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Krishnamurthy R, Schultz DH, Wang Y, Natarajan SK, Barlow SM, Dietsch AM. Multimodal Adaptations to Expiratory Musculature-Targeted Resistance Training: A Preliminary Study in Healthy Young Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2025; 68:987-1005. [PMID: 39908358 DOI: 10.1044/2024_jslhr-24-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2025]
Abstract
PURPOSE Exercise-induced adaptations, including neuroplasticity, are well studied for physical exercise that targets skeletal muscles. However, little is known about the neuroplastic potential of targeted speech and swallowing exercises. The current study aimed to gather preliminary data on molecular and functional changes associated with the neuroplastic effects of 4-week expiratory musculature-targeted resistance training in healthy young adults. METHOD Five healthy young adult men aged between 19 and 35 years, M (SD) = 28.8 (2.68) years, underwent 4 weeks of expiratory muscle strength training (EMST). We measured changes in maximum expiratory pressure (MEP), serum brain-derived neurotrophic factor (BDNF), and insulin-like growth factor 1 (IGF-1) levels at baseline and posttraining conditions. Furthermore, functional and structural magnetic resonance images were obtained to investigate the neuroplastic effects of EMST. We analyzed the effects of training using a linear mixed model for each outcome, with fixed effects for baseline and posttraining. RESULTS MEP and serum BDNF levels significantly increased posttraining. However, this effect was not observed for IGF-1. A significant increase in functional activation in eight regions was also observed posttraining. However, we did not observe significant changes in the white matter microstructure. CONCLUSIONS Preliminary data from our study suggest targeted resistance training of expiratory muscles results in molecular and neuroplastic adaptations similar to exercise that targets skeletal muscles. Additionally, these results suggest that EMST could be a potential intervention to modulate (or prime) neurotrophic signaling pathways linked to functional strength gains and neuroplasticity.
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Affiliation(s)
- Rahul Krishnamurthy
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Douglas H Schultz
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln
- Department of Psychology, University of Nebraska-Lincoln
| | - Yingying Wang
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln
| | | | - Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln
- Department of Biological Systems Engineering, University of Nebraska-Lincoln
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln
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Prathanee B, Buakanok N, Pumnum T, Ooppanasak N, Panyaek N. Impact of Respiratory Muscle Training and Quadriceps Exercises on Voice, Respiratory Function in Community-Dwelling Older Adults. J Voice 2025:S0892-1997(24)00433-8. [PMID: 39971674 DOI: 10.1016/j.jvoice.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 11/29/2024] [Accepted: 12/02/2024] [Indexed: 02/21/2025]
Abstract
OBJECTIVE This present study aimed to explore normative data and compare voice characteristics and respiratory function (Maximum counting duration: MCD peak expiratory flow rate: PEFR), Maximum inspiratory pressure: MIP), Maximum expiratory pressure: MEP), and quadriceps muscle strengthening before and after breathing with quadriceps exercises. STUDY DESIGN A one-group quasi-experiment design. SETTING Community-dwelling healthy elderly in Health Promoting Hospital. METHOD Thirty community-dwelling healthy elderly aged 60-70 years old were enrolled the study for normative data, and twenty-three were in complete study for comparison the outcomes. Participants were assessed voice characteristics via computer speech lab (CSL), respiratory function by peak flow meter, micro respiratory pressure meter, quadricep exercises by leg strength dynamometer and five times sit to stand. Program of breathing with quadriceps exercises were implemented twice a day in sitting, standing position, and walking for 7 weeks. RESULT Voice characteristics were presented normative data, and comparison between preseven-week and postseven-week program of program intervention revealed significant increasing percentage of Maximum phonation time (MPT) or Tsam (time of sample) of /a/, /u/, /i/ ranged 39.30%-55.46%; MCD 40.99%, Maximum inspiration pressure 20.59%, MEP 16.22% and PEFR 84.21%, after program function. CONCLUSION Program of breathing with quadriceps exercises could significantly increase MPT, MCD, MIP, MEP, and PEFR in community-dwelling healthy elderly within 7. These were guideline for prevention voice disorders and aspiration in older adult.
