Efficacy of chest expansion resistance exercise on respiratory function, trunk control and dynamic balance in patients with chronic stroke: A Comparative study.

Background Motor impairments caused by stroke result in impaired diaphragmatic and respiratory muscle function, changes in thoracic biomechanics on the hemiparetic side ultimately resulting in decreased efficiency of lung ventilation. This study aimed to examine the efficacy of chest expansion resistance exercise (CERE) on respiratory function, trunk control ability, and balance in patients with chronic stoke. Following a purposive sampling, thirty-five patients with chronic stroke were randomly allocated into two groups, i.e., the experimental group receiving CERE with conventional therapy and the control group receiving conventional therapy alone. Both the groups received therapy four times per week for a period of four weeks (total 16 sessions). Following assessments were done before and after treatment in both the groups: chest expansion ( axillary, nipple, xiphisternal levels) using measure tape, respiratory muscle strength using micro-respiratory pressure meter, trunk control using the Trunk Impairment Scale, and balance using mini-Balance Evaluation Systems Test. Results Both groups had 17 participants each (n = 34, drop-outs = 1) consisting of 12 males and 5 females having a mean age of 56.5 ± 12.98 years and 59.7 ± 10.2 years, respectively. Intra-group analysis showed a statistically significant increase in mean values of chest expansion, respiratory muscle strength, trunk control ability, and balance in the experimental group whereas the control group showed improvement only in trunk control ability and balance. Inter-group comparison revealed a better improvement in all the outcome variables in experimental group compared to the control group. Conclusions Based on these results, this study proved that CERE was more effective in improving respiratory function, trunk control, and balance in patients with chronic stroke.

Effectiveness of Respiratory Proprioceptive Neuromuscular Facilitation Techniques on Pulmonary Functions in Patients with Spinal Cord Injury - A Pilot Study

Background: Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion which is a life threatening condition that carries a high risk of morbidity and mortality. The Incidence of SCI varies from 9.2 to 56.1 per million. In the Indian setup, Approx. 20,000 new cases of SCI are added every year. Spinal cord injury (SCI) patients are at increased risk of chronic respiratory symptoms as Respiratory muscle paralysis both restricts maximum inflation of the lungs and impair the ability to cough. Patients with tetraplegia have decreased chest wall and lung compliance, rib cage stiffness with paradoxical chest wall movements. Material and method: A Pilot study was carried out on 04 Traumatic Spinal cord injury patients. The purpose of the study was To find out effectiveness of respiratory PNF on pulmonary functions (FVC & FEV1) & Chest Expansion in patients with spinal cord injury. The pulmonary Functions (FVC & FEV1) and chest expansion was measured by using Spirometer (PFT machine) and inch tape. The data was analyzed using standard statistical software. Result: In this study After 4 weeks of Intervention there was Significant Improvement in Pulmonary Functions ( Pre Mean of FEV1 & FVC 0.99 L & 1.03L and Post Mean of FEV1 & FVC was 1.25 L & 1.35L respectively) and Chest Expansion (Pre Mean was 1.15 cm and Post Mean was 1.62 cm at Xiphoid Process Level). Conclusion: This Study concluded that Respiratory PNF increases Pulmonary Functions and chest expansion in Patients with Spinal Cord Injury after 4 weeks of Intervention. Keywords: Spinal Cord Injury, Forced Expiratory Volume (FEV1), Forced vital Capacity, Peak expiratory flow rate, Respiratory Proprioceptive Neuromuscular Facilitation Technique.

Use of pacemaker in GBS dysautonomia

Autonomic dysfunction in Guillain-Barrè syndrome (GBS) involves labile hypotension, hypertension, resting tachycardia and sweating. While autonomic involvement affects 66% of patients with GBS, the changes are usually transient and reversible. We hereby delineate a case of a female who presented to our medical centre with flaccid, painless progressive quadriparesis with features of dysautonomia. She had resting tachycardia, was tachypneic with reduced chest expansion and required immediate invasive mechanical ventilation. After pertinent laboratory evaluation, nerve conduction studies were promptly performed at the bedside and findings were concordant with acquired acute inflammatory demyelinating polyneuropathy. The diagnosis of GBS was made on the standard set of investigations and plasmapheresis was initiated on the same day. Her intensive care unit stay was complicated by the multiple episodes of asystole. Even though a temporary transvenous pacemaker was inserted, she, unfortunately, succumbed to a sudden episode of asystole. This paper illustrates that GBS-associated autonomic dysfunction can be severe and close cardiac monitoring is imperative in these patients.

