Inspiratory Muscle Training in Individuals with Spinal Cord Injuries
1Sliwinski M, 2Boak S, 2Courville A, 2Dearwater M, 2Radhakrishnan S, 3Leathem J
1Columbia University Medical Center, New York, NY, USA; 2Columbia University, New York, NY, USA; 3John F. Kennedy Medical Center, Edison, NJ, USA
Objective: Though life expectancy is rising for individuals with spinal cord injuries (SCI), these individuals are considered to be at risk for many secondary health conditions. In this population, respiratory disorders are a common cause of re-hospitalization, and pneumonia is a leading cause of premature death. Prevention of respiratory illnesses is thus vital to individuals with SCI. Similar to the normative population, exercise is shown to positively affect prevention of these illnesses. Wheeling Forward’s Spinal Mobility X Class is an exercise program designed for individuals with SCI. The program consists of 3 circuits: strength, aerobic, and trunk stability. Inspiratory muscle training (IMT) was shown to improve diaphragm muscle hypertrophy in Paralympic athletes with SCI and short term increase in maximum inspiratory pressure in individuals with SCI. Therefore, developing effective respiratory training programs for community dwelling individuals with SCI in addition to exercise programs is critical for the prevention of illness. This study was designed to explore the effects on function when adding inspiratory respiratory training to the Spinal Mobility exercise program for individuals with SCI.
Design/Methods: Ten individuals consented and 6 completed the training. Participants were trained on IMT using the Respironics inspiratory muscle trainer. They were instructed to train twice daily and record on a daily diary sheet for 7 weeks while participating in the Spinal Mobility exercise program. Pre and post data were collected for four measures: transfer time, time to don and doff a t-shirt, four-directional sit and reach distance, and four-directional trunk strength using a hand held dynamometer (HHD).
Results: Overall subjects improved in all four measures, transfer test (mean 14.62 + 7.00 s), t-shirt test (mean 7.83 + 13.88 s), reach test (mean 3.75 + 8.06 in) and HHD (mean 6.73 +8.02 kg). Data was excluded from one subject in the t-shirt test and the transfer test due to reported excessive fatigue. Subject 3 demonstrated the greatest improvements in all measures and also reported the greatest compliance with IMT.
Conclusions: This pilot study demonstrated an overall positive impact on the four outcome measures for individuals who completed the study. The individual who completed the most training according to the training diaries had the greatest improvements in all measures. These results do not indicate whether the improvements were secondary to the exercise program or the IMT.
This study shows preliminary benefits in improving efficiency of some daily tasks for individuals with SCI who have respiratory compromise by regularly performing IMT and participating in exercise circuit training. Interestingly no other studies have used HHD to assess trunk stability in community dwelling adults with chronic SCI. Future studies are warranted to address the limitations of this study, which was exploratory in nature. Clinicians may nevertheless consider training and educating patients on IMT for home use prior to discharge from rehabilitation.
Support: The Program in Physical Therapy at Columbia University provided the inspiratory muscle training devices for the participants
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