Respiratory muscle training in children and adults with neuromuscular disease

Pedrosa, Rafaela; Silva, Ivanizia S; Azevedo, Ingrid Guerra; Forbes, Anne‐Marie; Fregonezi, Guilherme; Junior, Mário ET Dourado; Lima, Suzianne Rh; Guerra, Ricardo Oliveira; Ferreira, Gardênia Maria H.

doi:10.1002/14651858.cd011711

Cited by 23 publications

(3 citation statements)

References 53 publications

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“…Email: oktahariza@gmail.com Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia Jakarta, Indonesia iNtrodUCtioN Neuromuscular disorders (NMD) is defined as a group of disorders that involves pathology on the muscles, neuromuscular junctions, peripheral nerves and lower motor neurons, that lead to respiratory muscle weakness such as in muscular dystrophies, myasthenia gravis, inflammatory myopathies, etc. 1,2,3 Respiratory muscles are needed to create a difference in pressure to inflate and deflate the lung, to achieve ventilation. 4 Respiratory muscles are consisted of diaphragm, external intercostal muscle, and accessory breathing muscle.…”

Section: Correspondent Detail: Okta Harizamentioning

confidence: 99%

The Effects of Inspiratory Muscle Training in Neuromuscular Disorders: Review Article

et al. 2019

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Introduction: Progressive inspiratory muscles weakness in neuromuscular disorders (NMD) can lead to respiratory impairments, from restrictive lung to respiratory failure. Inspiratory muscle training (IMT) is an exercise with a device to increase inspiratory muscles strength and/or endurance. This article wasaimed to review the effect and prescription of IMT in NMD subjects.Methods: Searching method was done in PubMed and Google Scholar using keywords: “inspiratory muscle training” AND “neuromuscular disorders” AND “MIP” OR “PImax”.Results: Seven related studies were found. These studies shown that IMT increased inspiratory muscles strength and/or endurance in chronic progressive NMD. Most studies used threshold type. The intensities varied from 30% through 70% of maximum inspiratory pressure (MIP), minimum twice a day. Therepetition for strengthening was 10 times with 20-seconds rest between repetitions. Endurance trainings were done in 10 cycles of 1-minute breathing or for total 20 m inutes.Conclusion: Several evidences reported that IMT significantly improve strength and endurance of inspiratory muscles in chronic progressive NMD. It was effective in earlier phase of NMD. The minimum load intensity was 30% MIP.Keywords: Inspiratory muscle training (IMT), neuromuscular disorders (NMD), maximum inspiratory pressure (MIP)

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Section: Correspondent Detail: Okta Harizamentioning

confidence: 99%

The Effects of Inspiratory Muscle Training in Neuromuscular Disorders: Review Article

et al. 2019

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“…From an etio-pathogenic point of view, NMDs are inherited or acquired conditions affecting both children and adults and ultimately leading to a motor impairment with different severity degree and time-course characteristics, sometimes with a more or less rapidly progressive evolution, sometimes with timeelapsed clinical recurrence, also life threatening, mostly implying a significant everyday life burden of disease (Silva et al, 2019). Cardiac involvement, respiratory failure, and joint contractures are among the most frequent associated features that contribute to increased disability and impaired quality of life of the patient (Mercuri and Muntoni, 2013;Morrison, 2016).…”

Section: Introductionmentioning

confidence: 99%

Exercise-Related Oxidative Stress as Mechanism to Fight Physical Dysfunction in Neuromuscular Disorders

et al. 2020

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Neuromuscular diseases (NMDs) are a group of often severely disabling disorders characterized by dysfunction in one of the main constituents of the motor unit, the cardinal anatomic-functional structure behind force and movement production. Irrespective of the different pathogenic mechanisms specifically underlying these disease conditions genetically determined or acquired, and the related molecular pathways involved in doing that, oxidative stress has often been shown to play a relevant role within the chain of events that induce or at least modulate the clinical manifestations of these disorders. Due to such a putative relevance of the imbalance of redox status occurring in contractile machinery and/or its neural drive in NMDs, physical exercise appears as one of the most important conditions able to positively interfere along an ideal axis, going from a deranged metabolic cell homeostasis in motor unit components to the reduced motor performance profile exhibited by the patient in everyday life. If so, it comes out that it would be important to identify a proper training program, suitable for load and type of exercise that is able to improve motor performance in adaptation and response to such a homeostatic imbalance. This review therefore analyzes the role of different exercise trainings on oxidative stress mechanisms, both in healthy and in NMDs, also including preclinical studies, to elucidate at which extent these can be useful to counteract muscle impairment associated to the disease, with the final aim of improving physical functions and quality of life of NMD patients.

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“…1 In these patients, the unstretched chest wall muscles become shorter and stiffer due to the disease process. [2][3][4][5] When peak expiratory flow (PEF) falls below 160 L/min, it indicates an ineffective cough, and airway clearance becomes inefficient. 6 The combination of loss of respiratory muscle strength, ineffective cough, and decreased ventilation leads to a high risk of developing pneumonia, atelectasis, and respiratory insufficiency and failure.…”

Section: Introductionmentioning

confidence: 99%

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

Auger¹,

Hernando²,

Galmiche³

2017

Respir Care

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The aim of this systematic review is to examine the benefit/risk ratio of the use of mechanical insufflation-exsufflation (MI-E) devices for airway clearance in patients with neuromuscular diseases. A search was conducted for relevant studies in MEDLINE, the Cochrane Library, and the Health Technology Assessment Database using the main key words: cough, airway clearance, in-exsufflation. The search limits were studies published in English and French between 1970 and 2014 (literature watch until December 2015). The methodological quality of the studies was assessed using (1) the Cochrane Collaboration's risk of bias tool for randomized controlled trials and (2) the Institute of Health Economics' 20-item checklist for comparative and observational studies. Data were extracted into an evidence table according to (1) study design, (2) population characteristics (including age and type of diseases) and intervention (MI-E associated or not with other interventions), (3) outcome measures, and (4) key findings. Twelve studies met the inclusion criteria (4 randomized controlled trials, 3 comparative studies, and 5 observational studies). The quality of the selected studies was poor. None of the studies reported survival outcome. All studies evaluated change of pulmonary function parameters, such as peak expiratory flow. This review underlines the lack of robust data on mechanical medical devices used for airway clearance. The current scientific evidence does not support the use of MI-E for cough augmentation in patients with neuromuscular diseases, but health-care professionals are faced with the reality of medical practice and the absence of alternatives. Most European and American guidelines recommend the use of MI-E despite low-level evidence. However, even if performing comparative trials in a specific population is difficult, the medical device industry should provide reliable data to assist health-care professionals, providers, and payers in the decision-making process. This is the only way to ensure the best treatment for patients.

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Respiratory muscle training in children and adults with neuromuscular disease

Cited by 23 publications

References 53 publications

The Effects of Inspiratory Muscle Training in Neuromuscular Disorders: Review Article

The Effects of Inspiratory Muscle Training in Neuromuscular Disorders: Review Article

Exercise-Related Oxidative Stress as Mechanism to Fight Physical Dysfunction in Neuromuscular Disorders

Use of Mechanical Insufflation-Exsufflation Devices for Airway Clearance in Subjects With Neuromuscular Disease

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