Respiratory muscles and breathing techniques in obstructive abdominal muscle

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Respiratory muscles and breathing techniques in obstructive  abdominal muscle Powered By Docstoc
					Thematic Poster Session                                                                                                                       Hall C-32 - 12:50-14:40

                                                                    Sunday, September 16th 2007

                                                                                        Electromyographic analysis of the inspiratory muscle activity during
                                                                                        maximum inspiratory pressure maneuver in patients with COPD
           116. Respiratory muscles and                                                 T. Silva1 , F. Silva1 , D. Andrade1 , G. Delmondes1 , J. Araujo Filho1 , V Galindo
        breathing techniques in obstructive                                             Filho1 , P. Marinho1 , C. Amorim3 , P. Rocco2 , A. Dornelas de Andrade1 .
                                                                                          Department of Physicaltherapy, Fedral University of Pernambuco, Recife, Brazil;
            and neuromuscular diseases                                                  2
                                                                                          Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro,
                                                                                        Rio de Janeiro, Brazil; 3 Engineer, University of Vale do Parnaiba, Sao Jose dos
                                                                                        Campos, Brazil
Craniocaudal diaphragm displacement during inspiratory capacity                         Background: Hyperinflation in COPD patients harms inspiratory muscle function
maneuver in patients with COPD                                                          by modifying muscle length at rest and changing its contribution to the inspiratory
J. Araujo Filho1 , T. Silva1 , G. Delmondes1 , D. Andrade1 , F. Silva1 , V Galindo
                                                                          .             capacity (IC).
Filho1 , P. Marinho1 , M. da G. Rodrigues Machado2 , A. Dornelas de Andrade1 ,          Aim: Use electromyography (EMG) to evaluate individual contribution from
E. Just. 1 Department of Physicaltherapy, Federal University of Pernambuco,             sternocleidomastoid (STMD), scalene and diaphragm muscles during maximum
Recife, Pernambuco, Brazil; 2 Physicaltherapy, Universitary Center of Belo              inspiratory pressure (MIP), and correlate MIP values with the dyspnea index and
Horizonte, Belo Horizonte, Minas Gerais, Brazil                                         exercise tolerance level.
                                                                                        Methods: Twenty-one patients of both sexes were included in the study: 14
Background: The diaphragm undergoes important adaptations that are responsible          COPD patients (FEV 1% predicted 53.31±4.59) and 7 normal subjects in the
for pulmonary volume and capacity alterations in patients with COPD.                    control group (FEV 1% predicted 97.14±6.22), with a mean age of 60.3±11.58
Aim: Assess diaphragm cranio-caudal displacement (DCCD) during the inspi-               years. MIP maneuvers were repeated with 1-minute intervals until reaching
ratory capacity (IC) maneuver and analyze its correlation with values from the          three technically acceptable maneuvers with a variation of less than 20%. For
pulmonary function test, muscular inspiratory pressure (MIP), dyspnea index and         the analysis of the signal, stretches equivalent to the last three seconds of the
distance in the six-minute walk test (DW6).                                             electromyographic pulse were selected from the best MIP maneuver, and basal
Methods: Twenty-four individuals of both sexes participated in the study: 14 in         stretches of same duration were used to normalize the signal.
the COPD group (FVE 1 % = 57±17.6 and a mean age of 56.7±14.2) and 9 in                 Results: MIP was lesser in COPD patients (p = 0.015), with the preservation of the
the control group (FVE 1 % = 90.6±16.2 and a mean age of 62±13.3 years).                muscular activity. The muscle recruitment pattern was equivalent for both groups
IC (l) maneuvers were performed with the simultaneous measurement of DCCD               (p > 0.05). Medium frequency (MF) was higher for the STMD and diaphragm
(mm), which were obtained indirectly through displacement of the left intrahepatic      muscles, with a significant difference when compared to the scalene muscle
branch of portal vein through ultrasound examination.                                   (p = 0.018 and p = 0.046, respectively).
Results: COPD patients showed lower DCCD (19.71±7.36 mm) than the control               Conclusion: Although MIP presented lesser values in COPD, the inspiratory mus-
group (30.12±8.08 mm, p < 0.01). The COPD group showed lower mobilized                  cles showed preserved activity or increased its activity to compensate mechanical
IC (1.8±0.7 l) than the control group (2.04±0.62 l, p < 0.01). The variables            damage, thereby allowing relative preservation to perform daily activities and
FVE 1(%), FVE1 / FVC (%) and IC (%) exhibited a correlation with DCCD,                  exercises.
but the strongest correlation was with IC (%) (r = 0.829; p < 0.000). DCCD also         Supported by grants from CNPq – Brazil.
demonstrated a satisfactory correlation with functional dyspnea (r = – 0.56;
p < 0.001) and DW6 (r = 0.601; p < 0.001).
                                                                                        COPD influence over volume mobilization during incremental loading test
Conclusions: The ability of the diaphragm to become displaced and generate
                                                                                        T. Silva1 , D. Andrade1 , G. Delmondes1 , J. Araujo Filho1 , F. Silva1 , V Galindo
volumes is diminished in COPD. Thus, reduced mobility is related to the degree
                                                                                        Filho1 , P. Marinho1 , P. Rocco2 , A. Dornelas de Andrade1 . 1 Department of
of obstruction and pulmonary hyperinflation, which is common to this pathology.                                                                                  2
                                                                                        Physicaltherapy, Federal University of Pernambuco, Recife, Brazil; Laboratory
Moreover, reduced diaphragm function is reflected in a lower DW6 and a higher
                                                                                        of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro,
functional dyspnea.
Impact of pulmonary obstruction and hyperinflation on respiratory muscles                Background: The muscle disorders and pulmonary hyperinflation present in