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Affiliation(s)
- Benjamas Prathanee
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Mekong Health Science Research Institute, Khon Kaen, Thailand
| | - Netra Buakanok
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tawitree Pumnum
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nantiya Ooppanasak
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nichanun Panyaek
- Department of Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Krishnamurthy R, Krishnamoorthy C, Dietsch AM, Natarajan SK. Molecular biomarkers of dysphagia targeted exercise induced neuroplasticity: A review of mechanistic processes and preliminary data on detraining effects. Brain Res 2025; 1846:149287. [PMID: 39437875 DOI: 10.1016/j.brainres.2024.149287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 09/27/2024] [Accepted: 10/18/2024] [Indexed: 10/25/2024]
Abstract
While molecular adaptations accompanying neuroplasticity during physical exercises are well-established, little is known about adaptations during dysphagia-targeted exercises. This research article has two primary purposes. First, we aim to review the existing literature on the intersection between resistance (strength) training, molecular markers of neuroplasticity, and dysphagia rehabilitation. Specifically, we discuss the molecular mechanisms of two potential molecular markers: brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) in exercise-induced neuroplasticity. Second, we present preliminary data on the effects of two weeks of detraining on circulating serum BDNF, IGF-1 levels, and expiratory muscle strength. This subset is a part of our more extensive studies related to dysphagia-targeted resistance exercise and neuroplasticity. Five young adult males underwent four weeks of expiratory muscle strength training, followed by two weeks of detraining. We measured expiratory strength, circulating levels of BDNF, and IGF-1 at post-training and detraining conditions. Our results show that expiratory muscle strength, serum BDNF, and IGF-1 levels decreased after detraining; however, this effect was statistically significant only for serum BDNF levels. Oropharyngeal and upper airway musculature involved in swallowing undergoes similar adaptation patterns to skeletal muscles during physical exercise. To fully comprehend the mechanisms underlying the potential neuroplastic benefits of targeted exercise on swallowing functions, mechanistic studies (models) investigating neuroplasticity induced by exercises addressing dysphagia are critical. Such models would ensure that interventions effectively and efficiently achieve neuroplastic benefits and improve patient outcomes, ultimately advancing our understanding of dysphagia-targeted exercise-induced neuroplasticity.
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Affiliation(s)
- Rahul Krishnamurthy
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, United States; Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, United States.
| | - Chandan Krishnamoorthy
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, United States
| | - Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, United States; Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, United States
| | - Sathish Kumar Natarajan
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, United States
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Erturk N, Celik A, Kahraman Yaman S, Yaman H, Unal F, Calik Kutukcu E. Expiratory muscle strength training reduces oxidative stress and systemic inflammation in men with obstructive sleep apnea syndrome: a double-blinded, randomized parallel trial. Sleep 2024; 47:zsae221. [PMID: 39297486 DOI: 10.1093/sleep/zsae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/11/2024] [Indexed: 12/12/2024] Open
Abstract
STUDY OBJECTIVES This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS). METHODS Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea-Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated. RESULTS The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = -0.149; CR = -3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p < .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups. CONCLUSIONS EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS. CLINICAL TRIALS Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406.
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Affiliation(s)
- Nurel Erturk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tarsus University, Mersin, Turkey
| | - Adem Celik
- Department of Chest Medicine and Sleep Center, University of Health Sciences, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Sevim Kahraman Yaman
- Department of Medical Biochemistry, University of Health Sciences, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Huseyin Yaman
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ferhat Unal
- Data Management Unit, Middle East Technical University, Ankara, Turkey
| | - Ebru Calik Kutukcu
- Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Wang J, Liu F, Zhou M, Li D, Huang M, Guo S, Hou D, Luo J, Song Z, Wang Y. Effect of five different body positions on lung function in stroke patients with tracheotomy. Top Stroke Rehabil 2024:1-11. [PMID: 39460942 DOI: 10.1080/10749357.2024.2420545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 10/20/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND In stroke patients with tracheotomy, reduced lung function heightens pulmonary infection risk. Body position can affect lung function; however, its impact in stroke patients with tracheostomy remains unclear. OBJECTIVE To investigate the influence of five body positions on pulmonary function in stroke patients with tracheotomy. METHODS Pulmonary function was assessed in five body positions (supine, supine 30°, supine 60°, sitting, and prone) in 47 stroke patients who underwent tracheotomy. Diaphragmatic excursion during quiet breathing (DEQ), diaphragmatic thickening fraction during quiet breathing (DTFQ), and diaphragmatic excursion during coughing (DEC) were measured using ultrasound. Peak cough flow (PCF) was measured using an electronic peak flow meter. RESULTS Different positions had a significant impact on DEQ, DEC, and PCF in stroke patients with tracheotomy, although not on DTFQ. DEQ showed no significant differences between supine 60°, sitting, and prone positions. Both DEC and PCF reached their maximum values in the sitting position. In the sub-group analysis, DEQ in females did not show significant differences across different positions. Both males and females exhibited significantly higher PCF in the sitting compared to supine position. The lung function of obese patients was significantly better in the sitting than in the supine and supine 30° position. Regardless of the patient's level of consciousness and whether the brainstem was injured, lung function in the sitting position was significantly higher than in the supine position. CONCLUSIONS Body posture influences lung function in stroke patients with tracheotomy. Patients should adopt a sitting position to enhance pulmonary function.
