The effect of training on strength and endurance of the diaphragm in quadriplegia

Gross, D; Ladd, H; Riley, E.J.; Macklem, Peter T.; Grassino, A.

doi:10.1016/0002-9343(80)90157-6

Cited by 183 publications

(101 citation statements)

References 14 publications

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“…Maximum inspiratory mouth pressure (MIP), an index of ven tilatory muscle strength, is often also markedly reduced as compared to normals (Gross et al, 1980;Leith and Bradley, 1976). It has been demonstrated that the strength and endurance of the ventilatory muscles can be improved through a programme of inspiratory resistive training in normal subjects (Leith and Brad ley, 1976;Clanton et al, 1985a), chronic obstructive pulmonary disease (COPD) patients (Pardy et al, 1981;Belman and Mittman, 1980), as well as quadri plegics (Gross et at., 1980). Such training regimes have reported symptom relief and subjective improvements in breathing in quadriplegics (Gross et al, 1980), and increased exercise performance in COPD (Grassino et al, 1979).…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that the strength and endurance of the ventilatory muscles can be improved through a programme of inspiratory resistive training in normal subjects (Leith and Brad ley, 1976;Clanton et al, 1985a), chronic obstructive pulmonary disease (COPD) patients (Pardy et al, 1981;Belman and Mittman, 1980), as well as quadri plegics (Gross et at., 1980). Such training regimes have reported symptom relief and subjective improvements in breathing in quadriplegics (Gross et al, 1980), and increased exercise performance in COPD (Grassino et al, 1979). While such training regimes are thought to be important in protecting the ventilatory muscles against fatigue (Gross et al, 1980;Pardy et al, 1981;Grassino et al, 1979), little information is available concerning the effects such training may have on resting breathing pattern or breathing control.…”

Section: Discussionmentioning

confidence: 99%

“…Such training regimes have reported symptom relief and subjective improvements in breathing in quadriplegics (Gross et al, 1980), and increased exercise performance in COPD (Grassino et al, 1979). While such training regimes are thought to be important in protecting the ventilatory muscles against fatigue (Gross et al, 1980;Pardy et al, 1981;Grassino et al, 1979), little information is available concerning the effects such training may have on resting breathing pattern or breathing control. We hypothesised that increasing the strength and endurance of the ventilatory muscles would alter resting breathing pattern by increasing tidal volume (Vt) and decreasing fre quency (F).…”

Section: Discussionmentioning

confidence: 99%

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Ventilatory muscle endurance training in quadriplegia: effects on breathing pattern

1989

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SummaryWe examined the effects of ventilatory muscle endurance trazmng on resting breath ing pattern in 12 C6-C7 traumatic quadriplegics at least 1 year post-injury. All subjects had complete motor loss below the lesion level. Subjects were randomly assigned to a training (N = 6), or a control group (N = 6). Baseline tests included measurement of resting ventilation and breathing pattern using mercury in rubber strain gauges for 20 minutes in a seated position; maximum inspiratory mouth pressure (MIP) at PRC, and sustainable inspiratory mouth pressure for 10 minutes (SIP); lung volumes, and arterial blood gases (ABG's). The training protocol con sisted of breathing through an inspiratory resistor equivalent to 85% SIP for 15 minutes twice daily, 5 days a week for 8 weeks. Both trainers and controls attended the lab every 2 weeks for reassessment of MIP and SIP and the inspiratory resist ance was increased in the training group as SIP increased. At the end of 8 weeks, baseline tests were repeated. All subjects had normal ABG's. There was a significant increase in mean MIP and SIP in both the control group (30% ± 19% and 31% ± 18% respectively), and in the training group (42% ± 24% and 78% ± 49% respectively). Although the absolute values for both MIP and SIP were greater in the training group than in the control group, the differences were not significant. The alterations in resting breathing pattern were also the same in both groups. Mean frequency decreased significantly in the control group (20' 2/min ute to 16'9/minute) and, while insignificant, the change in frequency in the training group was the same, 19'4/minute to 16·4/minute. Mean tidal volume (Vt) in creased 18· 2% of baseline Vt in the control group and 17-0% baseline in the trainers, resulting in no change in minute ventilation. As MIP and SIP increased similarly in both groups, the data from the control and trainers was pooled and timing changes re-evaluated pre-and post-study. A significant decrease in mean Ti/ Ttot was obser ved, while no change in Vt/Ti was found. We concluded that the testing procedure

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ventilatory muscle endurance training in quadriplegia: effects on breathing pattern

1989

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“…19,20 Earlier studies imply that only with progressive resistance exercise in already functional muscles does one ®nd reports of a signi®cant increase in muscle strength or VC in the years following injury. 21,22 Carter noted in his study on experiences with high tetraplegics that patients admitted several months after their injury were still capable of signi®cant gains in their VC after an inpatient rehabilitation program using appropriate respiratory exercises and therapy. 23 Ho man compared the lung function values of sedentary tetraplegic patients with that of`athletic' SCI patients.…”

Section: Discussionmentioning

confidence: 99%

Vital capacity in tetraplegics twenty years and beyond

2001

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Objectives: To observe the trends in vital capacity (VC) over time in tetraplegics 20 years and more after injury, the e ects of age at injury, severity of injury and gender on this trend. Methods: The medical records of all spinal cord injured persons admitted to a regional spinal injury center from January 1960 to December 1996 were reviewed. Fifty-seven patients had documented post-rehabilitation VC (mean 1.3+1.1 years) and VC at 10 (mean 11.8+2.69) and 20 (20.60+2.67) years post injury and beyond. Results: The mean age at injury was 23.2+9.1 years. Severity of injury when classi®ed according the system proposed by Coll et al were: Group 1: C1 ± 4 Frankel A injury: 11.6%, Group 2: C5 ± 8 Frankel A injury: 55.6%, Group 3: C2 ± 8 Frankel B and C: 29.8% and Group 4: C2 ± 8 Frankel D: 3.5% respectively. The mean VC at initial, 10 and 20 years post injury was 2586+948, 2803+940 and 2525+818 cc respectively. Multivariate analysis of variance revealed that there was signi®cant di erence in VC over a 20 year period, (F(2,54)=8.43, P50.05). The di erence between VC at 10 years and VC at 20 years accounted for the 19.8% of the variance in VC over time (F(1,55)=12.35, P50.05). Age at injury, gender and severity of injury did not have a signi®cant in¯uence on the rate of decline in VC. Analysis of a subset of 26 patients who were followed up more than 20 years post injury (range 22 to 34.5 years) revealed similar,

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“…Most of these problems arise due to an inability of the patient to clear the increased secretions from the mucous glands and transudation of fluid into the alveoli (Kierwski et al, 1981). Tetraplegic patients have a reduced vital capacity due to decreased inspiratory capacity and low expiratory reserve volume (Forner, 1968) and are predisposed to developing inspiratory muscle fatigue (Gross et al, 1980). They are also, unable to make use of their abdominal muscles to cough.…”

Section: Otomymentioning

confidence: 99%

Minitracheotomy in the early respiratory management of patients with spinal injuries

et al. 1989

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SummaryMinitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases.This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.

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The effect of training on strength and endurance of the diaphragm in quadriplegia

Cited by 183 publications

References 14 publications

Ventilatory muscle endurance training in quadriplegia: effects on breathing pattern

Ventilatory muscle endurance training in quadriplegia: effects on breathing pattern

Vital capacity in tetraplegics twenty years and beyond

Minitracheotomy in the early respiratory management of patients with spinal injuries

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