activity and pulmonary volumes mobilization in COPD                                     patients with COPD interfere with ventilatory performance when inspiratory loads
T. Silva1 , P. Rocco2 , G. Desmondes1 , F. da Silva1 , D. Andrade1 , J. Araujo          are added.
Filho1 , V Galindo Filho1 , P. Marinho1 , C. Amorim3 , A. Dornelas de Andrade1 .
          .                                                                             Aim: Assess the influence of pulmonary obstruction over ventilatory strategies in
  Department of Physicaltherapy, Federal University of Pernambuco, Recife,              response to the incremental loading test (ILT).
Pernambuco, Brazil; 2 Laboratory of Pulmonary Investigation, Federal University         Methods: Twenty-one individuals of both sexes were included in the study:
of Rio de Janeiro, Rio de Janeiro, Brazil; 3 Bioengineer, University of Vale do         14 patients with COPD (FEV1 % predicted 53.31±4.59) and 7 in the control
Parniba, Sao Jose dos Campos, Brazil                                                    group (FEV1 %predicted 97.14±6.22), with equivalent ages (60.3±11.58 years).
                                                                                        ILT was performed with Threshold®, using loads of 15, 30, 45 and 60% of
                                                                                        maximum inspiratory pressure (MIP). For each load measured, other parameters
Background: Ventilatory patterns adopted during muscle resistance tests have
                                                                                        were recorded: respiratory rate (RR), Ti/Ttot ratio, inspired volume (IV) and
been reported in various studies. However, there are few reports comparing muscle
                                                                                        expired volume (EV). Thus, the obstruction level was obtained from FEV1 during
contractility and its mechanical efficiency in the respiratory system of patients with
                                                                                        the pulmonary test.
                                                                                        Results: RR exhibited a reduction in response to loads of 15, 30 and 45% in
Aim: Assess the impact of pulmonary obstruction and hyperinflation on respira-
                                                                                        relation to the basal RR values. Moreover, a 60% load presented a tendency to
tory muscle activity and pulmonary volume mobilization.
                                                                                        return to basal values. Imposed loads in the ILT did not influence the Ti/Ttot ratio.
Methods: A total of 22 individuals of both sexes were assessed: 14 COPD
                                                                                        Regarding pulmonary volumes, the control group exhibited a significant increase
patients (FEV1 = 54.1±15.9 % predicted, mean age 63.2±11.3 years) and 8
                                                                                        in IV and EV in relation to the basal values at all load levels. However, the
healthy volunteers (FEV1 = 98.5±17.6 % predicted, mean age 56.5±7.9 years).
                                                                                        COPD group increases EV only in response to loads of 30% (p =0.030 and 45%
All subjects were subjected to Maximal inspiratory pressure(MIP), resistance tests
                                                                                        (p = 0.01) when compared to basal values, but IV did not achieve a significant
(incremental loading test) and electromyography of scalene, sternocleidomastoid
                                                                                        difference. Thus, EV in response to the loads presented a strong correlation for
and diaphragm muscles. Ventilatory strategies were measured through mobilized
                                                                                        all loads applied in ILT.
volumes during the incremental loading test.
                                                                                        Conclusion: COPD alters volume generation in response to loads applied to
Results: Although the level of MIP was lower in the COPD group than the control
                                                                                        the respiratory system and higher pulmonary obstruction levels lead to lesser
group(62.1±24.2 versus 93.7±25.5; p = 0.015), the EMG activity during test incre-
                                                                                        ventilatory increments when inspiratory loads are imposed.
mental was similar in both groups. Furthermore, the addition of load only altered
                                                                                        Supported by CNPq and CAPES.
scalene muscular activity in COPD group: with load of 30% (RMS%Scalene =
11.32±0.63 p = 0.001), 45%(RMS%Scalene = 11.47±0.53; p = 0.001) and 60%                 P1148
(RMS%Scalene = 13.3±0.6; p < 0.0001) of basal values. It was observed a positive        Yoga breathing improves ventilatory efficiency in COPD patients
correlation between MIP and IC (r=0.482; p = 0.023) and VEF1 /FCV (r=0.428;             L. Pomidori1 , F. Campigotto1 , T. Man Amatya2 , L. Bernardi3 , A. Cogo1 . 1 Sports
p = 0.047).                                                                             Biomedical Studies Centre, University of Ferrara, Ferrara, Italy; 2 Asthma Clinic,
Conclusion: we suggest that the force and resistance deficits of inspiratory             Asthma Clinic, Katmandhu, Nepal; 3 IRCCS S. Matteo and Dept. of Internal
muscles were more related to alterations in the respiratory mechanics than possible     Medicine, Universty of Pavia, Pavia, Italy
damage to inspiratory muscle contractility.
Supported by CNPq and CAPES.
                                                                                        Yoga training is suggested as additional technique in pulmonary rehabilitation to
                                                                                        improve the management of dyspnoea. However its effect on ventilatory efficiency
                                                                                        in COPD patients is not known, whereas a slow breathing pattern was reported to
                                                                                        improve gas exchange and to reduce dyspnoea in heart failure patients. Aim: to
                                                                                        evaluate the effect of slow and deep yoga breathing in COPD patients (character-
                                                                                        ized by shallow, rapid breath). Methods:12 COPD patients (30%> FEV1<70%),