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Affiliation(s)
- Juan Wang
- Children's Rehabilitation Department, Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
| | - Fang Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
| | - Dan Li
- Department of Rehabilitation Medicine, The 940th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Lanzhou, China
| | - Meiling Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
| | - Shanshan Guo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
| | - Dianrui Hou
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Jiao Luo
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Zhenhua Song
- Department of Rehabilitation Medicine, The Haikou Hospital Affiliated to Xiangya Medical College of Central South University, Haikou, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Shenzhen, China
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Bhutada AM, Carnaby GD, Broughton WA, Beverly BL, Garand KL. Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study. Dysphagia 2024:10.1007/s00455-024-10760-9. [PMID: 39299941 DOI: 10.1007/s00455-024-10760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Despite the high estimated prevalence of dysphagia in OSA, there is a paucity of evidence supporting behavioral interventions for treatment. The purpose of this study was to assess the impact of expiratory muscle strength training (EMST) on validated, standardized metrics of swallow and airway clearance capacity functions in moderate-to-severe OSA. 10 participants with OSA (mean age = 65.2 years) completed four weeks of EMST training employing a prospective single-arm, double-baseline interventional design. The Modified Barium Swallow Impairment Profile (MBSImP) Component and Composite (Oral Total [OT] and Pharyngeal Total [PT]) scores measured swallow physiology. Airway clearance capacity measures included maximum expiratory pressure (MEP) and peak cough flow (PCF). A historical normative database was used for OSA patient comparison of swallowing metrics. A total of 234 swallows were analyzed. At baseline, impairments in lingual control, oral residue and esophageal clearance were observed. However, no significant differences in the MBSImP Composite (OT/PT) scores were observed between the OSA and healthy referent group. After EMST intervention, there were no significant differences in pre- to post-intervention Composite (OT/PT) scores. However, large effect size was observed for MEP (p < 0.001, d = 3.0), and non-significant, but moderate effect size was observed in PCF (p = 0.19, d = 0.44). Study findings further quantify swallowing in moderate-to-severe OSA and provide preliminary evidence supporting the impact of EMST on airway clearance capacity.
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Affiliation(s)
- Ankita M Bhutada
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
| | - Giselle D Carnaby
- Department of Communication Sciences and Disorders, School of Health Professions, University of Texas Health, San Antonio, TX, USA
| | - William A Broughton
- Department of Internal Medicine, University of South Alabama, 2451 USA Medical Center Dr, Mobile, AL, 36617, USA
| | - Brenda L Beverly
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Kendrea L Garand
- Department of Communication Science and Disorders, University of Pittsburgh, 3600 Atwood Street Suite 5012, 5th Floor Forbes Tower, Pittsburgh, PA, 15213, USA
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Gaspar L, Reis N, Sousa P, Silva APE, Cardoso A, Brito A, Bastos F, Campos J, Parente P, Pereira F, Machado N. Nursing Process Related to the Nursing Focus "Airway Clearance": A Scoping Review. NURSING REPORTS 2024; 14:1871-1896. [PMID: 39189270 PMCID: PMC11348224 DOI: 10.3390/nursrep14030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on "airway clearance". METHODS Research was conducted based on Joanna Briggs's Scoping Review Methodology. We searched four databases for published studies until December 2023. RESULTS From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. CONCLUSIONS Findings can add substantial value for systematizing the nursing process related to "airway clearance", improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.
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Affiliation(s)
- Luís Gaspar
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Neuza Reis
- Faculty of Health Sciences and Nursing, Universidade Universidade Católica Portuguesa, 4169-005 Porto, Portugal;
| | - Paula Sousa
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Abel Paiva e Silva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alexandrina Cardoso
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Alice Brito
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Fernanda Bastos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Paulo Parente
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Filipe Pereira
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
| | - Natália Machado
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal; (P.S.); (A.P.e.S.); (A.C.); (A.B.); (F.B.); (J.C.); (P.P.); (F.P.); (N.M.)
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Chen Q, Wu X, Huang Y, Chen L. Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. Int J Chron Obstruct Pulmon Dis 2024; 19:1093-1103. [PMID: 38800522 PMCID: PMC11128236 DOI: 10.2147/copd.s454804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose Whether Internet of Things (IoT)-based home respiratory muscle training (RMT) benefits patients with comorbid chronic obstructive pulmonary disease (COPD) remains unclear. Therefore, this study aims to evaluate the effectiveness of IoT-based home RMT for patients with COPD. Patients and Methods Seventy-eight patients with stable COPD were randomly divided into two groups. The control group received routine health education, while the intervention group received IoT-based home RMT (30 inspiratory muscle training [IMT] and 30 expiratory muscle training [EMT] in different respiratory cycles twice daily for 12 consecutive weeks). Assessments took place pre-intervention and 12 weeks post-intervention, including lung function tests, respiratory muscle strength tests, the mMRC dyspnea scale, CAT questionnaires, the HAMA scale, and 6-month COPD-related readmission after intervention. Results Seventy-four patients with COPD were analyzed (intervention group = 38, control group = 36), and the mean age and FEV1 of the patients were 68.65 ± 7.40 years, 1.21 ± 0.54 L. Compared to those of the control population, the intervention group exhibited higher FEV1/FVC (48.23 ± 10.97 vs 54.32 ± 10.31, p = 0.016), MIP (41.72 ± 7.70 vs 47.82 ± 10.99, p = 0.008), and MEP (42.94 ± 7.85 vs 50.29 ± 15.74, p = 0.013); lower mMRC (2.00 [2.00-3.00] vs 1.50 [1.00-2.00], p < 0.001), CAT (17.00 [12.00-21.75] vs 11.00 [9.00-13.25], p < 0.001), and HAMA (7.00 [5.00-9.00] vs 2.00 [1.00-3.00], p < 0.001) scores; and a lower incidence rate of 6-month readmission (22% vs 5%, p = 0.033). Conclusion Compared with no intervention, IoT-based home RMT may be a more beneficial intervention for patients with COPD.
