1. Log RESPIRATORY REHABILITATION WITH ABDOMINAL WEIGHTS:
A PROSPECTIVE CASE STUDY.
Stanley John Winser MPT (Neuro Sciences)*, Priya Stanley (BPT)*, George Tarion**
*Masterskill University College of Health science (MUCH), Malaysia
** Christian Medical College (CMC) , Vellore, India
Correspondence:
Log
a surface EMG and Forced Inspiratory Vital capacity (FIVC) was assessed using an adjustable portable spirometer.
CASE REPORT: The patient's history revealed that a C5 vertebrate fracture caused SCI after a fall from height (mango tree) in December He had applied to a clinic and had been managed conservatively with bed rest for 3 months. The patient's history included an internal fixator at his right femur because of a fracture that occurred in another vehicle accident before 6 yrs. The patient's medical status was stable. He had no pressure ulcers, range of motion (ROM) of all four limbs were full and free. On clinical neurologic examination, he had spastic tetraplegia with loss of motor function below the C6 level and loss of all sensation below C7 dermatome. Spasticity was found to have grade 1+ in Modified Asworth scale (MAS) in all 4 limbs. Deep tendon reflexes were hyperactive, and plantar response was extensor bilaterally.
EQUIPMENTS USED:
INTRODUCTION
Complete lesions of the spinal cord affect the respiratory inspiratory and expiratory muscles. Training of these muscles may improve the respiratory status. Owing to the permanent disability caused by the lesion it is important to identify the effective long term therapeutic modality to train these muscles.
AIMS AND OBJECTIVES
Abdominal weights was used to strengthen the diaphragm of a C6 ASIA (A) tetraplegic subject , for a period of 12 months with the aim of studying the long term effect of the technique as a part of respiratory rehabilitation.
METHODOLOGY
STUDY DESIGN: A prospective case study of a 30 year-old tetraplegic patient, with complete spinal cord section at C6 level, was considered.
STUDY APPROVAL: Written consent was obtained from the subject.. The study was approved by the fluid research committee of CMC.
STUDY DURATION: 1 year
OUTCOME MEASURES: The peak EMG amplitude of the diaphragm (DIA), intercostals (INT) and sternoclidomastiod (SCM) were assessed using
Adjustable spirometer to assess the FIVC
Electromyograpthy equipment
RESULTS SUMMARY:
Day rd month th month 9th month th month
Weight: 3kg EMG values
DIA: mV
INT: mV
SCM:
FIVC : 1772ml
Weight: 5 kg
EMG values
DIA: mV
INT: mV
SCM: mV
FIVC : 2080ml
Weights: 8 Kg EMG values
DIA: mV
INT: mV
SCM: mV
FIVC : 2280ml
Weight: 10 Kg EMG values
DIA: mV
INT: mV
SCM:
FIVC : 2440ml
Weight: 12 Kg EMG values
DIA: mV
INT: mV
SCM:
FIVC : 2760ml
STUDY PROTOCOL: Diaphragm was strengthened using abdominal weights for 15 minutes /day for six days/ week for a period of 1 year. An initial evaluation of weight to be placed over the abdomen was done. The evaluated weight was placed over the epigastric region with an isosceles triangular board.
RESULTS & DISCUSSION
Our study shows the following findings: 1.Measures of EMG of the DIA and SCM muscles as well as the FIVC have showed a gradual rise which implies: Use of abdominal weights as a part of respiratory rehabilitation has beneficial long term effects, 2.In patients with tetraplegia, respiratory muscles in particular, the diaphragm is trainable in terms of muscle efficiency, provided that the muscle performance is not severely compromised as in cases of ultra high lesions who require ventilator assistance. The improvement in the muscle efficiency obtained during the early rehabilitation can be maintained or improved using simple non sophisticated exercises like abdominal weights, 3.Clinically we did not observe any deterioration in the patients respiratory as well as functional status which is a good sign for a tetraplegic
Placement of EMG surface electrodes (neck electrodes records activity of SCM, 2 chest electrodes for INT and lower 2 electrodes for DIA
Evaluation of FIVC using spirometer
CONCLUSION
Abdominal weights can be used as an effective adjunct to pulmonary rehabilitation in improving the efficiency of diaphragm on a long term basis, thereby reducing the risks associated with pulmonary complications.
Diaphragm strengthening using weights
ANALYSIS
RELATED WORK
Stanley John Winser, et al. A comparison study of two breathing
exercise techniques in tetraplegics”. HEALTH (2009) Volume 1, No.2, Pg 88-92
Stanley John Winser et al.. Abdominal weights Vs Incentive spirometry, in the respiratory rehabilitation of complete tetraplegics. A comparative study. International Scientific Conference, MUCH, Malaysia.
DECLARATION
This article has been accepted for publication with the International journal of Health. Article in press.
Progress of EMG
Progress of FIVC