                             Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand B04:31
Thematic Poster Session                                                                                                                                 Hall C-32 - 12:50-14:40

                                                                             Sunday, September 16th 2007

without previous therapies and yoga practice, resident in Kathmandu (9M, 3F,                      Conclusions: These results suggest that the decrease in FRC by the manual CPT
age59−80yrs), were monitored (Lifeshirt System, Vivometric, CA) before and                        techniques in patients with severe COPD continues at least for 3 hours.
during a 30’yoga breathing (abdominal, lower and upper thoracic mobilisation).
We evaluated: tidal volume (VT), minute ventilation (VE), respiratory rate (RR),
inspiratory time (Ti), total breath time (Tt), fractional inspiratory time (Ti/Tt),               P1151
percent rib cage contribution to VT (RC%), phase angle (PhA), SpO2 and rapid                      Pimax in the evaluation of respiratory muscles function in the COPD
shallow breathing index (F/VT). Results (in the table as % baseline, except SpO2):                patients
the adoption of a deeper and slower breathing during yoga induces a significant                    V .M. Tudorache1 , C. Oancea2 , N. Bertici1 , M. Marc3 , O.F. Mladinescu4 . 1 Clinic
improvement in ventilatory efficiency, as demonstrated by the significant increase                  of Pneumology, University and Medicine and Pharmacy, Timisoara, Romania;
in SpO2 and no change in VE. Short-term training in yoga thus induces favorable                     Department of Physiology-Immunology, University and Medicine and Pharmacy,
respiratory changes in COPD.                                                                      Timisoara, Romania; 3 Clinic of Pneumology, University and Medicine and
Funded by EVK2CNR, Sensormedics Italy                                                             Pharmacy, Timisoara, Romania; 4 Clinic of Pneumology, Victor Babes Hospital,
                                                                                                  Timisoara, Romania; 5 Department of Physiopathology, University and Medicine
                                                                                                  and Pharmacy, Timisoara, Romania

