Brita Klefbeck

Effect of inspiratory muscle training in patients with multiple sclerosis

OBJECTIVEnTo evaluate whether inspiratory muscle training (IMT) improves inspiratory muscle strength, respiratory capacity, fatigue, and subjective perception of physical endurance in patients with advanced multiple sclerosis (MS).nnnDESIGNnRandomized controlled trial.nnnSETTINGnOutpatient clinic in Sweden.nnnPARTICIPANTSnFifteen severely disabled patients with MS, randomized to a training or control group.nnnINTERVENTIONnSeven patients trained with a Threshold inspiratory muscle trainer, twice every other day, with 3 sets of 10 loaded inspirations (40%-60% of patients maximal inspiratory pressure [Pimax]) over a 10-week period.nnnMAIN OUTCOME MEASURESnSpirometry, Pimax, maximal expiratory pressure (Pemax), clinical assessments, and questionnaires on the patients fatigue severity and physical endurance were evaluated.nnnRESULTSnAfter training, the Pimax (P<.008) and Pemax (P<.02) increased in the training group. The improvement in Pimax after 10 weeks of training was higher than the improvement in the control group (P<.01) and was maintained 1 month after the training period ended. The training affected neither respiratory function nor the patients symptoms.nnnCONCLUSIONSnIMT had a beneficial effect on inspiratory muscle strength in patients with MS and is recommended as a complement to ordinary physical training.

Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury.

Study design:A prospective cohort study.Objectives:To evaluate whether patients with cervical spinal cord injury (CSCI) are able to learn the technique of glossopharyngeal pistoning (breathing) for lung insufflation (GI) and if learned, to evaluate the effects of GI on pulmonary function and chest expansion after 8 weeks.Setting:Karolinska University Hospital, Stockholm, Sweden.Methods:Twenty-five patients with CSCI (21 men, four women) with a mean age of 46 years (21–70), from the Stockholm area, were used in this study. The participants performed 10 cycles of GI four times a week, for 8 weeks. Pulmonary function tests made before and after the GI training included vital capacity (VC), expiratory reserve volume (ERV), functional residual capacity (FRC; measured with nitrogen washout), residual volume (RV) and total lung capacity (TLC). Chest expansion was measured before and after training.Results:Five of the twenty-five participants had difficulty in performing GI and were excluded in further analysis. Performing a GI maneuvre increased participants VC on average by 0.88±0.5u2009l. After 8 weeks of training, the participants had significantly increased their VC 0.23u2009l, (P<0.001), ERV 0.16u2009l, (P<0.01), FRC 0.86u2009l, (P<0.001), RV 0.70u2009l, (P<0.001) and TLC 0.93u2009l, (P<0.001). Chest expansion increased at the level of the xiphoid process by 1.2u2009cm (P<0.001) and at the level of the fourth costae by 0.7u2009cm (P<0.001).Conclusions:After using GI for a period of 8 weeks, the participants with CSCI who could perform GI were able to improve pulmonary function and chest expansion.

Effects of glossopharyngeal pistoning for lung insufflation on vital capacity in healthy women.

Nygren-Bonnier M, Lindholm P, Markström A, Skedinger M, Mattsson E, Klefbeck B: Effects of glossopharyngeal pistoning for lung insufflation on vital capacity in healthy women. Am J Phys Med Rehabil 2007;86:290–294. Objectives:To determine whether healthy women could be trained to perform glossopharyngeal pistoning (GP) to insufflate the lungs to volumes exceeding maximum inspiratory capacity (IC), whether such insufflation caused discomfort, and the immediate and long-term effects on vital capacity (VC). Design:A randomized controlled trial. Twenty-six healthy women were randomly assigned to a training group (TG, n = 17) or to a control group (CG, n = 9). The TG performed 15–30 deep inspiratory efforts supplemented by GP to lung volumes exceeding IC, three times per week for 6 wks. Pulmonary function and chest expansion were measured before and after the 6-wk period. The TG was retested again 12 wks after the end of the training period. Results:One of 17 women had difficulty performing GP and was excluded. Temporary symptoms (while performing GP) were reported in 44% of subjects in the TG. After 6 wks of training, subjects in the TG had significantly increased their VC (P < 0.001). VC did not change in the CG. The increase in vital capacity of the TG was still evident after 12 wks without performing GP. Chest expansion increased significantly with GP. Conclusion:The women in the TG were able to perform the technique, and it did not cause major discomfort. VC increased significantly in the TG, and the increase was still present after 12 wks without GP.

