Impact of respiratory muscle training on blood gases and pulmonary function among patients with cervical spinal cord injury
More details
Hide details
Department of Physical Therapy for Cardiopulmonary Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt
Submission date: 2018-01-09
Final revision date: 2018-02-10
Acceptance date: 2018-02-10
Online publication date: 2018-02-14
Publication date: 2018-02-13
Corresponding author
Shehab M. Abd El- Kader   

Department of Physical Therapy for Cardiopulmonary Disorders and Geriatrics Faculty of Physical Therapy, Cairo University, Egypt
Electron J Gen Med 2018;15(3):em15
Pulmonary difficulties is the most common cause of morbidity and mortality following spinal cord injury, which is the main cause of chronic respiratory failure in young adults.

This study aimed to investigate the effect of resistive respiratory muscle training on blood gases and pulmonary function of patients with cervical spinal cord injury.

Thirty six patients with complete spinal cord injury at level from C5 to C8 of both sexes (23 males and 9 females), their age ranged from 23-41 years (30.51±6.82 year) were selected from ICU of Cairo University Hospital participated in this study. Their height ranged between 149-185cm. Participants equally enrolled to either training group (group A) or control group (group B). The respiratory muscle resisted training program was started for group (A) after the clinical stability of patient condition with a threshold positive expiratory pressure device using a three-way valve system via flanged mouthpiece. The patient performed six work sets, five minutes in duration, with a rest period in between for three minutes. All patients received a 45 minutes training/day, five days/ week for six weeks. The arterial blood gases and pulmonary function test are measured before and after exercise program.

The mean value of heart rate (HR), respiratory rate (RR), partial pressure of arterial carbon dioxide (PaCO2) and PH revealed significant reduction, where forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and partial pressure of arterial oxygen (PaO2) revealed significant increase in group (A) at the end of the study. However, changes in group (B) were not significant. Moreover, there were significant differences between both groups at the end of the study (P<0.05).

Resistive respiratory muscle training improves blood gases and pulmonary function suggesting this intervention as an efficacious therapy for patients with cervical spinal cord injury.

Tiftik T, Gökkaya N, Malas F, Tunç H, Yalçın S, Ekiz T, Erden E and Akkuş S. Does locomotor training improve pulmonary function in patients with spinal cord injury?. Spinal Cord (2015) 53, 467–470.
Yüceer N, Ozer E, Koyuncuoglu M. Spinal enterogenous cysts in infants. Eur J Gen Med 2006;3(4):193-196.
Terson de Paleville D, Lorenz D (2015) Compensatory muscle activation during forced respiratory tasks in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 217:54–62.
Erdoğmus B, Yazıcı B, Özdere B. Magnetic resonance imaging of primary intradural- extramedullary thoracolumbar hydatid cyst. Eur J Gen Med 2005; 2(2):86-88.
West CR, Campbell IG, Romer LM (2012) Assessment of pulmonary restriction in cervical spinal cord injury: a preliminary report. Arch Phys Med Rehabil 93:1463–1465.
Schilero GJ, Spungen AM, Bauman WA, Radulovic M, Lesser M. Pulmonary function and spinal cord injury. Respir Physiol Neurobiol 2009; 166: 129–141.
Htwe O, Hussain R, Selvi Naicker A. Challenges in Managing Severe Lower Limb Spasticity Associated with Bilateral Hip Joints Subluxation. Eur J Gen Med 2016;13(2):165-167.
Htwe O, Selvi Naicker A, Pei T. Spinal epidural hematoma due to anticoagulant therapy: a case report and literature review. Eur J Gen Med 2016;13(3):61-62.
Galeiras Vazquez R, Rascado Sedes P, Mourelo Fariña M, Montoto Marques A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. Biomed Res Int 2013; 2013: 168–757.
James J, Jose J. Spinal extradural Rosai Dorfman disease. Eur J Gen Med 2017;14(1):16-19.
Postma K, Haisma JA, de Groot S, Hopman MT, Bergen MP, Stam HJ et al. Changes in pulmonary function during the early years after inpatient rehabilitation in persons with spinal cord injury: a prospective cohort study. Arch Phys Med Rehabil 2013; 94:1540–1546.
Agrawal A, Timothy J, Pandit L, Kumar A, Singh G, Lakshmi R. Neurogenic pulmonary oedema. Eur J Gen Med 2007;4(1):25-32.
Sönmez G, Görür A, Mutlu H, Öztürk E, SıldıroğluO, Karagöz B. Spinal cord compression due to epidural extramedullary haematopoiesis in acute myeloid leukemia: MRI findings. Eur J Gen Med 2008;5(1):42-44.
Aslan S, Randall D, Krassioukov A, Phillips A, and Ovechkin A. Resistive respiratory training improves blood pressure regulation in individuals with chronic spinal cord injury. Arch Phys Med Rehabil. 2016; 97(6): 964–973.
Brown R., Dimarco A., Hoit J. and Garshick E. (2006): Respiratory dysfunction and management in spinal cord injury. Respir Care, 51 (8): 853-870.
Berlowitz D, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Spin. Cord. 2014; 52(3):175-80.
Larson JL, Covey MK, Wirtz SE, Berry JK, Alex CG, Langbein WE, et al. Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease. Am J RespirCrit Care Med. 1999; 160(2):500–507.
Griffiths LA, McConnell AK. The influence of inspiratory and expiratory muscle training upon rowing performance. EurJApplPhysiol. 2007; 99(5):457–466.
Mueller G, Perret C, Spengler CM. Optimal intensity for respiratory muscle endurance training in patients with spinal cord injury. J Rehabil Med. 2006; 38(6):381–386.
Kelly A., Garshick E., Erica R., Steven L. and Brown R. (2003): Spirometry testing standards in spinal cord injury. Chest, 123 (3): 725-730.
Golder F., Fuller D., Davenport P., Johnson R. and Bolser D. (2003): Respiratory motor recovery after unilateral spinal cord injury: eliminating crossed phrenic activity decreases tidal volume and increases contralateral respiratory motor output. The Journal of Neurosciencs, 23(6):2494-2501.
Gregoretti C., Olivieri C. and Navalesi P. (2005):Physilogic comparison between convetional mechanical ventilation and transtracheal openventilation in acute traumatic quadriplegic. Crit Care Med, 33(5):1111-1118.
Wanke T., Karl T., Monika M., Formanek F. and Lwick H. (1994): Inspiratory muscle training in patients with duchenne muscular dystrophy. Chest 105 (s): 475 – 482.
Lin K., Chuang G., Wu H., Chang C. and Kou Y. (1999): Abdominal weight and inspiratory resistance; their immediate effects on inspiratory muscle functions during maximal voluntary breathing in chronic tetraplegic patients. Arch Phys Med Rehabil 80: 741-745.
Derrickson J., Ciesia N., Simpson N. and Pinie C. (1992): A comparsion of two Breathing Exercise programs for patients with quadriplegia. Physical Therapy; 72: 763 – 769.
Liaw M., Lin M., Cheng P., Wong M. and Tang F. (2000): Resistive inspiratory muscle training; its effectiveness in patients with acute complete cervical cord injury. Arch Phys Med Rehabil; 81: 752-6.
Rutchik A., Weissman A., Almenoff P., Spungen A., Bauman W. and Grimm D. (1998): Resistive inspiratory muscle Training in subjects with chronic cervical spinal cord injury. Arch Phys Med Rehabil; 79: 293-297.
Journals System - logo
Scroll to top