            SpO2         VT            Ti              Ti/Tt          RR            F/VT          In the last years there were many attempts to standardisation the spirometric
                                                                                                  parameters in order to obtain an objective evaluation of the respiratory muscles
rest (SE)   91 (3.4)     100           100             100            100           100           function. An important parameter is represented by maximal inspiratory pressure
Yoga (SE)   92.8 (3.8)   104.3 (4.3)   206.5 (106.6)   114.4 (14.2)   68.8 (16.1)   71.0 (33.4)   (PIMAX).
p           0.01         0.01          0.007           0.01           0.001         0.03          Determination of PIMAX, correlation with other parameters in the context of
                                                                                                  exacerbated COPD.
No significant changes in VE, RC%, PhA. SpO2 showed a signifcant linear relatioship only           We measured PIMAX and maximal expiratory pressure (PEMAX) in 56 patients
with VT (r= 0.53)
                                                                                                  with exacerbated COPD (50 male, 6 female), in 35 with stable COPD (31 male,
                                                                                                  4 female) and 48 healthy (41 male, 7 female) with the same demographic data.
                                                                                                  The patients were smokers (30 p/y). We excluded the interfering factors (residual
P1149                                                                                             volume     200%) as well as patent comorbidities. The investigations included
Effects of pursed-lip breathing on respiratory sensation, EEG, and heart                          body-pletismography as well as body mass index (BMI), lean body weight (LBW),
rate in healthy subjects and the patients with COPD                                               fat body weight (FBW), percent body fat (%BF), SaO2.
Y. Sano1 , H. Kurosawa2 , M. Kohzuki3 , W. Hida2 . 1 Department of Rehabilitation,                PIMAX values were significatly decreased (p < 0.05) in the group of patients
Sanno Hospital, Tokyo, Japan; 2 Health Administration Center, Tohoku University,                  with exacerbated COPD (5.04±2.35) vs. control group (6.73±2.18) and stable
Sendai, Japan; 3 Department of Internal Medicine and Rehabilitation Science,                      COPD (6.56±2.15). The PIMAX values in the group with stable COPD were
Tohoku University School of Medicine, Sendai, Japan                                               not significantly decreased compared with control group, which corellates with
                                                                                                  FEV1 (r = 0.56, p < 0.05) and BMI (r=0.52 p < 0.05). The multivariable regression
Background: Pursed-lip breathing (PLB) is a traditional skill to make breath                      analisys indicate that causal relationship between BMI and PIMAX becomes
more effective and to control dyspnea, especially in patients with severe airflow                  stronger when the associate variable between LBW and %BF (r2= 0,93, p < 0.02)
limitation such as COPD.                                                                          is taken in consideration. Instead in exacerbations the significant decrease of
Aim: To examine the effects of PLB on electroencephalograph (EEG), respiratory                    PIMAX correlated only with the decrease of PEMAX (r = 0.55, p < 0.01).
sensation, and heart rate (HR) in health and disease.                                             PIMAX could be, along with other parameters, a marker of the respiratory muscles
Methods: Three healthy subjects (Age 30.7±6.5 yr) and four patients with COPD                     disfunctions caused by exacerbation of COPD. Follow-up of the PIMAX evolution
(68.5±2.5 yr were examined. Before the studies, PLB was instructed to the                         could be used in rehabilitation program.
subjects. With the conventional setting, EEG recording was performed at supine
position. After 5 minutes being at rest with breathing normally, PLB was continued
for 10 minutes. A similar protocol was performed as a control, in which the                       P1152
subjects breathed through paper mouthpiece.                                                       Different patterns of diaphragm breathing in COPD and healthy subjects
Results: There were not significant differences of dominant frequencies of alpha                   assessed by optoelectronic plethysmography
wave between the two group. However, respiratory sensation in the patients with                   A. Skoczylas1 , E. Wojda1 , E. Romanski1 , P. Sliwinski1 . 1 Dept. of Respiratory
COPD was ameliorated during PLB, while those in the healthy subjects changed                      Failure Diagnosis and Treatment, Institute of TB and Lung Diseases, Warsaw,
little. HR response was also different between both group. It slightly increased in               Poland
the patients with COPD, while decreased in the healthy subjects. Conclusion: We
could not detect specific changes in EEG in this study. However, favorable changes                 Aim: Diaphragm breathing is one of the exercises used in COPD patients rehabili-
during PLB in patients with COPD were confirmed. HR response in patients with                      tation and it may be difficult to perform. We used optoelectronic plethysmography
COPD was very interesting, but further investigation is needed to elucidate the                   (OEP) to test the breathing pattern during this maneuver.
