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Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study

Published:December 16, 2021DOI:https://doi.org/10.1016/j.apmr.2021.11.006

      Abstract

      Objective

      To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP.

      Design

      The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG.

      Setting

      Research facility.

      Participants

      Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37).

      Intervention

      Not applicable.

      Main Outcome Measures

      IMP, LOI, UEMS, FIST-SCI.

      Results

      UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]).

      Conclusions

      The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), ATG (assisted transfer group), COPD (chronic obstructive pulmonary disease), FIST-SCI (Function in Sitting Test for individuals with spinal cord injury), FSB (functional sitting balance), IMP (inspiratory muscle performance), ITP (independent transfer group), LOI (level of injury), MIP (maximal inspiratory pressure), PG (paraplegia group), SCI (spinal cord injury), SMIP (sustained maximal inspiratory pressure), TG (tetraplegia group), UEMS (upper extremity motor score)

      Keywords

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