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Affiliation(s)
- Qiong Chen
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Xuejuan Wu
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Yanjin Huang
- Nursing Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Lingling Chen
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
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Hao X, Yang Y, Qin Y, Lv M, Zhao X, Wu S, Li K. The Effect of Respiratory Muscle Training on Swallowing Function in Patients With Stroke: A Systematic Review and Meta-Analysis. West J Nurs Res 2024; 46:389-399. [PMID: 38545931 DOI: 10.1177/01939459241242533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND The improvement of swallowing function after stroke is a significant challenge faced by patients and health care professionals. However, the current evidence synthesis of the effects of respiratory muscle training (RMT) on swallowing function is limited. OBJECTIVE To assess the effectiveness of RMT on swallowing recovery in patients undergoing stroke. METHODS The CKNI, WanFang Data, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and Cochrane Library databases were searched for studies evaluating RMT interventions' effect on swallowing outcomes. Risks of bias were evaluated using the approach recommended by the Cochrane Collaboration tool and a summary of findings table was generated using the GRADE approach. Outcomes were synthesized using a random-effects meta-analysis model. RESULTS RMT interventions reduced the risk of aspiration (SMD = 1.19; 95% CI, 0.53-1.84), the recovery process of water swallowing function (RR = 1.22; 95% CI, 1.05-1.42), and the activity of the swallowing muscles (SMD = 2.91; 95% CI, 2.22-3.61). However, there was no significant effect of RMT on the functional level of oral intake (SMD = 0.70; 95% CI, -0.03 to 1.42). CONCLUSIONS RMT can be regarded as an innovative, auxiliary means in the near future to better manage and improve swallowing function, given its improving effect on work outcomes in this review.
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Affiliation(s)
- Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Miaohua Lv
- School of Nursing, Jilin University, Changchun, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Dietsch AM, Krishnamurthy R, Young K, Barlow SM. Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:729-739. [PMID: 38324264 DOI: 10.1044/2023_jslhr-23-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making. METHOD We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation. RESULTS All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived. CONCLUSIONS Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.
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Affiliation(s)
- Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
| | - Rahul Krishnamurthy
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Kelsey Young
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
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11
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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12
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Tashiro D, Oki Y, Nonomura N, Takeyama Y, Osaki T, Morimoto Y. Maximum abdominal excursion assessment using an abdominal excursion measuring device: Reliability and validity of a new device for simple and quantitative assessment of respiratory function. Med Eng Phys 2024; 124:104093. [PMID: 38418023 DOI: 10.1016/j.medengphy.2023.104093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024]
Abstract
This study aimed to verify the reliability and validity of abdominal expansion and respiratory function measurements. Forty healthy adult males underwent lung capacity, effort lung capacity, respiratory muscle strength, cough strength, diaphragm ultrasound, and abdominal expansion measurements. Abdominal expansion was measured using a device developed to accurately evaluate abdominal movements and calculate maximum abdominal expansion on the ventral side (AE-max: the difference between maximal abdominal contraction at the same time as maximal-effort expiration and maximal abdominal expansion at the same time as maximal-effort inspiration). Intra- and inter-rater reliabilities of the AE-max measurements were examined, the paired t-test was used for assessing the ratios of the expansion and contraction displacement components in AE-max, and regression analysis was used to obtain equations for predicting maximum inspiratory pressure (MIP) based on AE-max. Both intra- and inter-rater reliabilities were high. Criterion-related validity showed that AE-max was associated with all respiratory function parameters, especially MIP, and a high percentage of expansion displacement. Regression analysis showed that AE-max was significantly associated with MIP. Based on its association with MIP, the large proportion of expansion displacement in AE-max, and the results of the multiple regression analysis, we conclude that AE-max is a helpful measure for estimating MIP.