mechanisms.                                                                                       Methods: 7 severe COPD patients (FEV1 = 0.81±0.31 L, 31% pred.) and 6 healthy
                                                                                                  controls were asked to increase the abdomen when inspire. After the patients had
P1150                                                                                             been taught to use the diaphragm, chest wall, its compartments’ volumes and
Duration continues to decrease in FRC after manual physiotherapy in                               breathing pattern were recorded by OEP.
patients with COPD                                                                                Results: On the basis of the chest wall volume curves three groups were
K. Matsumoto1 , H. Kurosawa2 , R. Imanishi3 , N. Mori3 , Y. Tasaku3 , S. Kobayashi1 ,             characterized (figures): A. proper use of the diaphragm; B. chaotic diaphragm
M. Yanai1 . 1 Department of Rehabilitation, Ishinomaki Red Cross Hospital,                        twitch; C. sudden tidal volume decrease.
Ishinomaki, Miyagi, Japan; 2 Health Administration Center, Tohoku University,                     The TV decrease (1.153±0.405 vs 0.878±0.37L)* in C group was ob-
Sendai, Miyagi, Japan; 3 Department of Internal Medicine and Rehabilitation                       served suddenly after 35±15 s, mostly by diminishing the end inspira-
Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan                     tory volumes (DVEIcw = 0.394±0.174*; DVEIrcp = 0.162±0.097*; DVEIrca
                                                                                                  0.055±0.039**; DVEIrc 0.218±0.103 L*). There was decrease in peak expiratory
Background: As chest physiotherapy (CPT) techniques, manual stretching of                         (171±23 mL/s***) and inspiratory (104±31 mL/s**) flow. Minute ventilation
intercostals and other respiration related muscles to mobilize thoracic cage                      decreased by 4.56±1.11 L/min (p = NS), the frequency of breathing remained
had been frequently performed in patients with airflow limitation, especially in                   constant. *p < 0.05, **p < 0.01, ***p < 0.001; cw: chest wall; rc: rib cage, rcp:
Japan. We previously reported that functional residual capacity (FRC) decreased                   pulmonary rc; rca: abdominal rc.
immediate after the CPT in the patients with severe chronic obstructive pulmonary
disease (COPD).
Aim: In this study, we examined how long the effect does continue following the
Subjects and Methods: In 8 patients with COPD (M: F = 8: 0. age; 68.8±4.9
yr), we measured FRC and visual analogue scales (VAS) of subjective symptoms
before and immediate, 1 hours, 3 hours, 6 hours, 9 hours, 24 hours after the
CPT techniques. After the baseline measures of pulmonary function test (VC:
2.76±0.69 L, FVC: 2.59±0.63 L, FEV1: 0.85±0.26 L), the CPT described above
including manual breathing support technique were performed for about total 40
minutes. Lung volume was measured using body plethysmography.
Results: FRC significantly decreased from 5.99±1.12 L to 5.73±1.06 L (p < 0.05)
immediate after the CPT. FRC continued to be less than the baseline value until
3 hour after the CPT, but seemed recovered to the baseline after 6 hour after the
CPT. VAS scales of subjective symptoms that related with dyspnea improved in
all patients, although there were not significant correlation between the change of
VAS scales and the changes in FRC.

                                Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand B04:31
Thematic Poster Session                                                                                                                       Hall C-32 - 12:50-14:40

                                                                     Sunday, September 16th 2007

                                                                                         from MVV maneuver (comparison of second and the last but one MVV graphic
                                                                                         area) using Heron theorem.
                                                                                         Results: No correlation were found between MVV and RRVR (mean MVV:
                                                                                         66±26 l/min, RRVR: 0.58±0.17 cm2 , r: 0.15 and p: 0.65). RRVR decline in
                                                                                         mean 42%. Nine patients showed a RRVR bellow 80% (37%, 41%, 42%, 42%,
                                                                                         49%, 63%, 71%, 72% and 74%) and six patients demonstrated MVV below 80%
                                                                                         (39%, 45%, 54%, 59%, 65% and 76%). Four patients with normal MVV (>80%
                                                                                         predicted value) showed a RRVR bellow 80% (74%, 71%, 49% and 42%).
                                                                                         Conclusion: MVV is a nonspecific endurance maneuver that not correlates
                                                                                         with RRVR fatigue index. Specific endurance tests should be use for endurance
                                                                                         evaluation in MG patients.
                                                                                         Fregonezi G.A.F is supported by CNPq – Brazil, and Casan P. is member of Red

