Respiratory rehabilitation with abdominal weights: a prospective case study

Stanley John Winser, Priya Stanley, George Tarion

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DOI: 10.4236/health.2010.25061                

Abstract

Objective: Abdominal weights was used to strengthen the diaphragm of a C6 ASIA (A) tetraplegic subject with the aim of studying the long term effect of the technique as a part of respiratory rehabilitation. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India. Study Design: Prospective case study. Material and methods: The peak EMG amplitude of the diaphragm (DIA), intercostals (INT) and sternoclidomastiod (SCM) were assessed using a surface EMG and inspired lung volume (ILV) was assessed using an adjustable portable spirometer. The measurements were repeated after 3, 6, 9 and 12 months of inspiratory muscle training for a period of 15 minutes daily, 6 days a week for 12 months. Results and discussion: Peak amplitudes recorded by the EMG of DIA and SCM muscles showed a progressive increase, INT muscle did not show a consistent change. INV showed a gradual rise from 1772ml to 2760 ml over the study period. These values have the following significance: 1) Use of abdominal weights as a part of respiratory rehabilitation has beneficial long term effects; 2) In patients with tetraplegia, respiratory muscles in particular the diaphragm, are trainable in terms of muscle efficiency; 3) The improvement in the muscle efficiency obtained during the early rehabilitation can be maintained or improved using simple non sophisticated exercises like abdominal weights post discharge. Conclusions: Abdominal weights can be used as an effective adjunct to pulmonary rehabilitation in improving the efficiency of diaphragm on a long term basis, thereby reducing the risks associated with pulmonary complications.

Keywords

Tetraplegia; Abdominal Weights; EMG

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Zimmer, M.B., Nantwi, K. and Goshgarian, H.G. (2007) Effect of spinal cord injury on the respiratory system: Basic research and current clinical treatment options. Journal of Spinal Cord Medicine, 30(4), 319-330.
[2]	Forner, J.V. (1980) Lung volumes and mechanics of breathing in tetraplegics. Paraplegia, 18(4), 258-266.
[3]	Rutchik, A., et al. (1998) Resistive inspiratory muscle training in subjects with chronic cervical spinal cord injury. Archives of Physical Medicine and Rehabilitation, 79(3), 293-297.
[4]	Bake, B., Fugl-Meyer, A.R. and Grimby, G. (1972) Brea- thing patterns and regional ventilation distribution in tetraplegic patients and in normal subjects. Clinical Science, 42, 117-128.
[5]	De Troyer, A. and Estenne, M. (1991) Review article: The expiratory muscles in tetraplegia. Paraplegia, 29(6), 359-363.
[6]	Bhaskar, K.R., et al. (1991) Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition. American Review of Disease, 143(3), 640-648.
[7]	Jackson, A.B. and Groomes, T.E. (1994) Incidence of respiratory complications following spinal cord injury. Archives of Physical Medicine and Rehabilitation, 75(3), 270-275.
[8]	Claxton, A.R., Wong, D.T., Chung, F. and Fehlings, M.G. (1998) Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Canadian Journal of Anesthesia, 45(2), 144-149.
[9]	Fishburn, M.J., Marino, R.J. and Ditunno, J.F. Jr. (1990) Atelectasis and pneumonia in acute spinal cord injury. Archives of Physical Medicine and Rehabilitation, 71(3), 197-200.
[10]	Frankel, H.L., Coll, J.R., Charlifue, S.W., et al. (1998) Long term survival in spinal cord injury: A fifty year investigation. Spinal Cord, 36(4), 266-274.
[11]	Akabas, S.R., Bazzy, A.R., DiMauro, S. and Haddad, G.G. (1989) Metabolic and functional adaptation of the diaphragm to training with resistive loads. Journal of Applied Physiology, 66(2), 529-535.
[12]	Belman, M.J. and Shadmehr, R. (1988) Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease. Journal of Applied Physiology, 65(6), 2726-2735.
[13]	Boutellier, U., BuÈ chel, R., Kundert, A. and Spengler, C. (1992) The respiratory system as an exercise limiting factor in normal trained subjects. European Journal of Applied Physiology, 65(4), 347-353.
[14]	Grassino, A. (1989) Inspiratory muscle training in COPD patients. European Respiratory Journal, Supplement 7, 581s-586s.
[15]	Leith, D.E. and Bradley, M. (1976) Ventilatory muscle strength and endurance training. Journal of Applied Physiology, 41(4), 508-516.
[16]	Morgan, D.W., Kohrt, W.M., Bates, B.J. and Skinner, J.S. (1987) E€ects of respiratory muscle endurance training on ventilatory and endurance performance of moderately trained cyclists. International Journal of Sports Medicine, 8(2), 88-93.
[17]	Noseda, A., et al. (1987) Resistive inspiratory muscle training and exercise performance in COPD patients. A comperative study with conventional breathing retraining. Bulletin European Physiopathologie Respiratoire, 23(5), 457-463.
[18]	Gross, D., et al. (1980) The e€ect of training on strength and endurance of the diaphragm in quadriplegia. American Journal of Medicine, 68(1), 27-35.
[19]	Biering-Sorensen, F., Lehmann Knudsen, J., Schmidt, A., Bund-gaard, A. and Christensen, I. (1991) Effect of respiratory training with a mouth-nose-mask in tetraplegics. Paraplegia, 29(2), 113-119.
[20]	Derrickson, J., Ciesla, N., Simpson, N. and Imle, P.C. (1992) A comparison of two breathing exercise programs for patients with quadriplegia. Physical Therapy, 72(11), 763-769.
[21]	Bodin, P., Fagevik Olsen, M. and Bake, B. (2005) Effects of abdominal binding on breathing pattern during breathing exercises in persons with tetraplegia. Spinal Cord, 43, 117-122.
[22]	Kisner, C. and Colby, L.A. In: Management of pulmonary conditions. Therapeutic Exercises: Foundation and techniques, 3rd Edition, FA. Davis Company Publishers, 665-672.
[23]	Wetzel, J.L. and Lunsford, B.R. (1995) In: Scot Irwin, T., Ed., Management of pulmonary conditions. Cardio pulmonary physical therapy: A guide to practice, 3rd Edition, Mosby publisher, St. Louis, 584-586.
[24]	Lin, H. and Chung, C.-C. (1999) Abdominal weight and Inspiratory resistance: Their immediate effects on inspiratory muscle functions during maximal voluntary brea- thing in chronic tertraplegic patients. Archives of Physical Medicine and Rehabilitation, 80(7), 741-745.
[25]	Jennifer, B., Christer, S., Lars, L. and Alex, G. (1998) Effects of lung volume on diaphragm EMG signal strength during voluntary contractions, Journal of Applied Physiology, 85(3), 1123-1134.