Expiratory muscle training in spinal cord injury: a randomized controlled trial.

To assess the effectiveness of expiratory muscle training on the pulmonary function of spinal cord injured patients. Randomized controlled trial. Acute inpatient rehabilitation hospital. Patients (N=29, 22 men and 7 women) with recent traumatic, motor complete, spinal cord injury (SCI) at or above level T1 consecutively admitted to an SCI rehabilitation service. Subjects were randomized to either resistance training (n=16) or sham training (n=13). The subjects completed either sham training or expiratory muscle resistive training with maximal expiratory force using a small handheld device, which is a tube with an aperture at the distal end, for 10 repetitions twice a day 5 days a week for a total of 6 weeks. Pulmonary function tests were measured before and after the training program and included forced vital capacity (FVC); forced expiratory volume in 1 second (FEV1); maximum expiratory pressure (MEP), which is often referred to as forced expiratory pressure; maximum inspiratory pressure (MIP), which is often referred to as negative inspiratory force; inspiratory capacity (IC); expiratory reserve volume (ERV); total lung capacity (TLC); functional residual capacity (FRC); and residual volume (RV). FVC, FEV1, and ERV improved in both groups. Although exit values of MEP were improved in both groups compared with entry values, this increase was statistically significant only in the resistance training group. No significant improvements occurred in IC, TLC, FRC, or RV from entry to exit. MIP improved in both groups, but this increase was statistically significant only in the resistance training group. There was also a significant between-group difference in MEP exit values (98cmH(2)O for the resistance training group and 59cmH(2)O for the sham training group, t=3.45, P=.002). Multivariate analyses failed to reveal significant effects of treatment for any of the pulmonary function tests. The resistance training group had significantly greater exit MEP values than the sham training group in univariate analysis only. However, improvements in pulmonary function were noted in both the resistance training and sham training groups. Although multivariate analysis failed to reveal a significant difference between groups, these findings offer some indication that expiratory training may benefit people with SCI.

Roth EJ ，Stenson KW ，Powley S ，Oken J ，Primack S ，Nussbaum SB ，Berkowitz M ... -  《-》

Functional magnetic stimulation for conditioning of expiratory muscles in patients with spinal cord injury.

Lin VW ，Hsiao IN ，Zhu E ，Perkash I ... -  《ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION》

Rationale of the combined use of inspiratory and expiratory devices in improving maximal inspiratory pressure and maximal expiratory pressure of patients with chronic obstructive pulmonary disease.

Battaglia E ，Fulgenzi A ，Ferrero ME 《-》

Randomized control trial of effects of a 10-week inspiratory muscle training program on measures of pulmonary function in persons with multiple sclerosis.

Fry DK ，Pfalzer LA ，Chokshi AR ，Wagner MT ，Jackson ES ... -  《Journal of Neurologic Physical Therapy》

Abdominal binder improves lung volumes and voice in people with tetraplegic spinal cord injury.

To investigate the effect of an elasticated abdominal binder on respiratory, voice, and blood pressure outcomes for people with a motor complete acute tetraplegia during the first year after injury. Randomized crossover study. Large university-affiliated referral hospital. Consenting participants (N=14, 13 men and 1 woman) with recent, motor complete, C3-T1 spinal cord injury. Abdominal binder on/off with participant seated in upright wheelchair, with 3 repeated measures at 6 weeks, 3 months, and 6 months after commencing daily use of an upright wheelchair. Forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure were measured. Mean arterial pressure, maximum sustained vowel time, and sound pressure level were also measured. Overall, an abdominal binder resulted in a statistically significant improvement in forced vital capacity (weighted mean difference .34 L [95% confidence interval (CI) .10-.58], P=.005), forced expiratory volume in 1 second (.25 L [95% CI -.01 to .51], P=.05), peak expiratory flow (.81 L/s [95% CI .13-1.48], P=.02), maximal inspiratory pressure (7.40 cm H(2)O [95% CI 1.64-13.14], P=.01), and maximum sustained vowel time (3.75 s [95% CI .90-6.60], P=.01). There was no statistically significant improvement in maximal expiratory pressure (5.37 cm H(2)O [95% CI -1.15 to 11.90], P=.11), mean arterial pressure (4.41 mmHg [95% CI -6.15 to 14.97], P=.41), or sound pressure level (1.14 dB [95% CI -1.31 to 3.58], P=.36). An individually fitted abdominal binder significantly improved forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximum sustained vowel time in people with newly acquired tetraplegia. Further study is needed into the effect of the long-term use of the abdominal binder on breathing mechanics, functional residual capacity, total lung capacity, and respiratory health.

Wadsworth BM ，Haines TP ，Cornwell PL ，Rodwell LT ，Paratz JD ... -  《-》