A Comparison of Two Breathing Exercise Programs for Patients with Quadriplegia
J. Derrickson, N. Ciesla, N. Simpson, P. Inle - Phys Ther. 1992; 72: 763-769

This study compared the use of abdominal weights (AbWts) to inspiratory resistive muscle training (IMT) on selected measures of pulmonary function. Eleven patients, aged 16 to 41 years with complete cervical injuries were randomly assigned to either an AbWts or IMT treatment groups. Subjects in both treatment groups received daily treatments (five times weekly) for 7 weeks. Forced vital capacity (FVC), inspiratory capacity (IC), maximal voluntary ventilation (MVV), peak expiratory flow rate (PEFR), and inspiratory mouth pressure (PImax) were measured weekly. Although the data did not support the effectiveness of one method of training over the other, the larger increase in MVV with the IMT protocol may be indicative of an endurance training effect with this protocol.

Points of Interest: Respiratory complications are the most frequent cause of morbidity and mortality in patients after acute spinal cord injury that leads to quadriplegia. Mortality has been documented to increase to 30% in patients with quadriplegia who develop atelectasis or pneumonia.1 Paralysis and paresis of the inspiratory and expiratory muscles result in decreased inspiratory force, decreased vital capacity2,3, secretion retention, and decreased coughing ability, all of which are risk factors for the development of pneumonia and atelectasis.

Medical Comment: The Breather’s expiratory resistance (Positive Expiratory Pressure - PEP Therapy) mimics pursed lip breathing which helps to keep the airways open. The theory is breathing out against resistance helps to keep the smaller airways open during exhalation to mobilize mucus towards the larger airways for easier expectoration.}
There were significant differences within groups, however, for all variables, except IC. The mean difference from week 1 to week 7 was greater on all pulmonary function tests for IMT group than for AbWts group, although there were no significant differences between groups on pulmonary function values at the beginning of the study.
The relative benefits of IMT include an inexpensive training procedure that may be self-administered over the long term in comparison with training with AbWts, which requires more staff of family intervention.