Respiratory Muscle Weakness and Respiratory Muscle Training in Severely Disabled Multiple Sclerosis Patients.Respiratory Muscle Weakness and Respiratory Muscle Training in Severely Disabled Multiple Sclerosis Patients Gosselink R, Kovacs L, Ketelaer P, et al (Respiratory Rehabilitation and Respiratory Division, University Hospitals and Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven The KATHOLIEKE UNIVERSITEIT LEUVEN (Catholic University of Leuven in English) or in short K.U.Leuven, is the largest, oldest, and most prominent university in Belgium. , Leuven; National Multiple Sclerosis Centre, Belgium), Arch Phys Med Rehabil. 2000;81:747-751. One of the most important factors in the morbidity and mortality Morbidity and Mortality can refer to:
In part 1, 28 patients with MS who were confined to bed or who used wheelchairs were studied. Respiratory muscle weakness was assessed by spirometric testing of forced vital capacity forced vital capacity n. Abbr. FVC Vital capacity measured with subject exhaling as rapidly as possible. forced vital capacity, n a measure of the maximum rate of exhalation. (FVC FVC forced vital capacity. FVC abbr. forced vital capacity FVC, n See forced vital capacity. FVC forced vital capacity. ), and inspiratory in·spi·ra·to·ry adj. Of, relating to, or used for the drawing in of air. inspiratory pertaining to or used in the inspiration of air into the lungs. and expiratory ex·pi·ra·to·ry adj. Of, relating to, or involving the expiration of air from the lungs. expiratory relating to or employed in the expiration of air from the lungs. muscle strength (PImax, PEmax) was tested using a manometer. Values for FVC, PImax, and PEmax were also compared to published norms, with values from these patients being expressed as a percentage of the value predicted as normal in people without impairments. The pulmonary index (PI) was used to determine cough efficacy. The PI scale ranges from 4 to 11, with a score of 4 indicating a normal (effective) cough, and a score of 11 indicating the most ineffective cough. The impact of this neurological disorder Noun 1. neurological disorder - a disorder of the nervous system nervous disorder, neurological disease disorder, upset - a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; on functional status was assessed using the Expanded Disability Status Scale The Kurtzke Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis.[1] The EDSS quantifies disability in eight Functional Systems (FS) and allows neurologists to assign a Functional System Score (FSS) in each of these. (EDSS EDSS Expanded Disability Status Scale EDSS Equine Digit Support System EDSS Executive Decision Support System EDSS Equipment Deployment and Storage System EDSS Electronic Document Storage System EDSS Electronic Data Storage System EDSS Electronic Document Submission System ). The EDSS scale ranges from 0 to 10, with a score of 0 indicating no disability and a score of 10 equivalent to death. Results showed a significantly decreased FVC (1.4 [+ or -] 0.9 L, 43 [+ or -] 26% predicted), a PEmax that was significantly more reduced than PImax (29 [+ or -] 1.5 cm [H.sub.2]O, 18 [+ or -] 8% predicted and 25 [+ or -] 14 cm [H.sub.2]O, 27 [+ or -] 11% predicted), a PI score that indicated severely impaired cough efficacy (median PI score = 10, range = 6-10), and an EDSS score that confirmed the markedly reduced mobility of this patient group (median score = 8.5, range = 6.5-9.5). For part 2, 21 patients with MS who were bedridden bed·rid·den or bed·rid adj. Confined to bed because of illness or infirmity. or used wheelchairs were studied to determine the effects of expiratory muscle training on FVC. Three patients dropped out from the study. Twice per day, the training group (n=9) performed 3 series of 15 expiratory contractions using an adapted inspiratory muscle trainer at 60% of PEmax. The control group (n=9) performed breathing exercises to enhance maximum inspiration. Measurements of PImax, PEmax, FVC, and PI were repeated after 3 months of training and at 3 months after the training period ended. After 3 months of training, PImax improved 39%, and PEmax improved 30% over their respective initial (baseline) values in the training group. Only the increase in PImax was statistically significant, however. PI scores in the training group were also significantly improved relative to baseline values after 3 months of training. PI values after 3 months of training were likewise significantly improved in the training group compared with the control group. When measured 3 months after the end of training, PI values remained significantly better in the training group as compared with the control group. No significant changes were observed in FVC for the training or control groups throughout this study. From data collected in part 1, the authors concluded that expiratory muscle strength was significantly more impaired than inspiratory muscle strength in persons with advanced MS. This impairment significantly affected their FVC, cough efficacy, and functional status in a deleterious manner. From the results of part 2, they concluded that expiratory muscle training enhanced both inspiratory and expiratory muscle strength and significantly improved objective and subjective cough efficacy. The improvements in cough efficacy lasted for 3 months following the training period for individuals with advanced MS. Nancy B Schuster, PT Community Health Services health services Managed care The benefits covered under a health contract Portland, Me |
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