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Publication of the Medical Rehabilitation is under the auspices of the Committee on Rehabilitation, Physical Education and Social Integration of the Polish Academy of Science
Article
Medical Rehabilitation - quarterly journal
Volume 13 year 2009, Issue number 1
Changes of ventilatory parameters in the positional training of persons after cervical spinal cord injury
Authors: Piotr Tederko, Marek Krakuski
Medical Rehabilitation 2009; 13(1): 11-17
Changes of ventilatory parameters in the positional training of persons after cervical spinal cord injury
Zmiany parametrów wentylacyjnych w trakcie pionizacji osób po urazie rdzenia kręgowego w odcinku szyjnym
Piotr Tederko (A,B,C,D,F), Marek Krakuski (A,D,E)
Medical University of Warsaw, Departament of Rehabilitation
2nd Departament of Rehabilitation of Musculoskeletal Disorders, Marian Weiss STOCER Rehabilitation Centre, Konstancin, Poland
Key words
spinal cord injury, spirometry, ventilatory parameters, rehabilitation, postural training
Abstract
Background: Cervical spinal cord injury (CSCI) is followed by mixed respiratory dysfunction.
Purpose: Evaluation of the ventilatory parameters of CSCI patients in postures typical for positional training. Material: 51 CSCI patients in a mean age of 34.4 (SD=14.6) years; complete motor deficite (CMD) 66.6%; injury of C5 level or above – 68.6%. Control group(CG): 10 healthy volunteers.
Method: Spirometry and flow-volume examination in recumbent (R), sitting (S) and vetrical 60o tilt (V) positions. Main results: Expiratory reserve volume (ERV) undergoes significant positional changes in CG (R: 1.34 L, H: 0.25 L, V: 0.79 L; p=0.02), but not in CSCI patients. Transition from R to S in CMD persons results in a significant decrease in vital capacity (VC) (from 2.45 to 1.75 L; p=0.0008); inspiratory capacity (IC) (from 2.48 to 1.41 L; p=0.0008); forced expiratory volume in 1 second (FEV1)(from 2.21 to 1.64 L; p=0.002); forced vital capacity (FVC) (from 2.55 to 1.78 L; p=0.0004). The FEV1/FVC rate does not depend on positional changes ranging from 89.7% to 93.9% of the reference values. Ventilatory parameters in the incomplete motor deficite (ICMD) group do not differ significantly between the examined body positions. Transition between R and S in the CMD group results in a significant decrease in the peak expiratory flow (PEF) (from 4.23 to 3.53 L/s) and the peak inspiratory flow (PIF) (from 3.89 to 3.43 L/s), while in ICMD the PEF increases from 4.01 to 4.39 L/s and the PIF increases from 3.66 to 4.18 L/s.
Conclusions: Transition from R to S in CSCI patients results in increased restriction. CMD patients express a reduction of peak flows while in the ICMD peak flows increase after transition between R and S. Shifting from S to a 60o vertical tilt with standard trunk stabilization does not change significantly the respiratory parameters in CSCI patients.