Rodrigo Torres-Castro

Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

Study design:Cross-sectional.Objective:To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A.Setting:Large tertiary hospital in Chile.Methods:Peak cough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC).Results:Fifteen in-patients with complete tetraplegia (C4–C6) were included. Median age was 33 years (16–56). PCF during the different interventions was PCF for MEE was 183±90 l min−1; PCF for MEE-AC was 273±119 l min−1; PCF for AS-MEE was 278±106 l min−1 and PCF for AS-MEE-AC was 368±129 l min−1. We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P=0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P=0.00001).Conclusion:Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a low-cost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.

Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares

Cough is a natural reflex that protects respiratory airways against infections or mucus retention. Cough maintains an adequate cleaning of the airways and is a mainstay of respiratory therapy. It can be triggered voluntarily by the patient or by a specific cough device. Peak cough flow (PCF) is used to assess the effectiveness of the cough. When this value is below 160 L/min, cough is considered inefficient and becomes a risk factor for respiratory problems. Patients with weak cough, especially those with neuromuscular disease, have in common a low tidal volume and a decreased maximum insufflation capacity. Both factors directly affect the inspiratory phase previous to cough, which is considered vital to obtain the optimum flow for a productive cough. Different therapeutic measures may help to increase cough efficiency among patients with cough weakness. These interventions may be performed using manual techniques or by mechanical devices. The aim of this review is to analyze the different techniques available for cough assistance, set a hierarchy of use and establish a scientific basis for their application in clinical practice.

Sonographic Measurement of the Quadriceps Muscle in Patients With Chronic Obstructive Pulmonary Disease Functional and Clinical Implications

The purpose of this study was to determine the association between functionality as assessed by the 6‐minute walking test (6MWT), maximal voluntary contraction of the quadriceps (MVCQ), and quadriceps thickness and echo intensity as measured by sonography, in patients with chronic obstructive pulmonary disease (COPD).

Incidence of Guillain-Barré syndrome in Chile: a population-based study

The Guillain‐Barré syndrome (GBS) incidence rate (IR) varies between 0.16 and 3.00 cases per 100,000 inhabitants. Little data exist on the epidemiology of GBS in Latin American countries. Our objective was to describe GBS epidemiology based on a national database in a Latin American country and to contribute to the global map of GBS epidemiology. This was a retrospective study that included all reported GBS cases in Chile between 2001 and 2012. Gender, age, seasonal occurrence, and geographical distribution were analyzed. A total of 4,158 GBS cases were identified from 19,513,655 registries. The mean age was 37 ± 24 years, and 59% of patients were male (male to female ratio of 1.5 : 1). Gender IR was 2.53/100,000 for males and 1.68/100,000 for females. The overall standardized IR was 2.1/100,000, although this varied between 1.61/100,000 (2001) and 2.35/100,000 (2010). The seasonal distribution was as follows: autumn 22%; winter 25%; spring 27%; and summer 26%. The geographical IR were as follows: far North 1.49/100,000; North 1.94/100,000; Central 1.97/100,000; South 3.18/100,000; and far South 2.78/100,000. The reported IR of GBS in Chile was similar to other studies based on national databases. In Chile, IR was greater in men and in the south.

The immediate effect of soft tissue manual therapy intervention on lung function in severe chronic obstructive pulmonary disease

Background and objective In chronic obstructive pulmonary disease (COPD), accessory respiratory muscles are recruited as a compensatory adaptation to changes in respiratory mechanics. This results in shortening and overactivation of these and other muscles. Manual therapy is increasingly being investigated as a way to alleviate these changes. The aim of this study was to measure the immediate effect on lung function of a soft tissue manual therapy protocol (STMTP) designed to address changes in the accessory respiratory muscles and their associated structures in patients with severe COPD. Methods Twelve medically stable patients (n=12) with an existing diagnosis of severe COPD (ten: GOLD Stage III and two: GOLD Stage IV) were included. Residual volume, inspiratory capacity and oxygen saturation (SpO2) were recorded immediately before and after administration of the STMTP. A Student’s t-test was used to determine the effect of the manual therapy intervention (P<0.05). Results The mean age of the patients was 62.4 years (range 46–77). Nine were male. Residual volume decreased from 4.5 to 3.9 L (P=0.002), inspiratory capacity increased from 2.0 to 2.1 L (P=0.039) and SpO2 increased from 93% to 96% (P=0.001). Conclusion A single application of an STMTP appears to have the potential to produce immediate clinically meaningful improvements in lung function in patients with severe and very severe COPD.

Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

Effects of body weight-support treadmill training on postural sway and gait independence in patients with chronic spinal cord injury

Objective To examine the effects of a six-week body weight-support treadmill training (BWSTT) program on center-of-mass control and gait independence in chronic, incomplete spinal cord injury (iSCI) patients. Design Descriptive. Setting Clinica Los Coihues. Neurorehabilitation center in Santiago, Chile. Participants 17 chronic iSCI patients and 17 healthy subjects. Outcome Measures An instrumented sway (ISway) test was performed before and after the implementation of a six-week BWSTT program. The standing balance of participants was measured by Normalized jerk (NJ) and root mean square (RMS). These values were used to assess the standing balance of participants, and were correlated with the scores obtained on the Walking Index Spinal Cord Injury (WISCI) II test. Results Significant differences were found in standing balance (i.e., through NJ) after the BWSTT program (P = 0.016), but no significant differences were found in RMS values for postural sway (P = 0.693). None of the patients obtained improved WISCI II scores pre- vs. post-intervention. Conclusion While a BWSTT program can improve center-of-mass control in iSCI patients, no effects were recorded for gait independence. Trial Registration National Clinical Trials, registry number NCT02703883.

Heart Rate Variability in Children with Bronchiolitis Obliterans

Post-infectious bronchiolitis obliterans (PIBO) is a respiratory disease characterised by obstruction of the small airways. This obstruction limits the exercise capacity and reduces the quality of life of affected children. Two children with PIBO who were 10 and 14 years of age and both oxygen-dependent are presented. Both children underwent heart rate variability (HRV) measurements, revealing an increase in the LFnu and the LF/HF ratio and demonstrating a predominant effect on the sympathetic system. The functional capacity was assessed by a six-minute walking test (6MWT), and the distance travelled was lower than the reference values. Spirometry revealed advanced obstructive ventilatory limitation in both cases. The HRV measurements are consistent with the decrease in physical fitness in these children and indicate the need for further studies on HRV in this pathology.

Acute Effects of Air Stacking Versus Glossopharyngeal Breathing in Patients with Neuromuscular Disease

Objective: To compare the effects of Air Stacking (AS) and Glossopharyngeal Breathing (GPB) on the Maximum Insufflation Capacity (MIC) in patients with Neuromuscular Disease (NMD). Methods: We design a randomized cross-over study. Children and adolescents with NMD who were users of non-invasive mechanical ventilation were recruited. Vital capacity (VC) and MIC were measured before and after the intervention with AS and GPB. Values were compared pre- and postintervention and were considered statistically significant if p <0.05. Results: We selected 14 patients with a median age of 12.5 years (range 9-18) with the following diagnoses: Duchenne Muscular Dystrophy (7), Spinal Muscular Atrophy Type II (3), Spinal Cord

Chest physiotherapy for acute wheezing: an inappropriate protocol in a misdiagnosed group of patients

Dear Editor, We read with interest the paper by Olhager on body composition in late preterm infants (1). We wondered why the authors focused mainly on the first 10 days of life, stating that “on day four, most late preterm infants have adapted to extrauterine life”: Micheli, quoted in the paper, reports that fluid and metabolic adaptation to extrauterine life in preterm infants ends during the second postnatal week (2). Despite a lower fat-mass content than term infants at birth, late preterms at full-term had a higher fat mass. However, when this postnatal fat-mass catch-up occurs is unknown. In our sample, at 15 days of life, late preterm infants had a percentage fat mass similar to that of term infants at birth. That is, when birth weight is fully regained and growth resumes (Table 1). As in Olhager and others, late preterm infants had a higher percentage fat mass than term infants at similar postconceptional age (Table 1) (1,3). We think this implies, logically, that they gained more fat mass and less fat-free mass than an hypothetical foetus in utero during the same period. Therefore, in our view, these data do not support Olhager’s conclusion that “in late preterms, the weight gained after the initial postnatal weight loss mainly consisted of a gain in fat-free mass”: in Table 3, late preterm infants’ percentage fat mass doubles from birth to full term (1). In Olhager’s report, full-term postconceptional age of late preterm infants was significantly inferior to that of term infants: this should be included in multivariate analysis when analysing length. Additionally, this might raise doubts about the appropriateness of matching. We agree that late preterm infants’ early growth may be crucial in their later metabolic outcomes: additional well-designed studies are warranted. References 1. Olhager E, T€ornqvist C. Body composition in late preterm infants in the first ten days of life and at full term. Acta Paediatr 2014. doi: 10.1111/apa. 12632 [Epub ahead of print]. 2. Micheli JL, Pfister R, Junod S, Laubscher B, Tolsa JF, Schutz Y, et al. Water, energy and early postnatal growth in preterm infants. Acta Paediatr Suppl 1994; 405: 35–42. 3. Gianni M, Roggero P, Liotto N, Amato O, Piemontese P, Morniroli D, et al. Postnatal catch-up after late preterm birth. Pediatr Res 2012; 72: 637–40.