Abstract
Roth EJ, Stenson KW, Powley S, Oken J, Primack S, Nussbaum SB, Berkowitz M. Expiratory
muscle training in spinal cord injury: a randomized controlled trial.
Objective
To assess the effectiveness of expiratory muscle training on the pulmonary function
of spinal cord injured patients.
Design
Randomized controlled trial.
Setting
Acute inpatient rehabilitation hospital.
Participants
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).
Interventions
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.
Main Outcome Measures
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).
Results
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 (98cmH2O for the resistance training group and 59cmH2O 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.
Conclusions
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.
Key Words
List of Abbreviations:
ERV (expiratory reserve volume), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), MEP (maximum expiratory pressure), PEFR (peak expiratory flow rate), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the United States Department of Education, National Institute on Disability and Rehabilitation Research through the Rehabilitation Research and Training Center on Prevention and Treatment of Secondary Complications of Spinal Cord Injury (grant no. H133B80007), the Dr. Scholl Foundation, and the Rehabilitation Institute of Chicago.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