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Affiliation(s)
- Daisuke Tashiro
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan.
| | - Yutaro Oki
- Department of Public Health Kobe University Graduate School of Health Sciences, Kobe City, Hyogo, Japan
| | - Natsuha Nonomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yuki Takeyama
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Tohmi Osaki
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan
| | - Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe City, Hyogo, Japan; Department of Rehabilitation, Nishi-Kinen Port-island Rehabilitation Hospital, Kobe City, Hyogo, Japan
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13
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Li MP, Liu WC, Wu JB, Luo K, Liu Y, Zhang Y, Xiao SN, Liu ZL, Huang SH, Liu JM. Machine learning for the prediction of postoperative nosocomial pulmonary infection in patients with spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3825-3835. [PMID: 37195363 DOI: 10.1007/s00586-023-07772-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE The purpose of this study was to establish the best prediction model for postoperative nosocomial pulmonary infection through machine learning (ML) and assist physicians to make accurate diagnosis and treatment decisions. METHODS Patients with spinal cord injury (SCI) who admitted to a general hospital between July 2014 and April 2022 were included in this study. The data were segmented according to the ratio of seven to three, 70% were randomly selected to train the model, and the other 30% were used for testing. We used LASSO regression to screen the variables, and the selected variables were used in the construction of six different ML models. Shapley additive explanations and permutation importance were used to explain the output of the ML models. Finally, sensitivity, specificity, accuracy and area under receiver operating characteristic curve (AUC) were used as the evaluation index of the model. RESULTS A total of 870 patients were enrolled in this study, of whom 98 (11.26%) developed pulmonary infection. Seven variables were used for ML model construction and multivariate logistic regression analysis. Among these variables, age, ASIA scale and tracheotomy were found to be the independent risk factors for postoperative nosocomial pulmonary infection in SCI patients. Meanwhile, the prediction model based on RF algorithm performed best in the training and test sets. (AUC = 0.721, accuracy = 0.664, sensitivity = 0.694, specificity = 0.656). CONCLUSION Age, ASIA scale and tracheotomy were the independent risk factors of postoperative nosocomial pulmonary infection in SCI. The prediction model based on RF algorithm had the best performance.
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Affiliation(s)
- Meng-Pan Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- The First Clinical Medical College of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Wen-Cai Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- The First Clinical Medical College of Nanchang University, Nanchang, 330006, People's Republic of China
- Department of Orthopaedics, Shanghai Jiao Tong University Affifiliated Sixth People's Hospital, Shanghai, China
| | - Jia-Bao Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Kun Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Yu Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Yu Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Shi-Ning Xiao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Zhi-Li Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Shan-Hu Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
| | - Jia-Ming Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
- Institute of Spine and Spinal Cord, Nanchang University, No.17 Yongwaizheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
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14
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Erturk N, Celik A, CalikKutukcu E. High- and low-intensity expiratory muscle strength training in patients with severe obstructive sleep apnea syndrome using non-invasive mechanical ventilation: A double-blinded, randomized controlled trial. Heart Lung 2023; 61:29-36. [PMID: 37087896 DOI: 10.1016/j.hrtlng.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The effects of expiratory muscle strength training (EMST) with different intensity on stages of sleep were not examined in patients with obstructive sleep apnea syndrome (OSAS). OBJECTIVES The aim of this study was to compare the effects of high- and low-intensity EMST (H-EMST and L-EMST) on disease severity, sleep stages, disease-related symptoms, daytime sleepiness, fatigue severity, and sleep quality in adult patients with severe OSAS using non-invasive mechanical ventilation (NIMV). METHODS Thirty-one clinically stable patients with severe OSAS were included in this prospective, randomized controlled, double-blinded study. These were randomly divided into two groups. The H-EMST group underwent training at 60% of maximum expiratory pressure (MEP) and the L-EMST group at 30% of MEP, seven days a week for eight weeks. Apnea hypopnea index (AHI), sleep stages, and respiratory sleep parameters were recorded using polysomnographic sleep analysis. RESULTS AHI decreased by 34.57% and 20.20% in the H-EMST and L-EMST groups, respectively. A statistically significant improvement in disease severity classifications distributions was observed in the H-EMST group after training (p = 0.016). A greater number of symptoms improved in the H-EMST. The effects of training on respiratory muscle strength, daytime sleepiness, fatigue perception, and sleep quality levels were comparable between the two groups (p>0.05). CONCLUSIONS H-EMST training is more effective in reducing disease severity and disease-related symptoms than L-EMST. Further studies are warranted for evaluating the long-term effects of EMST with larger sample sizes in OSAS.
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Affiliation(s)
- Nurel Erturk
- Cardiopulmonary Rehabilitation Unit, University of Health Sciences, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.
| | - Adem Celik
- Department of Chest Medicine and Sleep Center, University of Health Sciences, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ebru CalikKutukcu
- Department of Cardiorespiratory Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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15
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Cacciante L, Turolla A, Pregnolato G, Federico S, Baldan F, Rutkowska A, Rutkowski S. The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis. Qual Life Res 2023; 32:1-26. [PMID: 35460472 PMCID: PMC9034447 DOI: 10.1007/s11136-022-03133-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life. METHODS The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments). CONCLUSION Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.