                                                                                         Effects of air stacking on peak cough flows (PCFs) and forced vital
                                                                                         capacities (FVCs) in patients with Duchenne muscular dystrophy
                                                                                         T.B. Carvalho3 , M.C. Berto1 , L.Y. Nakano1 , A.N. Moraes1 , A.S. Nakashima2 .
                                                                                           Brazilian Muscular Dystrophy Association, ABDIM, S˜ o Paulo, SP, Brazil;
                                                                                           Departament of Clinical Medicine, School of Medicine University of S˜ o Paulo,
                                                                                         S˜ o Paulo, SP, Brazil; Department of Neuropediatric, Federal University of S˜ o
                                                                                           a                                                                          a
                                                                                         Carlos, S˜ o Carlos, SP, Brazil

                                                                                         Severe respiratory muscle weakness and pulmonary complications are the main
                                                                                         cause of morbidity and mortality in patients with Duchenne muscular dystrophy
                                                                                         Objectives: we evaluated the effect of air stacking training in with patients DMD.
                                                                                         Material and Methods: thirty three patients with DMD aging 13 to 25 with a
                                                                                         FVC bellow 70% of the predicted were trained air stacking for one year. Every
                                                                                         month the FVC and the PCF were evaluated. Ten series of air stacking maneuvers
                                                                                         training were performed three times a day using a manual bag ventilation device.
                                                                                         The results were analyzed with an established significance value of P < 0.05.
Conclusions: Diaphragm breathing is very difficult for both healthy and COPD              Results: the characteristics of the thirty three patients evaluated were: age:
groups. Probably respiratory muscle fatigue plays a great role. Some patients could      18.1±3.4, height: 163.2±8.2 cm, body weight: 49.6±16.5 kg, and body mass
not be able to learn proper diaphragm breathing pattern.                                 index 18.6±6 kg/m2 . Significant differences were found in the FVC (liters)
                                                                                         measurements in the four evaluations (P < 0.05). The PCF increased significantly
P1153                                                                                    (P < 0.05) along the four months of training.
Abdominal muscle activity during the use of the valsalva maneuver and                    Conclusions: daily training of the air stacking maneuver improved cough effec-
pursed-lip breathing with different lung volumes in the third trimester of               tiveness and FVC.
B. Oliveira1 , A. Lemos2 , T. Silva1 , V. Caiaffo1 , A. Dornelas de Andrade1 .           P1156
  Department of Physicaltherapy, Federal University of Pernambuco, Recife, PE,           Long-term effects of glossopharyngeal pistoning for lung insufflation in
Brazil; 2 Physicaltherapy, FIR, Recife, Brazil                                           persons with cervical spinal cord injury
                                                                                         M. Nygren-Bonnier1,2 , K. Wahman3 , P. Lindholm4 , A. Markstr¨ m5 , N. Westgren6 ,
Background: During the expulsive stage of labor, pregnant women use breathing            B. Klefbeck1,2 . 1 Karolinska Institutet, Department of Neurobiology, Care Science
maneuvers associated to abdominal contraction to help the delivery of the fetus.         and Society, Division of Physiotherapy, Stockholm, Sweden; 2 Karolinska
There are no reports in the literature that investigate abdominal muscle activity        University Hospital, Department of Physical Therapy, Huddinge, Sweden;
during these efforts.                                                                      Karolinska Institutet, Department of Neurobiology, Care Sciences and Society,
Objective: The aim of the present study was to use surface electromyography to           Division of Neurorehabilitation, Stockholm, Sweden; 4 Karolinska Institutet,
evaluate abdominal muscle activity (rectus, internus obliquos, external obliquos)        Department of Physiology and Pharmacology, Section of Environmental
during Valsalva maneuvers (VM) and pursed-lip breathing at different lung                Physiology, Stockholm, Sweden; 5 Karolinska Institutet, National Respiratory
volumes.                                                                                 Centre, Department of Anaesthesia and Intensive Care, Department of Clinical
Method: The sample was composed of 6 first-time pregnancies, with a mean                  Sciences, Danderyd Hospital, Stockholm, Sweden; 6 Karolinska University
of age 26.5±7.8 years, gestational age of 33.8±3.96 weeks and no history of              Hospital, Spinalis Clinic and Research Unit, Stockholm, Sweden
pulmonary disease.
Results: A tendency toward increased abdominal activity was found during                 Introduction: Cervical spinal cord injury (CSCI) leads to severe respiratory
maneuvers done at total lung capacity (TLC). External obliquos muscle activity           deficiency due to partial or total paralysis of respiratory muscles, which leads
during VM in TLC was greater than in the prolongation of expiration at tidal             to diminished tidal volumes, sighs, and cough flows.
volume. There was no correlation between abdominal muscle activity when                  Aims: To evaluate the immediate and long-term effects of glossopharyngeal
compared to abdominal rectus diastasis and fundal uterus height.                         pistoning for lung insufflation (GI) on lung function, and ability to cough in
Conclusion: The present study suggests that breathing in great lung volumes              persons with CSCI.
before the expulsive effort in labor results in better abdominal muscle activation.      Methods: Twenty-five subjects, mean 47 yrs, with CSCI, in Stockholm were
Supported by grants from CNPq-Brazil.                                                    included. The subjects performed 10 repetitions of GI four times a week during
                                                                                         eight weeks. Vital capacity (VC), expiratory reserve volume (ERV), functional
P1154                                                                                    residual capacity (FRC), total lung capacity (TLC), residual volume (RV) and the
Maximal voluntary ventilation in myasthenia gravis: is the way to access                 peak cough flow (PCF) were measured before and after the eight weeks.
respiratory muscle endurance?
V. Resqueti1 , G. Fregonezi1 , S. Bruno1 , N. Calaf2 , P. Casan2 . 1 Physical Therapy,   Table 1. Pulmonary function before and after eight weeks
Health Science Center, Universidade Federal do Rio Grande do Norte, Natal,
Brazil; 2 Respiratory Departament, Hospital de Sant Pau i Sant Creu, Facultat de         Function                Before                  After 8 weeks             Sign.
Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
                                                                                         VC (l)                  3.14±0.85               3.37±0.92                 0.001
Background: Respiratory muscles weakness has been reported in myasthenia                 ERV (l)                 0.86±0.40               1.02±0.45                 0.01
gravis (MG) patients.                                                                    FRC (l)                 3.46±1.11               4.32±1.45                 0.001
Objective: Investigate if MVV is correlated with relative respiratory volume
reduction (RRVR).                                                                        TLC (l)                 5.74±1.36               6.67±1.55                 0.001
Methods: Ten patients with generalized MG (8 female and 2 male), age 64±16               RV (l)                  2.60±0.95               3.30±1.28                 0.001
years, BMI 29±4.6 Kg/m2, PIMax: 51±18 cmH2 O and PEmax 107±35 cmH2 O                     PCF (l/min)             387.65±85.92            394.95±83.10              n.s.
were studied. Diagnosis was made using clinical, electrophysiological, and labo-
ratory criteria. MVV was evaluated ask to pateints” breathe as deeply and rapidly        n = 20, liter (l), minutes (min)
as possible” in 12 second.
After MVV classification in accordance with severity, relative respiratory volume         Results: Five of the 25 subjects had difficulty performing GI and were excluded
reduction (RRVR) was calculated. RRVR is one fatigue index that is calculated            from the analysis. After eight weeks of training the subjects had significantly

