ArticlesRespiratory muscle weakness and respiratory muscle training in severely disabled multiple sclerosis patients☆1,☆2,☆3,☆4,☆5,☆6,☆7,☆8,☆9
Section snippets
Part 1
Twenty-eight bedridden or wheelchair-bound MS patients (mean age, 58 ± 14yrs; mean duration of the disease, 27 ± 13yrs) were studied to examine the contribution of respiratory muscle weakness to their impaired health status. FVC, inspiratory and expiratory muscle strength (PImax and PEmax), Pulmonary Index (PI), and Extended Disability Status Scale (EDSS) were measured. All patients were in a clinically stable condition for at least 4 weeks (no recent infection or exacerbation). All tests were
Pulmonary function, cough efficacy, and functional status
A significantly reduced FVC (1.4 ± 0.9L, 43 ± 26% predicted) was observed. The median PI score was 10 (ranging from 6 to 11) indicating severely impaired cough efficacy. The high median score on the EDSS (8.5, ranging from 6.5 to 9.5) (table 1) confirmed the markedly reduced mobility of the patients, nearly all being wheelchair bound or bedridden.
Respiratory muscle strength
The PEmax (29 ± 15cmH2O, 18 ± 8% predicted) was significantly more reduced than the PImax (25 ± 14cmH2O, 27 ± 11% predicted) (p <.01). Mean isometric
Discussion
It was concluded from the first part of the study that in wheelchair-bound and bedridden MS patients, expiratory muscle strength was more affected than inspiratory muscle strength. Expiratory muscle strength was significantly related to FVC, cough efficacy, and functional status.
From the second part of the study, it was concluded that expiratory muscle training tended to enhance both inspiratory and expiratory muscle strength and significantly improved the objectively and subjectively rated
Acknowledgements
The authors gratefully thank Mrs. R. Schepers for her expert help with statistical analysis, and Mrs. V. Debusschere, G. DeDekker, and N. Demolon for their assistance in data collection and supervision of the training.
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Supported by the Fonds voor Wetenschappelijk Onderzoek–Vlaanderen, grant P. 0188.97.
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
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Reprint requests to Rik Gosselink, PhD, Professor of Respiratory Rehabilitation, Division of Respiratory Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven Belgium.
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