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Affiliation(s)
- Luisa Cacciante
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater University of Bologna, via Massarenti, 9, Bologna, Italy
- Operative Unit of Occupational Medicine, IRCCS Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Sara Federico
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Francesca Baldan
- Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Anna Rutkowska
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
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Sato S, Miyazaki S, Tamaki A, Yoshimura Y, Arai H, Fujiwara D, Katsura H, Kawagoshi A, Kozu R, Maeda K, Ogawa S, Ueki J, Wakabayashi H. Respiratory sarcopenia: A position paper by four professional organizations. Geriatr Gerontol Int 2023; 23:5-15. [PMID: 36479799 PMCID: PMC11503586 DOI: 10.1111/ggi.14519] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.
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Affiliation(s)
- Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
| | | | - Akira Tamaki
- Department of Physical Therapy, School of RehabilitationHyogo Medical UniversityKobeJapan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition ResearchKumamoto Rehabilitation HospitalKumamotoJapan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Dai Fujiwara
- Department of Rehabilitation MedicineSaka General HospitalMiyagiJapan
| | - Hideki Katsura
- Department of Respiratory MedicineTokyo Women's Medical UniversityTokyoJapan
| | | | - Ryo Kozu
- Department of Physical Therapy Science, Graduate School of Biomedical SciencesNagasaki UniversityNagasakiJapan
| | - Keisuke Maeda
- Department of Geriatric MedicineHospital, National Center for Geriatrics and GerontologyObuJapan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Graduate School of Health Care and NursingJuntendo UniversityChibaJapan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
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Das AK, Sharma A, Sondhi R, Goyal S. A simple incentive spirometry device for morale-boosting for geriatric patients. Eur Geriatr Med 2022; 13:1495-1496. [PMID: 35895278 DOI: 10.1007/s41999-022-00683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Akshaya Kumar Das
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005, Rajasthan, India
| | - Ankur Sharma
- Trauma & Emergency (Anesthesiology), All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005, Rajasthan, India.
| | - Romita Sondhi
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005, Rajasthan, India
| | - Shilpa Goyal
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, 342005, Rajasthan, India
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Bazdyrev ED, Terentyeva NA, Galimova NA, Krivoshapova KE, Barbarash OL. Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.
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Affiliation(s)
- E. D. Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - N. A. Terentyeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - N. A. Galimova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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19
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Yang MX, Wang J, Zhang X, Luo ZR, Yu PM. Perioperative respiratory muscle training improves respiratory muscle strength and physical activity of patients receiving lung surgery: A meta-analysis. World J Clin Cases 2022; 10:4119-4130. [PMID: 35665118 PMCID: PMC9131220 DOI: 10.12998/wjcc.v10.i13.4119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical role of perioperative respiratory muscle training (RMT), including inspiratory muscle training (IMT) and expiratory muscle training (EMT) in patients undergoing pulmonary surgery remains unclear up to now.
AIM To evaluate whether perioperative RMT is effective in improving postoperative outcomes such as the respiratory muscle strength and physical activity level of patients receiving lung surgery.
METHODS The PubMed, EMBASE (via OVID), Web of Science, Cochrane Library and Physiotherapy Evidence Database (PEDro) were systematically searched to obtain eligible randomized controlled trials (RCTs). Primary outcome was postoperative respiratory muscle strength expressed as the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Secondary outcomes were physical activity, exercise capacity, including the 6-min walking distance and peak oxygen consumption during the cardio-pulmonary exercise test, pulmonary function and the quality of life.
RESULTS Seven studies involving 240 participants were included in this systematic review and meta-analysis. Among them, four studies focused on IMT and the other three studies focused on RMT, one of which included IMT, EMT and also combined RMT (IMT-EMT-RMT). Three studies applied the intervention postoperative, one study preoperative and the other three studies included both pre- and postoperative training. For primary outcomes, the pooled results indicated that perioperative RMT improved the postoperative MIP (mean = 8.13 cmH2O, 95%CI: 1.31 to 14.95, P = 0.02) and tended to increase MEP (mean = 13.51 cmH2O, 95%CI: -4.47 to 31.48, P = 0.14). For secondary outcomes, perioperative RMT enhanced postoperative physical activity significantly (P = 0.006) and a trend of improved postoperative pulmonary function was observed.
CONCLUSION Perioperative RMT enhanced postoperative respiratory muscle strength and physical activity level of patients receiving lung surgery. However, RCTs with large samples are needed to evaluate effects of perioperative RMT on postoperative outcomes in patients undergoing lung surgery.
