A comparison study of two breathing exercise techniques in tetraplegics

Objective: To compare the effectiveness of ab-dominal weights and incentive spirometry for improving the strength of diaphragm in tetra-plegics. Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vel-lore, Tamil Nadu, India. Study Design: Two group comparison study Methods: Seventeen patients who fulfilled the inclusion criteria were assigned into an ABW or INS treatment groups using judgment sampling after obtaining an informed consent. Evaluation of the chest, respiratory status, vital signs and strength of diaphragm were done during initial assessment. ABW group underwent diaphrag-matic strengthening using Abdominal weights (ABW) and INT group with Incentive Spirometer (INS) for 15 minutes daily, 6 days a week, for a period of 6 weeks. The pre and post training values of peak amplitude in electro myogram (EMG) of the diaphragm, intercostals and ster-nocleidomastoid muscles were measured. Statistical analysis: The analysis was done using SPSS 11. The pre and post-training values of peak EMG amplitudes of the diaphragm, inter- costals and sternocleidomastoid were com- pared within the groups using Wilicoxon’s sign test and between the two groups using Mann- Whitney’s test. Results: The peak EMG of diaphragm of ABW group raised from 1.1289 to 1.3036 milli-volts with a significance of p<0.001, whereas it fell from 1.7001 to 1.0441 milli-volts among INS group subjects with a significance of p<0.001. Comparison between the 2 groups showed sta-tistically significant improvement in diaphrag-matic strength among the ABW group. Conclusion: The results of this study sug-gests that, in the pulmonary rehabilitation of motor complete tetraplegic subjects abdominal weighted training of the diaphragm has better results in improving the strength of the muscle.Sponsorship: Fluid research grant of Christian Medical College, Vellore.

Assessment of Bronchodilator Response in Children with Asthma Exacerbation Using the Respiratory Resistance Values

Sixty-four pediatric patients with asthma exacerbation were studied. The children were subjected to respiratory resistance evaluation using the Airflow Perturbation Device (APD) and spirometry evaluation. They were then administered albuterol and 15 minutes later the APD and spirometry evaluations were repeated. Eleven of the children could not perform spirometry. The APD results demonstrated that respiratory resistance of the patients decreased by about 20%, indicating that the APD could detect the expected response to bronchodilator. However, no similar conclusion could be made with the spirometry parameters (FVC, FEV1, FEV1/FVC, and FEF25% - 75%) performed on the same patients. The differences on the spirometry parameters did not change significantly before and after bronchodilator administration. Furthermore, these differences were negligibly increased or decreased for some with no consistency between the FVC, FEV1, FEV1/FVC, and FEF25% - 75%. Even though all the children were clinically improved after albuterol administration and discharged home, this could not be demonstrated by spirometry data. This study validates previous reports that spirometry is not a reliable pulmonary diagnostic tool for young children, as spirometry is highly effort-dependent and requires a substantial degree of patient cooperation. APD on the other hand is a reliable, simple, effortless diagnostic tool that can be utilized in evaluation and management of children with asthma symptoms and exacerbation.