The effect of trunk support on performance during arm ergometry in patients with cervical cord injuries

Earlier studies have shown that the diaphragm might have a postural function that could interfere with its respiratory function during arm cycling in patients with cervical cord injuries with impaired elbow extension. The purpose of this study was to evaluate the effect of trunk support on working performance in such patients. Ten patients with low-cervical-cord injuries performed an arm ergometer test without and with trunk support with at least one week between the tests. The work load averaged 30 (20-50) Watt. Oxygen uptake at steady state averaged 0.71 ± 0.09 1/min without trunk support and 0.64 ± 0.10 1/min with trunk support, P< 0.05. There was no difference in blood lactate without or with trunk support. Maximum performance time averaged 8.3 ± 4.3 min without trunk support and 19.5 ±8.8 min with trunk support, P < 0.01. Oxygen saturation tended to decrease during work and returned to resting values after termination. This study showed that trunk support during arm ergometry in cervical-cord-injury patients with impaired elbow extension decreased the energy cost during sub-maximal work and increased the time to perform work. The results indicate that trunk stabilisation might improve performance of activities of daily living and that it should also be considered during exercise affecting the postural balance of these patients.

Experiences of decreased lung function in people with cervical spinal cord injury

Purpose.u2003The present aim was to explore and describe experience of decreased lung function among people with cervical spinal-cord injury (CSCI). Method.u2003Thirty-three people with CSCI with a lesion between levels C4 and C8 entered the study. Qualitative content analysis was used. A semi-structured interview guide was constructed with the main focus on experience of symptoms related to decreased lung function. Results.u2003 The experience related to decreased lung function was limitations in breathing function, the ability to cough and voice function. Individual self-management strategies were described in relation to these limitations. The overarching theme throughout the interviews was that although the limitations were in most cases significant compared to the situation before injury, they were not necessarily experienced or referred to as a problem. Conclusions.u2003Breathing function, the ability to cough and voice function were perceived as limited in most of the present participants with CSCI compared to before the injury. Most had adapted to the situation and had developed their own strategies for handling the limitations. However, these limitations did not only become normal for the individuals because of compensatory strategies, these limitations were usually experienced as a problem not to speak of.

Patients’ with ALS and caregivers’ experiences of non-invasive home ventilation

The purpose of this study was to describe the patients’ with ALS and their caregivers’ experiences of non-invasive positive-pressure ventilation. In-depth interviews with seven patients and eight caregivers were analyzed using a qualitative content analysis method. Three main themes emerged: “Getting to know the ventilator”, “Embracing the ventilator” and “Being on a ventilator on a 20–24-h basis”. The patients reported improved sleep and improved activity level but also contradictory emotions as to starting on the ventilator. The ability to stay at home close to the family was mentioned. Findings for the caregivers revealed an initial period of stress and interrupted sleep followed by a period of harmony and relief from stress. When the patient was on the ventilator 20–24 h, the findings indicate an extensive involvement in the care of the patient, as well as dealing with several kinds of technical situations with the ventilator devices causing the caregivers another period of stress. The caregivers revealed a deepened understanding as to how the patients benefited from the non-invasive positive-pressure ventilation (NPPV) treatment. The patients and their caregivers in this study benefited from NPPV in several aspects but the caregivers also experienced periods of stress and interrupted sleep.