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Affiliation(s)
- Meng-Xuan Yang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiao Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiu Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ze-Ruxin Luo
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Peng-Ming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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20
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García-Saugar M, Jaén-Jover C, Hernández-Sánchez S, Poveda-Pagán EJ, Lozano-Quijada C. [Recommendations for outpatient respiratory rehabilitation of long COVID patients]. An Sist Sanit Navar 2022; 45:e0978. [PMID: 34750595 PMCID: PMC10114010 DOI: 10.23938/assn.0978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/13/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
The appearance of COVID-19 has been a problem for public health on a global scale, putting pressure on health care systems. The after-effects of this illness have highlighted the importance of rehabilitation in long COVID patients involv-ing different health professionals. The treatment of the respiratory after-effects of this disease in an outpatient setting is a specialized field. It is appropriate to offer a series of practical recommendations of cardio-respiratory rehabilitation that are helpful to the professionals involved in the after-effects when ending hospitalisation. This review of the literature includes ten key aspects of respiratory physiotherapy that range from assessment, parameters to monitor, signs of alarm and respiratory rehabilitation techniques and other exercises for this population.
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Affiliation(s)
- M García-Saugar
- Área de Fisioterapia. Departamento Patología y Cirugía. Universidad Miguel Hernández. Elche. Alicante. España..
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21
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Zhang W, Pan H, Zong Y, Wang J, Xie Q. Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 103:1179-1191. [PMID: 34780729 DOI: 10.1016/j.apmr.2021.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/25/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate if respiratory muscle training is capable of reducing the occurrence of respiratory complications and improving dysphagia (swallowing or cough function) after stroke? DESIGN Systematic review of randomized control trials based on the Cochrane guidelines. PARTICIPANTS Patients (> 18 years old) were diagnosed with stroke. INTERVENTION Respiratory muscle training aimed at increasing respiratory muscles' strength by using the threshold resistance trainer or flow-oriented resistance trainer. OUTCOME MEASURES Respiratory complications, swallowing and cough function. RESULTS Eleven trials (n=523 participants) were included . Respiratory muscle training reduced the risk of respiratory complications (RR0.51, 95%CI 0.28 to 0.93, I2 = 0%,P=0.03, ARD =0.068, NNT=14.71) compared with no/sham respiratory intervention. It also decreased the liquid type PAS scores by 0.81 (95% CI -1.19 to -0.43, I2 = 39%, P<0.0001). There was no significant association between respiratory muscle training and FOIS scores, cough function:increased FOIS scores by 0.47 (95%CI -0.45 to 1.39, I2 = 55%, P=0.32), decreased PECF-VC by 18.70 L/min (95%CI -59.74 to 22.33, I2 = 19%, P=0.37) and increased PECF-RC by 0.05 L/min (95% CI -40.78 to 40.87 I2 = 0%, P=1.00) . CONCLUSION This meta-analysis provided evidence that respiratory muscle training is effective in reducing the risk of respiratory complications, and improving dysphagia by reducing penetration or aspiration during swallowing liquid bolus after stroke. However, there was no sufficient evidence to determine that respiratory muscle training improves cough function. Additional multi-center studies using larger patient cohorts are required to validate and support these findings. Furthermore, long-term follow-up studies should be performed to measure outcomes, at the same time avoiding bias due to confounding factors such as heterogeneity of the etiologies of dysphagia.
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Affiliation(s)
- Weisong Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Huijuan Pan
- Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Ya Zong
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
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22
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Using Ultrasound to Document the Effects of Expiratory Muscle Strength Training (EMST) on the Geniohyoid Muscle. Dysphagia 2021; 37:788-799. [PMID: 34132896 DOI: 10.1007/s00455-021-10328-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
Expiratory muscle strength training (EMST) is an exercise program designed to strengthen the muscles of expiration by increasing expiratory load during breathing exercises using either resistive or pressure threshold devices. Previous research has shown that EMST may increase submental suprahyoid muscle activity as measured with surface electromyography. The impact of EMST on submental muscles is of interest to those who treat dysphagia. The purpose of this study was to determine whether the cross-sectional area of the geniohyoid muscle changes as observed with ultrasound during a 5-week EMST program performed at 75% of maximum expiratory strength using the EMST150 device in healthy adults. Ten healthy adults participated in the 5-week program. Maximum expiratory pressure (MEP) and cross-sectional area of the geniohyoid muscle were measured weekly. Geniohyoid cross-sectional area was measured from ultrasound images recorded in the coronal plane. Repeated Measures ANOVA was used to determine whether there were significant changes among the dependent variables over the study period. Both MEP and geniohyoid area increased significantly in response to a 5-week program of EMST. EMST in healthy adults is effective at strengthening the geniohyoid muscle as reflected by significantly increased cross-sectional area measured with B-mode ultrasound. This is the first study to document weekly change in muscle morphology as a result of EMST. Increasing geniohyoid muscle mass and consequent strength through a program of EMST may be beneficial for persons with pharyngeal stage dysphagia resulting from reduced hyolaryngeal elevation, reduced laryngeal closure, or reduced UES opening.