Prevalence and factors related to sleep apnoea in ankylosing spondylitis

An increased prevalence of obstructive sleep apnoea (OSA) has been suggested in patients with ankylosing spondylitis (AS) in a few controlled studies. We aimed to study the prevalence of OSA compared to controls and to investigate if disease-related and non-disease-related factors were determinants of OSA in AS patients. One hundred and fifty-five patients with AS were included in the Backbone study, a cross-sectional study that investigates severity and comorbidities in AS. Controls were recruited from the Swedish CArdioPulmonary bioImage Study. To evaluate OSA, the participants were asked to undergo home sleep-monitoring during one night’s sleep. For each AS patient 45–70 years old, four controls were matched for sex, age, weight, and height. OSA was defined as an apnoea-hypopnoea index (AHI) ≥ 5 events/hour. Sixty-three patients with AS were examined with home sleep-monitoring, and 179 controls were matched with 46 patients, 45–70 years. Twenty-two out of 46 (47.8%) patients with AS vs. 91/179 (50.8%) controls had OSA (AHI ≥ 5 events/hour), P = 0.72. No differences in the sleep measurements were noted in AS patients vs. controls. In logistic regression analysis adjusted for age and sex, higher age, higher BMI, and lesser chest expansion were associated with the presence of OSA in the 63 AS patients. In the current study, patients with AS did not have a higher prevalence of OSA compared to matched controls. AS patients with OSA had higher BMI, were older, and had lesser chest expansion because of more severe AS compared to patients without OSA. Key points • Patients with ankylosing spondylitis did not have a higher prevalence of obstructive sleep apnoea versus matched controls. • Patients with ankylosing spondylitis and obstructive sleep apnoea were older and had higher body mass index versus patients without obstructive sleep apnoea. • Patients with ankylosing spondylitis and obstructive sleep apnoea had lesser chest expansion versus patients without obstructive sleep apnoea.

Chest Mobility Exercise with Staked Breathing Versus Chest Mobility Exercises with Incentive Spirometery On Chest Expansion with Pleural Effusion Patient: A Comparative Study

Background: Pleural effusion is one of the commonly seen respiratory conditions in India with approximately 1 million people being diagnosed each year. Twenty to forty percent of hospitalized patients with bacterial pneumonia develop pleural effusion. In India unlike western countries, tuberculosis pleura effusion is common. The pleural cavity is involved in approximately 5% of all patients with tuberculosis. Since there was no literature regarding the effectiveness chest mobility exercise with staked breathing or chest mobility exercises with incentive spirometery in pleural effusion. There was a need to find out as to which approach are the best ones to implement. Objective: To compare the efficacy of chest mobility exercise with stacked breathing versus chest mobility exercise with incentive spirometery on chest expansion in patients with pleural effusion. Materials and Method: 20 patients with pleural effusion were selected by easy sampling and randomly assigned into two groups (10 patients each groups). Group A received chest mobility exercises and intensive spirometery and group B received chest mobility exercises and stacked breathing. Both groups were instructed to perform the intervention 3 time per day, 8 to 10 time per session for one week. Chest expansion was measured by thoracic flow cytometry before and after one week of intervention. Result: In group A chest expansion increase from 2.68 to 2.87 which was statistically significant (P value < 0.0023). In Group B the chest expansion increases from 2.94 to 3.09 which was not statistically significant (P value < 0.216). Conclusion: It was concluded from the result that both chest mobility exercises with intensive spirometery and chest mobility exercise with stacked breathing are equally effective in improving the chest expansion in subject with pleural effusion. KEY WORDS: Pleural effusion, Chest mobility exercises, Incentive Spirometry, Stacked breathing, Thoracic flow cytometry.

Effect of Scapular Retraction Exercise on Shoulder Alignment, Pulmonary Function and Aerobic Capacity in Subjects with Forward Shoulder Posture

Background: Forward shoulder posture is identified when the acromion process is most anteriorly positioned when compared with the position of mastoid process, which is characterized by acromion protraction infront of the line of gravity as well as protraction, downward rotation and anterior tilt of scapula. It is one of the common postural abnormality that accounts for 60% of shoulder abnormalities, with an incidence of 75% in the right side and 66% in left side. The study aims to find the effect of scapular retraction exercises on shoulder alignment, pulmonary function and aerobic capacity in subjects with forward shoulder posture. Methods: The study was conducted on 14 subjects with FSP within the age group of 18 to 25. Scapular retraction exercises were given to the subjects for a duration of 3 weeks. Pre and post test values of scapular index, chest expansion, incentive spirometry and six minute walk test was taken. Results: Subjects showed statistically significant differences with a mean difference of 0.7(cm) for scapular index right, 0.68(cm) for scapular index left, 0.59(cm) for upper chest expansion, 1.21(secs) for inspiratory hold time using incentive spirometry and 6.79(m) for aerobic capacity (p<0.05, CI =95%). Pre and post mean scores of scapular index, chest expansion, inspiratory hold time and 6 minute walk test reveals that scapular retraction exercises has a positive impact on improving shoulder alignment, pulmonary function, and aerobic capacity Conclusion: Scapular retraction exercises is effective in improving shoulder alignment, pulmonary function and aerobic capacity in subjects with Forward shoulder posture KEY WORDS: Forward shoulder posture, rounded shoulder, pulmonary function, aerobic capacity, scapular retraction exercises, lung volume.