The SNIP was obtained near functional residual capacity using a plug adjusted to fit one nostril of the participants, while the other nostril was manually closed by the technician. All MIP, MEP and SNIP maneuvers were performed four times, with intervals of at least 60 s between each measurement.…”

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Noninvasive determination of inspiratory pressure in patients with spinal cord injury: what is the best method?

et al. 2009

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:256-260 cular diseases, the prognostic value of SNIP for the evaluation of diaphragm strength has been shown to be comparable to that of nonvolumetric and invasive tests. (8)(9)(10)(11) The determination of SNIP is a rapid, easily executed procedure, and the equipment required is portable. To examine the hypothesis that SNIP can detect reduced inspiratory muscle strength in SCI patients, we compared SNIP, MIP and other pulmonary function parameters in SCI patients presenting total loss of motor function, stratifying the sample according to the level of the injury.From June to October of 2005, 26 SCI patients were evaluated at the Hospital SarahBrasilia. The inclusion criteria were as follows:Pulmonary complications are responsible for elevated morbidity and mortality rates in tetraplegic patients.(1) Spinal cord injury (SCI) can cause weakness and respiratory muscle paralysis in varying degrees, depending on the level and completeness of injury.(2,3) The traditional investigations used in SCI patients are spirometry and determination of lung volumes. However, various factors can influence MIP and MEP results, (4)(5)(6)(7) and the value of MIP as an index of inspiratory power has been questioned. AbstractThe aim of the study was to evaluate the performance of sniff nasal inspiratory pressure (SNIP) and MIP in individuals with spinal cord injury. We evaluated 26 patients with spinal cord injury. Mean FVC in those with tetraplegia was 52 ± 19% of predicted, compared with 78 ± 23% of predicted in those with paraplegia (p < 0.05). In contrast, the percentage of predicted SNIP was lower in those with tetraplegia than in those with paraplegia (p < 0.05). In all participants, SNIP correlated significantly with the level of the injury (r = 0.489; 95% CI: 0.125-0.737). The impact that the greater discriminatory power of SNIP has on the diagnosis of impaired pulmonary function in spinal cordinjured patients should be investigated further. Keywords

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“…Later, there was a valid argument suggesting that severity or completeness of the injury might playa role on pulmonary dysfunction after SCI. The results from a large transversal study in chronic spinal cord injured patients 175 revealed that there is a positive correlation between maximal respiratory pressures and level of the injury only in the motor complete SCI (AIS grades A and B). However, this was not the case for the motor incomplete SCI group (AIS grade C-D).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function and respiratory muscle activation in individuals with chronic spinal cord injury.

Paleville¹,

G.l.²

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DEDICATIONI would like to dedicate this dissertation to my best friend and the love of my life Andres and to my precious children Benjamin and Jeremias.They are the center of my universe. 111 ACKNOWLEDGEMENTSI would like to express my greatest gratitude to my mentor Dr. Susan Harkema, who gave me a lifetime opportunity in allowing me to work with her. Dr. Harkema not only gave me guidance and the tools to conduct my investigation; but also she gave me independence to explore and explode my own potential. I have learned in the past five years more than many would in their lifetime. She allowed me to truly understand that the main reason behind sciences is to improve people's life; translating lab findings to the clinic, giving hope and alleviating the pain of many who are suffering. Pulmonary complications associated with persistent respiratory muscle weakness and paralyses are critical problems faced by patients with chronic spinal cord injury (SCI). The aim of this dissertation is to investigate the role of neurological injury and neural plasticity on pulmonary function after SCI in humans. We tested the following hypotheses: 1) post-SCI respiratory insufficiency is related to the severity of the spinal lesion; 2) respiratory insufficiency is related to abnormal neuromuscular activity of respiratory muscles and that the electromyographic (EMG) amplitude of respiratory muscles is correlated to respiratory muscle strength and 3) locomotor training, an activity-based therapy, improves pulmonary function in individuals with cervical and upper thoracic SCI. We recorded standard sitting spirometry in SCI (n=35) and noninjured individuals (n=15). We also recorded EMG patterns from inspiratory, expiratory and accessory muscles during maximal respiratory pressures maneuvers. Motor incomplete SCI subjects have significantly higher pulmonary function than motor complete (p = 0.006). The respiratory muscle activation patterns were variable in SCI during all maneuvers. VI After SCI, neural plasticity results in a compensatory recruitment of nonrespiratory muscles for pulmonary function. Higher maximal inspiratory pressure (MIP) is related to higher EMG activity of the upper trapezious in the cervical incomplete group, suggesting that this muscle is being successfully recruited to create higher inspiratory pressure. EMG activity of the latissimus dorsi is negatively correlated with maximal expiratory pressure (MEP) in both cervical motor complete and incomplete subjects, suggesting that this muscle is being recruited as a compensatory strategy for forced expiration in individuals with cervical SCI. Locomotor training is a beneficial intervention for improving pulmonary function in SCI individuals. These findings can improve our understanding of the mechanisms that underlie respiratory insufficiency and may be useful to develop objective, quantitative evaluation of the neural control of respiration after neurologic injury.VB

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Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level

Cited by 29 publications

References 21 publications

Treinamento de músculos inspiratórios em pacientes com quadriplegia

Treinamento de músculos inspiratórios em pacientes com quadriplegia

Noninvasive determination of inspiratory pressure in patients with spinal cord injury: what is the best method?

Pulmonary function and respiratory muscle activation in individuals with chronic spinal cord injury.

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