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23
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Shen Y, Ru W, Huang X, Chen S, Yan J, Yang Z, Cai G. Impact of chronic respiratory diseases on re-intubation rate in critically ill patients: a cohort study. Sci Rep 2021; 11:8663. [PMID: 33883614 PMCID: PMC8060362 DOI: 10.1038/s41598-021-88007-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/26/2021] [Indexed: 01/18/2023] Open
Abstract
Chronic respiratory diseases' (CRDs) impact on re-intubation rate remains unclear. We investigated the association between these factors in mechanically ventilated patients. Data were extracted from the freely available online Medical Information Mart for Intensive Care III database. CRDs were defined according to ICD-9 codes. Generalised linear regression and propensity score matching were performed. Of 13,132 patients, 7.9% required re-intubation. Patients with chronic obstructive pulmonary disease (COPD) had higher re-intubation (OR 2.48, 95% CI 1.83-3.33) and mortality rates (OR 1.64, 95% CI 1.15-2.34) than those without. Patients with asthma had a lower mortality rate (OR 0.63, 95% CI 0.43-0.92) but a similar re-intubation rate to those of patients without. These findings remained stable after propensity score matching and bootstrapping analysis. The association of COPD with re-intubation was significantly stronger in patients with high oxygen-partial pressure (PaO2) or mild disease severity but was independent of carbon dioxide partial pressure. Corticosteroid use was associated with increased re-intubation rates in subgroups without CRDs (OR 1.77-1.99, p < 0.001) but not in subgroups with CRDs. COPD patients with high post-extubation PaO2 or mild disease severity should be carefully monitored as they have higher re-intubation and mortality rates.
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Affiliation(s)
- Yanfei Shen
- Department of Intensive Care, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou, 322100, Zhejiang, People's Republic of China
| | - Weizhe Ru
- Department of Oncology, Cixi People's Hospital, Cixi, 315300, Zhejiang, People's Republic of China
| | - Xinmei Huang
- ENT Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, People's Republic of China
| | - Shangzhong Chen
- Department of Intensive Care, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou, 322100, Zhejiang, People's Republic of China
| | - Jing Yan
- Department of Intensive Care, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou, 322100, Zhejiang, People's Republic of China
| | - Zhouxin Yang
- Department of Intensive Care, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou, 322100, Zhejiang, People's Republic of China.
| | - Guolong Cai
- Department of Intensive Care, Zhejiang Hospital, No. 12, Lingyin Road, Hangzhou, 322100, Zhejiang, People's Republic of China.
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24
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Nagano A, Wakabayashi H, Maeda K, Kokura Y, Miyazaki S, Mori T, Fujiwara D. Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment. J Nutr Health Aging 2021; 25:507-515. [PMID: 33786569 PMCID: PMC7799157 DOI: 10.1007/s12603-021-1587-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 01/31/2023]
Abstract
The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.
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Affiliation(s)
- A Nagano
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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25
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Sadjadi R, Sullivan S, Grant N, Thomas SE, Doyle M, Hammond C, Corre C, Mello N, David WS, Eichler F. Clinical trial readiness study of distal myopathy and dysphagia in nephropathic cystinosis. Muscle Nerve 2020; 62:681-687. [PMID: 32737993 DOI: 10.1002/mus.27039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nephropathic cystinosis is a lysosomal storage disorder with late-onset systemic complications, such as myopathy and dysphagia. Currently employed outcome measures lack sensitivity and responsiveness for dysphagia and myopathy, a limitation to clinical trial readiness. METHODS We evaluated 20 patients with nephropathic cystinosis in two visits over the course of a year to identify outcomes sensitive to detect changes over time. Patients also underwent an expiratory muscle strength training program to assess any effects on aspiration and dysphagia. RESULTS There were significant differences in the Timed Up and Go Test (TUG) and Timed 25-Foot Walk (25-FW) between baseline and 1-y follow-up (P < .05). Maximum expiratory pressure (MEP) and peak cough flow (PCF) significantly improved following respiratory training (P < .05). CONCLUSIONS Improved respiratory outcomes may enhance patients ability to expel aspirated material from the airway, stave off pulmonary sequelae associated with chronic aspiration, and yield an overall improvement in physical health and well-being.
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Affiliation(s)
- Reza Sadjadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stacey Sullivan
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Natalie Grant
- Center for Rare Neurological Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan E Thomas
- Division of Pediatric Nephrology, Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Maya Doyle
- Department of Social Work, School of Health Sciences, Quinnipiac University, Hamden, Connecticut, USA
| | - Colleen Hammond
- Cystinosis Adult Care Excellence Initiative, Reading, Massachusetts, USA
| | - Camille Corre
- Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicholas Mello
- Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William S David
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Florian Eichler
- Center for Rare Neurological Diseases, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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