Malin Nygren-Bonnier

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.

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

Purpose. The present aim was to explore and describe experience of decreased lung function among people with cervical spinal-cord injury (CSCI). Method. Thirty-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.  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. Breathing 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.

Non‐invasive Ventilation as Airway Clearance Technique in Cystic Fibrosis

BACKGROUND AND PURPOSE For patients with cystic fibrosis, chest physiotherapy is crucial for evacuating airway secretions. Because chest physiotherapy increases energy expenditure, fatigue and dyspnoea, non-invasive ventilation (NIV) could be beneficial for severely ill patients during airway clearance. The aim of the study is to evaluate and compare the effects between NIV and positive expiratory pressure (PEP) on airway clearance. METHODS Prospective, randomized trial compares PEP to NIV. Thirty-two subjects, mean age 31 years, mean forced expiratory volume in 1 second 47% (±14) and mean forced vital capacity 69% (±13), completed a 3-month randomized trial comparing NIV with standard PEP treatment as airway clearance technique. Lung functions testing, 6-minute walk test, blood gases, sputum culture and inflammatory parameters were measured before and after the treatment period. RESULTS There was a significant reduction in lung clearance index (LCI) following NIV compared with PEP (p = 0.01). LCI is performed within the lung function testing. DISCUSSION Non-invasive ventilation was shown to be a good alternative to PEP in chest physiotherapy for patients with cystic fibrosis who are severely ill.

Airway clearance techniques in neuromuscular disorders: A state of the art review

This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.

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

Aim:  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 High-Intensity Hatha Yoga on Cardiovascular Fitness, Adipocytokines, and Apolipoproteins in Healthy Students: A Randomized Controlled Study.

BACKGROUND Yoga exercises are often used as a form of body and mind exercise to increase performance. However, knowledge about the physiologic effects of performing high-intensity Hatha yoga exercises over a longer time period remains limited. OBJECTIVE To investigate the effects of high-intensity yoga (HIY) on cardiovascular fitness (maximal oxygen consumption, estimated from the Cooper running test), ratings of perceived exertion (RPE), heart rate (HR), heart rate recovery (HRR), blood pressure (BP), adipocytokines, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and glycosylated hemoglobin (HbA1c) in healthy students. METHODS The 44 participants (38 women and 6 men; median age, 25 years [range, 20-39 years]) were randomly assigned to an HIY or a control group. The HIY program was held for 6 weeks (60 minutes once a week). Cardiovascular fitness, RPE, HR, HRR, BP, adipocytokines, HbA1c, ApoA1, and ApoB were measured at baseline and after 6 weeks in both groups. RESULTS HIY had no significant effects on cardiovascular fitness (mean dose: 390 minutes [range, 210-800 minutes]), HR, HRR, BP, or any of the blood parameters. However, secondary findings showed that [corrected] ApoA1 (1.47 ± 0.17 to 1.55 ± 0.16 g/L; p = 0.03) and adiponectin (8.32 ± 3.32 to 9.68 ± 3.83 mg/L; p = 0.003) levels increased significantly in the HIY group after 6 weeks. CONCLUSIONS Six weeks of HIY did not significantly improve cardiovascular fitness. However, secondary findings showed that [corrected] ApoA1 and adiponectin levels increased significantly in the HIY group. This finding suggests that HIY may have positive effects on blood lipids and an anti-inflammatory effect.

Effects of yogic exercises on functional capacity, lung function and quality of life in participants with obstructive pulmonary disease : a randomized controlled study

BACKGROUND Knowledge of hatha yogic exercises, the most used yoga style, for increasing functional capacity in patients with obstructive pulmonary diseases remains limited. AIM The aim was to evaluate the effects and feasibility of hatha yoga (HY) compared to a conventional training program (CTP) on functional capacity, lung function and quality of life in patients with obstructive pulmonary diseases. DESIGN Randomized clinical trial. SETTING The study was performed at the Karolinska University Hospital, Stockholm, among outpatients. POPULATION Thirty-six patients with obstructive pulmonary disease. METHODS Forty patients were randomized with 36 (24 women, median age =64, age range: 40-84 years) participating in HY (N.=19) or CTP (N.=17). Both HY and CTP involved a 12-week program with a 6-month follow-up. Functional capacity (using the 6-Minute Walk Test), lung function (spirometry), respiratory muscle strength (respiratory pressure meter), oxygen saturation (SpO2), breathlessness (Borg), respiratory rate (f) and disease-specific quality of life (CRQ) were measured at baseline, at 12 weeks and at a 6-month follow-up. RESULTS Testing for interactions (group x time) with ANOVAs showed significant effects on the CRQ fatigue (P=0.04) and emotional (P=0.02) domains, with improvements in the CTP group after the 12-week intervention (P=0.02 and 0.01, respectively) but not in the HY group. No between group effects emerged, however, within each group, significant improvements emerged for the six-minute walk distance (6MWD) after 12-week intervention (HY: mean difference 32.6 m; CI: 10.1-55.1, P=0.014; CTP: mean difference 42.4 m; CI: 17.9-67.0, P=0.006). SECONDARY OUTCOMES within-group improvements in CRQ appeared in both groups. Within the HY group, f decreased and SpO2 increased. Improved effects after follow-up emerged only for the CTP group for diastolic blood pressure (P=0.05) and CRQ emotional and fatigue domain (P=0.01). CONCLUSIONS There were no between-group differences. After 12 weeks, 6MWD improved significantly within both groups. Within the HY group, improvements in the CRQ mastery domain, f and SpO2 emerged. Within the CTP group, there were improvements in lung function parameter forced vital capacity, respiratory muscle strength and all CRQ-domains. The CTP also exhibited effects on CRQ after the 6months follow-up. CLINICAL REHABILITATION IMPACT Limited effects of HY and CTP emerged. HY seems feasible and safe as a form of physical exercise for pulmonary disease patients. As part of the rehabilitation, HY may constitute an alternative to other physical training activities and may be a useful addition to formal rehabilitation programs.