                             Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand B04:31
Thematic Poster Session                                                                                                                      Hall C-32 - 12:50-14:40

                                                                    Sunday, September 16th 2007

increased their VC, ERV FRC, TLC and RV (table 1). The subjects inhaled with           the cough force and is non-invasive,practical,reachable and cheap. The aim
GI, 0.88 l, p < 0.001, on top of the VC.                                               of this study to investigate the relationship between spirometric measurements
Conclusions: By using this technique, GI, for a period of eight weeks the subjects     (FVC,FEV1,PEF) and mouth pressure measurements (PI max, PE max) and PCF
who could perform GI were able to increase the VC, ERV, FRC, TLC and RV          .     (assisted and non-assisted) in patients with NMD.This study included 63 patients
Further studies are needed to investigate if the use of GI can prevent respiratory     with NMD (29 F, 34 M; mean age of 25.1±12 y). Patients were classified as
complications.                                                                         rapidly progressive (n= 24) and variable (n= 39) according to progression of their
                                                                                       diseases. The mean duration of disease was 79.8±243.9 months. Spirometry, PCF
P1157                                                                                  (assisted and non-assisted) and mouth pressure measurements (PI max, PE max)
Can the thoracic-abdominal thrust manoeuvre (TATM) ameliorate cough in                 were performed.
amyotrophic lateral sclerosis (ALS)?                                                   Assisted PCF (308.7±127.3 L/min) was significantly higher than non-assisted PCF
B. Buyse1 , N. Veranneman1 , I. Coosemans2 , V. Barbier2 , R. Gosselink2 ,             (295.2±128. 7 L/min)(p < 0.001). There was a weak positive correlation between
W. Robberecht3 . 1 Dept. of Pneumology and Centre for Sleep Monitoring, CPAP           PCF and PI max (rs= 0.38), a moderate positive correlation between PCF and PE
and Home Ventilation, University Hospital Gasthuisberg, Leuven, Belgium;               max (rs= 0.57)(for all p < 0.001). There was a strong positive correlation between
  Dept. of Respiratory Physiotherapy and Revalidation, University Hospital             PCF and peak flow rate (rs= 0.86), a moderate correlation between PCF and
Gasthuisberg, Leuven, Belgium; 3 Dept. of Neurology, University Hospital               FEV1(rs=0.72),and FVC(rs= 0.66) (for all p < 0.001). The mean PCF value was
Gasthuisberg, Leuven, Belgium                                                          lower in patients with progressive disease(p < 0.001).
                                                                                       Conclusion: PCF, which is a reachable, practical, and cheap test, was found
Aim: to evaluate if cough assistance by TATM – a technique often applied in            valuable in the follow-up of patients with NMD.
patients with neuromuscular disease and cough inability – is useful in ALS-
patients.                                                                              P1160
Methods: in 49 consecutive patients maximal inspiratory mouth pressures (MIP)          Combination of chest wall mobilization and respiratory muscle training in
and vital capacities (VC) (= inspiratory components of cough ability), maximal         comprehensive outpatient pulmonary rehabilitation improves pulmonary
expiratory mouth pressure (MEP) and maximal peak flows (PEF) (= expiratory              function in pattients with COPD
components of cough ability), and the ALS-Functional Rating Scale for speech –         T. Shioya1 , M. Satake1 , H. Takahashi2 , K. Sugawara2 , C. Kasai2 , N. Kiyokawa2 ,
range 4 = normal to 0 = not understandable – (= surrogate parameter of glottic         T. Watanabe2 , S. Fujii2 , M. Honma2 . 1 Department of Physical Therapy,
cough coordination) were determined. All patients performed flow/volume curves          Akita University School of Health Sciences, Akita, Japan; 2 Department of
with peak cough flows (PCF) and PCFs while TATM was applied (PCFass).                   Rehabilitation, Akita City General Hospital, Akita, Japan
Results: The group presented (median(25−75 perc.)) MIP: 33 (25−61), VC:
68 (45−87), MEP: 33 (20−59), PEF: 65 (42−47) %pred. and speech rating 3                Purpose: This study was conducted to investigate that combination of chest wall
(2−4); the gain in PCF on TATM expressed as (PCFass-PCF)/PCF)*100 = −3                 mobilization by squeezing technique and respiratory muscle training (RMT) in
(−11 to +8)%, only 8/49 demonstrated an increase >15% and even 10/49 a                 outpatient pulmonary rehabilitation (PR) improved pulmonary function in patients
decrease >15%. Using multivariate analysis PCFass–PCF (L/s) = −0.4475 +                with stable COPD.
0.2974*VC(L) − 0.09731*MIP(kPa) − 0.1224*MEP(kPa) + 0.4323*speech _                    Methods: Forty-four patients with stable COPD (43 male, 2 female; age: 71±5,
0.2648*PEF(L) (r2 = 32% with only MEP and the speech factor making a sig-              FVC: 2.87±0.78 L, FEV1: 1.27±0.50 L (43±5%pred)) divided into either a
nificant contribution: the gain was higher if MEP is more reduced (p = 0.0249)          chest PR group or an education group. Chest PR program consisted of chest
and speech more preserved (p = 0.0143)). In several patients the flow/volume curve      wall mobilization by squeezing technique by physical therapists, RMT and
while TATM was applied showed a flattening suggesting pharyngeal collapse or            respiratory muscle stretch gymnastics (RMSG). In RMT, both inspiratory and
inadequate glottic opening during the assisted forced expiration.                      expiratory muscle training were performed twice daily for 15 min. at home using
Conclusion: in ALS-patients TATM can sometimes worsen cough ability, even              a pressure threshold device. The patients visited outpatient clinic every two weeks.
though the technique can be considered in subjects with severe expiratory muscle                                      ,
                                                                                       Pulmonary functions (TLC, RV FVC, FEV1, PEmax, PImax), six-minute walking
dysfunction without overt bulbar (speech) dysfunction.                                 distance (6MD), chronic respiratory questionnaire (CRQ) were evaluated at 0, 1,
                                                                                       3, 6, 9 and 12 months.
P1158                                                                                  Results: In Chest PR group, FVC increased from 2.83±0.67 to 3.00±0.78 L
Pulmonary functions in patients with neuromuscular disease                             (p < 0.01; control vs month 12). RV decreased from 3.31±0.53 to 2.85±0.48
D. Inal-Ince1 , S. Savci1 , H. Arikan1 , M. Saglam1 , M. Bosnak-Guclu1 . 1 School of   (p < 0.01). 6MD increased from 314±152 to 380±162 m (p < 0.01). The total
Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey              values of CRQ increased from 96±25 to 112±22 (p < 0.05). No significant
                                                                                       improvements in pulmonary function and 6MD were obtained in an education
Aim: The aim of this study was to compare the pulmonary functions and                  group.
respiratory muscle strength of patients having scoliosis and not having scoliosis      Conclusions: We conclude that combination of chest wall mobilization by squeez-
with neuromuscular disease, and healthy subjects.                                      ing technique, RMT and RMSG in outpatient PR improve pulmonary function,
Methods: Eighteen patients with scoliosis (12.92±3.66 years, 12 M, 6 F), twenty        exercise capacity and HRQOL in patients with stable COPD.
patients without scoliosis (9.80±2.14 years, 16 M, 4 F) and sixteen healthy
subjects (11.00±3.41 years, 14 M, 2 F) participated in this study. Pulmonary
                                                                                       The important stage at the conversion of DMD patients’ lung functions
function test was performed using a spirometer. Inspiratory and expiratory muscle
                                                                                       Z. Li, J. Huang, Y. Luo, L. Peng, X. Yao. Department of Pulmonary Medicine,
strength (MIP and MEP, respectively) were measured using a portable mouth
                                                                                       the 1st Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong,
pressure device.
                                                                                       China; Department of Neurology, the 1st Affiliated Hospital of Sun Yat-Sen
Results: FEV1 (60.13±30.07%, 97.19±26.25%, 100.13±19.16%, respectively),
                                                                                       University, Guangzhou, Guangdong, China
FVC (59.69±30.32%, 90.69±24.28%, 105.63±19.26%, respectively), FEF25−75
were significantly lower in patients with scoliosis when compared with patients
                                                                                       Object: To investigate the important stage at the conversion of DMD patients’
without scoliosis (p < 0.05) and heallthy subjects (p < 0.05). PEF (51.21±16.71%,
                                                                                       lung functions.
69.94±19.48%, 95.31±28.70%, respectively) was significantly different among
three groups (p < 0.05). The mean percentage of MIP (59.23±25.47%,
76.50±33.36%, 89.95±32.77%, respectively) was significantly lower in patients
with scoliosis when compared with healthy subjects (p < 0.05). The mean percent-
age of MEP (34.97±20.81%, 39.41±14.55%, 72.18±18.90%, respectively) was
significantly different among the three groups (p < 0.05).
Conclusion: Scoliosis is an important factor in neuromuscular disease because
lung functions and respiratory muscle strength are affected.