Observations of four children with severe cerebral palsy using a novel dynamic platform. A case report

Abstract The aim was to evaluate effects on bone mineral content (BMC) in children with severe cerebral palsy (CP) standing on a self-controlled dynamic platform (vibrations, jumps and rotation), assess reactions expressed and record negative effects. An experimental design was used. Four children with severe CP participated. Two children used the platform for 8–9 months while two children were controls (period I). After 1 year, the former users were controls (period II). Dual-energy X-ray absorptiometry was performed. Children in period I (Child 1/Child 2) were exposed to whole body vibration for 330/394 min on 28/25 occasions and showed a percentage change in BMC values at the lumbar spine of +35/+23% (versus controls, Child 3/Child 4, −9/+7%), left legs −9/ −12% (vs. −2/ −12%) and right legs +61/+34% (vs. −18/+10%). Children in period II (Child 3/Child 4) were exposed for 524/635 min on 57/64 occasions. The corresponding percentage change in BMC values at the lumbar spine was +10/+10% (+21/+5%), left legs +26/+22% (0/+5%) and right legs +26/+17% (+15/ −1%). The childrens reactions were perceived positive. No negative effects were recorded. Standing on a self-controlled dynamic platform may be an enjoyable method to increase BMC in children with severe CP.

Glossopharyngeal pistoning for lung insufflation in children with spinal muscular atrophy type II

Aim:u2002 To evaluate whether children with spinal muscular atrophy (SMA) type II were able to learn glossopharyngeal pistoning for lung insufflation (GI), and to evaluate the effects of GI on pulmonary function and chest expansion.

Effects of standing on bone density and hip dislocation in children with severe cerebral palsy

Abstract The aim of the study was to evaluate whether standing time associates with bone density and/or hip dislocation in children with severe cerebral palsy. The study design was cross-sectional and descriptive. Eleven boys and seven girls, median age 10.5 years, with severe cerebral palsy participated. Spasticity was measured with modified Ashworth scale. Seven children had scores of 0–1, and 11 had scores of 2–4. Eight of 18 had insulin-like growth factor-I levels lower than −2 standard deviations below the age-matched mean. Time spent in the Standing shell was recorded. Bone mineral density levels determined using dual energy X-ray absorptiometry and hip X-ray were evaluated. Time spent in the Standing shell was 40 min/day (range=4–164). The lumbar spine bone mineral density was 73% of that of age-matched able-bodied controls. Standing time was not associated with bone mineral density, but in 11 children with modified Ashworth scale scores of 2–4, standing time was significantly and negatively associated with hip dislocation. We conclude that time spent in the Standing shell in these 18 children did not affect whole body bone mineral density. In children with spasticity, the association to hip dislocation was significantly negative.

LUNG CLEARANCE IN CHILDREN WITH DUCHENNE MUSCULAR DYSTROPHY OR SPINAL MUSCULAR ATROPHY WITH AND WITHOUT CPAP (CONTINUOUS POSITIVE AIRWAY PRESSURE)

Bronchiolar clearance was studied in 7 boys in the age range of8 to 17 years, 6 with Duchenne muscular dystrophy (DMD)and 1 with spinal muscular atrophy type II (SMA-II). These boys had healthy lungs but a severely reduced muscular strength (wheelchair dependent). In 6 of the boys, clearance was studied twice, at one occasion as a control and at the other occasion following treatment with continuous positive airway pressure (CPAP). A control group of healthy adults was used. In the clearance examinations, 6- μ m Teflon particles, labeled with 111 In was inhaled extremely slowly, 0.05 L/s. This gives a deposition mainly in the bronchioles. Lung retention was measured after 0, 24, 48, and 72 hours. A model for deposition of particles in the adult lung was scaled down to represent the children in this study. Deposition in various airway generations was calculated to be similar in children and adults. Also the measured retentions were similar in the boys and the adults. In the clearance experiments during CPAP treatment, there was a significantly lower retention after 72 hours (but not after 24 and 48 hours)than in the control experiments. The results indicate that a severe reduction of muscular strength, and thereby a reduction of mechanical movement of the lung, does not affect clearance from large and small airways. However, some effect of clearance from small airways cannot be excluded due to the short measuring period. The small but significant effect of the CPAP treatment might have potential clinical importance and suggest that bronchiolar clearance can be affected by some form of mechanical force.