Abdominal plasty with and without plication-effects on trunk muscles, lung function, and self-rated physical function

Abstract Background: Weight loss after obesity and pregnancy is associated with excess abdominal skin and weakness of the abdominal wall, which is assumed to cause low back pain and reduce lung function. Today, abdominoplasty is the only known method to treat excess skin, and plication is used to improve aesthetics and function alone or in addition to surgery. There is lack of evidence concerning the surgery’s effect on trunk muscles, lung function, and physical function. The aim was to evaluate the effect on trunk muscle endurance, lung function and self-rated physical function after abdominoplasty with and without muscle plication. Aim: To evaluate the effect on trunk muscle endurance, lung function, and self-rated physical function after abdominoplasty with and without muscle plication. Methods: A series of 125 people were randomised to abdominoplasty with or without rectus abdominis muscle plication. Trunk muscle endurance, lung function, and self-rated physical function (disability rating index) were measured before and 1 year after surgery. Results: There were no significant differences in any of the measured variables between the groups either before or after surgery. A significant decrease (p = .02) in back muscle endurance was seen after abdominoplasty without muscle plication. A significant positive effect (p = .04) in one of the activities (running) assessed by DRI was reported after abdominoplasty with muscle plication. Conclusions: No significant differences in trunk muscle endurance, lung function, or self-rated physical function were found after abdominoplasty with vs without plication. As the primary indication for surgery was excess skin and not diastasis of the rectus abdominis muscles, there is a need for future trials before conclusions can be drawn of effect of abdominoplasty and plication.

Effects of glossopharyngeal breathing on speech and respiration in multiple sclerosis: a case report

This case report describes the effects of glossopharyngeal breathing on respiration and speech in a patient with tetraplegia due to multiple sclerosis. Glossopharyngeal breathing is a technique where air is insufflated with the glossopharyngeal muscles, to increase vital capacity. Results from follow-up assessments up to 20 months after intervention showed that (1) the patient’s speech and respiratory function with glossopharyngeal breathing improved over time, (2) the patient’s respiratory function without glossopharyngeal breathing deteriorated over time (possibly because of a severe cold), and (3) at each assessment, the patient’s speech and respiratory function was better with glossopharyngeal breathing than without it.

Acute effects of glossopharyngeal insufflation in people with cervical spinal cord injury

Objectives: To evaluate acute effects of glossopharyngeal insufflation (GI) on lung function, airway pressure (Paw), blood pressure and heart rate (HR) in people with cervical spinal cord injury (CSCI). Design: Case-control design. Setting: Karolinska Institutet, Stockholm, Sweden. Participants: Ten participants with CSCI suffering from lesions between C4 and C8, and ASIA classification of A or B were recruited. Ten healthy particpants familiar with GI were recruited as a reference group. Outcome measures: Spirometry, mean arterial blood pressure (MAP), Paw, and HR were measured in a sitting and a supine position before, during, and after GI. Results: GI in the study group in a sitting position increased total lung capacity (TLC) by 712 ml: P < 0.001, vital capacity (VC) by 587 ml: P < 0.0001, Paw by 13 cm H2O: P < 0.01, and HR by 10 beats/min: P < 0.001. MAP decreased by 25 mmHg, P < 0.0001. Significant differences were observed between groups comparing baseline with GI. The reference group had a higher increase in; TLC (P < 0.01), VC (P < 0.001), Paw (P < 0.001) and HR (P < 0.05) and a higher decrease in MAP (P < 0.001). With GI in a sitting compared to a supine position, TLC, MAP, HR, Paw remained unchanged in the study group, while residual volume decreased in the supine position (P < 0.01). Conclusion: There was a difference between the groups in the increase in TLC; VC; Paw, HR and in the decrease in MAP with GI, however MAP, HR and Paw responded in similar way in both groups in a sitting as well as a supine position. If performed correctly, the risks of GI resulting in clinically significant hemodynamic changes is low, although syncope may still occur.