| Abstrakt: |
Background and Purpose: Inspiratory Muscle Training (IMT) is an intervention used to improve functional performance, respiratory capacity, and recently as a method to improve low back pain (LBP). This case study reports on the effects of IMT combined with Pilates-based physical therapy (PPT) on an insidious onset right hemi-diaphragm partial paralysis in an older woman with LBP. Case Description: The subject was an 81-year old female with a history of chronic bronchitis, chronic LBP, and a prolonged period of hospital bed-rest due to pneumonia and an insidious onset right hemi-diaphragm paralysis. Outpatient PPT with 2 L supplemental oxygen (02O) was initially provided for 12 weeks which was followed by PPT with IMT utilizing the Threshold inspiratory muscle training device for 16 additional weeks. Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) measurements were taken with the MicroMedical Mouth Pressure Manometer upon initiation of IMT and after 7 and 16 weeks of IMT. The IMT protocol commenced at 20% of MIP and was progressed by increments of 5% over the next 5 sessions resulting in a workload reflecting 45% of baseline MIP for 10 minutes daily. IMT was administered after PPT sessions which consisted of PPT exercises with emphasis on core musculature engagement, axial elongation, flexibility, and overall strengthening. Daily IMT as described above was also performed at home between PT sessions. Outcomes: MIP and MEP increased substantially from baseline (50-63.3 cm H2O and 95.3-125.3 cm H2O) which were 9% and 7%, respectively, above her age-predicted values, but LBP symptoms persisted. Palpation and visual observation of right sided bucket-handle motion increased substantially and was better coordinated during PPT with longer inspiratory durations. The subject reported substantially less dyspnea and improved walking ability and no longer required supplemental 02O after 16 weeks of combined IMT and PPT. At baseline the subject was denied spinal surgery because of poor respiratory status, but was cleared for surgery after IMT and PPT due to improved respiratory capacity enabling safe administration of anesthesia. Discussion: Combined IMT and PPT improved respiratory muscle strength, hemi-diaphragm paralysis and dyspnea, and resolved the need for supplemental 02O, but did not affect LBP symptoms. Combined IMT and PPT appear to be important therapeutic interventions for patients with hemi-diaphragm paralysis. Since IMT was added after 12 weeks of PPT, combined IMT and PPT appear to be responsible for the improvements observed in this case report. Further investigation of combined IMT and PPT in patients with hemi-diaphragm paralysis is warranted. [ABSTRACT FROM AUTHOR] |
