Respiratory functional and motor control deficits in children with spinal cord injury

Abstract

Children with spinal cord injury (SCI) are at high risk for developing complications due to respiratory motor control deficits. However, underlying mechanisms of these abnormalities with respect to age development and injury characteristics are unclear. To evaluate the effect of SCI and age on respiratory motor control in children with SCI, we compared pulmonary function and respiratory motor control outcome measures in healthy typically developing (TD) children to age-matched children with chronic SCI. We hypothesized that the deficits in respiratory functional performance in children with SCI are due to the abnormal and age-dependent respiratory muscle activation patterns. Fourteen TD (age 7 ± 2 yrs., Mean ± SD) and twelve children with SCI (age 6 ± 1 yrs.) were evaluated by assessing Forced Vital Capacity (FVC); Forced Expiratory Volume in 1sec (FEV1); and respiratory electromyographic activity during maximum inspiratory and maximum expiratory airway pressure measurements (PImax and PEmax). The results indicate a significant reduction (p<.01) of FVC, FEV1 and PEmax values in children with SCI compared to TD controls. During PEmax assessment, children with SCI produced significantly decreased (p<.01) activation of respiratory muscles below the neurological level of injury (rectus abdominous and external oblique muscles). In addition, children with SCI had significantly increased (p<.05) compensatory muscle activation above the level of injury (upper trapezius muscle). In the TD group, age, height and weight have significantly (p<.05) contributed towards increase in FVC and FEV1. In children with SCI, only age was significantly (p<.05) correlated with FVC and FEV1 values. These findings indicate the degree of SCI-induced respiratory functional and motor control deficits in children are age-dependent.

Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury

“…7d). Pulmonary function testing [23][24][25][26] 3-5 years post-initial AB-LT at 6-8 years of age revealed normal capacity [5,6]. These results suggest the stability and durability of improved respiratory function years following completion of an intense program of AB-LT.…”

Estudo Epidemiológico Dos Procedimentos Cirúrgicos Para Fechamento De Fístula Anal No Estado De Goiás De 2010 a 2018

“…Dessa forma, lesões cervicais e torácicas causam maior fraqueza ou paralisia dos músculos respiratórios, aumentando diretamente a carga de trabalho respiratória e levando a baixos volumes espirométricos e pressões estáticas na boca. Consequentemente, a ativação expiratória e muscular abdominal prejudicada resulta em diversas complicações, como tosse ineficaz, retenção de muco e aumento do risco de atelectasia e pneumonia (SINGH et al, 2018). Segundo Baydur, Adkins e Milic-Emili (2001) exibem ainda, volumes pulmonares e taxas de fluxo reduzidos como resultado da fraqueza muscular respiratória Na prática clínica geral e na pesquisa, o teste de função pulmonar (TFP) é usado para avaliar a função motora respiratória.…”

“…Segundo Baydur, Adkins e Milic-Emili (2001) exibem ainda, volumes pulmonares e taxas de fluxo reduzidos como resultado da fraqueza muscular respiratória Na prática clínica geral e na pesquisa, o teste de função pulmonar (TFP) é usado para avaliar a função motora respiratória. Em pessoas com LM, esse teste inclui medidas espirométricas e de pressão máxima das vias aéreas adquiridas com o sujeito na posição sentada (SINGH et al, 2018).…”

“…Sendo a Azatioprina primeira escolha para DC leve a moderada. (SINGH et al, 2018). Estudos apontam que o Infliximabe possui a maior probabilidade de ser efetivo como agente indutor de remissão (86 %), em contrapartida o Adalimumabe possui maior efetividade como terapia de manutenção de remissão (48 %).…”

Impact of Activity-Based Therapy on Respiratory Outcomes in a Medically Complex Child

“…Children with an upper cervical injury often require permanent tracheostomy with chronic mechanical ventilation [ 5 ]. They also have significantly reduced lung function compared to typically developing peers and higher levels of activation of compensatory muscles above the level of the injury [ 6 ]. As a result, even in persons who do not require chronic mechanical ventilation, devices to augment secretion clearance, such as those that deliver mechanical insufflation-exsufflation and/or high frequency chest wall oscillation, are often employed with manual therapies or nebulized medications to promote airway clearance and expansion [ 3 ].…”