The relationship between peak cough flow and respiratory functions in
patients with neuromuscular diseases
G. Kuran1 , I. Yeldan2 , H. Issever3 , Y. Parman4 , G. Okumus1 , E. Kiyan1 .
  Department of Chest Diseases, Istanbul University Istanbul Medical Faculty,
Istanbul, Capa, Turkey; 2 School of Physical Therapy and Rehabilitation, Istanbul
University, Istanbul, Capa, Turkey; 3 Department of Public Health, Istanbul
University Istanbul Medical Faculty, Istanbul, Capa, Turkey; 4 Department of
Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Capa, Turkey

Evaluation of spirometry and maximum mouth pressure measurement is important
in the follow-up of patients with neuromuscular disease(NMD). However,these
measurements require cooperation and also they are expensive, measurements
take long time and it is not easy to obtain these tests anytime. Another important
measurement in the follow-up is peak cough flow (PCF).PCF is used to evaluate           Relation between FVC% and clinical history.

                            Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand B04:31
Thematic Poster Session                                                                                               Hall C-32 - 12:50-14:40

                                                                   Sunday, September 16th 2007

Methods: Measure forced vital capacity(FVC) of 65 DMD patients at the age of
6- to 22-year-old. The data of FVC% were presented by scatterplot and analyzed
by SPSS12.0.
Results: There is no regularity found at the first four years of DMD. But FVC%
was showed decline trend starting from the fifth year.
Conclusion: The fifth year is an important stage that FVC% decline gradually.
The time is significant for clinical treatment and rehabilitation.
Keywords: Duchenne’s type muscular dystrophy (DMD) Lung functions Forced
vital capacity(FVC).

Anxiety, depression and quality of life in patients with neuromuscular
G. Kuran1 , H. Issever2 , G. Okumus1 , Y. Parman3 , E. Kiyan1 . 1 Department of
Chest Diseases, Istanbul University Istanbul Medical Faculty, Istanbul, Capa,
Turkey; 2 Department of Public Health, Istanbul University Istanbul Medical
Faculty, Istanbul, Capa, Turkey; 3 Department of Neurology, Istanbul University
Istanbul Medical Faculty, Istanbul, Capa, Turkey

Anxiety,depression and poor quality of life (QOL) are important problems in
chronic lung diseases. These problems affect the patients and their relatives be-
cause of increased dependence of patients, especially in progressive disorders(PD).
The aim of this study to investigate1)anxiety and depression in patients with
neuromuscular disease (NMD)(with and without respiratory symptoms(RS))and
in their relatives2) patients’QOL,3) factors affecting anxiety, depression and
QOL.50 patients with NMD(28 M,22 F;mean age:26±19.1y) were included in
the study. In respect of disease progression, patients were classified as rapidly
progressive(n= 23)and variable(n = 27)groups. Hospital Anxiety and Depression
Scale(HAD),Short Form 36(SF-36),nocturnal desaturation, spirometry and peak
cough flow (PCF) measurement were performed.RS and presence of obstructive
sleep apnea(OSA) were evaluated in all patients and HAD has been applied
to primary relatives of patients. Of patients,20% had anxiety and 20% had
depression. There was no relationship between anxiety-depression of patients
and spirometry values, PCF and anxiety-depression of their relatives(p > 0.05),but
desaturation index of patients with anxiety was high. Pain and general health
scores were low in patients with RS(p = 0.02). Social functioning score was low
in patients with OSA (p = 0.05). Mental health and social functioning scores were
significantly low in patients with depression (p = 0.04;0.05,respectively). Mental
health, general health and social functioning scores were low in patients with
anxiety (p = 0.003;0.01;0.01,respectively). Physical functioning scores were low in
patients with PD(p = 0.04).In conclusion;anxiety and depression negatively affect
the QOL in patients with NMD.

A comparison between patients with dysfunctional breathing and asthma
C. Hagman1 , C. Janson2 , M. Emtner2,3 . 1 Department of Physiotherapy, Falu
Hospital, Falun, Sweden; 2 Department of Medical Sciences, Respiratory
Medicine and Allergology, Uppsala University, Uppsala, Sweden; 3 Department
of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden

Background: The term dysfunctional breathing (DB) has been introduced to
describe patients who display a divergent breathing pattern and have breathing
problems that cannot be attributed to a specific medical diagnosis such as asthma,
chronic obstructive pulmonary disease or sensory hyper-reactivity. The aim of
this study was to investigate similarities and differences in patients with DB, and
patients with well-controlled asthma regarding symptoms, anxiety, depression,
sense of coherence, health related quality of life and effects on daily life.
Methods: Twenty-five consecutive patients with DB and 25 age and sex matched
patients with asthma (ages 20−73 years) participated in the study. The diagnosis of
DB was based on the presence of a dysfunctional breathing pattern and at least five
symptoms associated with dysfunctional breathing. Data was collected from the
patient journals, from pulmonary function testing and self-report questionnaires.
Results: The group with DB had lower health related quality of life (Short-Form
36): vitality (mean) 47 vs. 62, social functioning 70 vs. 94, and role emotional 64
vs. 94 (p < 0.05) than the asthmatic group. The DB group had a higher prevalence
of anxiety (56 vs. 24%) and a lower sense of coherence (134 versus 156) (p < 0.05).
Hyperventilation, defined according to Nijmegens Symptoms Questionnaire, was
observed in 56% of patients with DB versus 20% in the asthma group (p = 0.02).
We also found that many patients with DB (60%) had previously been treated
with asthma medication.
Conclusions: The results of the study indicate that patients with dysfunctional
breathing are more disabled than patients with well-controlled asthma.

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Description: Respiratory muscles and breathing techniques in obstructive abdominal muscle