DOI QR코드

DOI QR Code

The Efficacy of Pulmonary Rehabilitation Using Mechanical In-Exsufflator in Stroke Patients with Tracheostomy Tube

강제 양압식 호흡훈련이 기관절개관을 삽입한 뇌졸중 환자의 호흡재활에 미치는 효과

  • Jang, Sang-Hun (Graduate school of physical therapy, Daegu University) ;
  • Lee, Yean-Seop (Graduate school of physical therapy, Daegu University) ;
  • Kim, Jin-Sang (Department of physical therapy, Daegu University)
  • 장상훈 (대구대학교 재활과학과 대학원) ;
  • 이연섭 (대구대학교 재활과학과 대학원) ;
  • 김진상 (대구대학교 재활과학대학 물리치료학과)
  • Received : 2012.04.25
  • Accepted : 2012.07.12
  • Published : 2012.07.31

Abstract

The purpose of this study was to investigate the efficacy of mechanical in-exsufflator (MI-E) with on pulmonary rehabilitation in stroke patients with trachostomy tube. Methods: We studied ten stroke patients who had neither history nor radiologic finding of pulmonary disease. The pulmonary function was evaluated by measuring forced vital capacity (FVC), forced expiratory volume at one second (FEV1) and forced expiratory ratio (FEV1/FVC) The capacity of cough was evaluated by measuring manual assisted peak cough flow (MPCF). Data were analyzed statistically using repeated ANOVA test. Results:The results were as follows : 1) There are significant improvement of FVC and FEV1 according to training period (p<.05). 2) There are significant improvement of MPCF according to training period (p<.05). Conclusion:These results suggest that MI-E training can be used as an effective therapeutic modality for improvement of pulmonary function and capacity of cough in stroke patients with tracheostomy.

Keywords

Mechanical in-exsufflator;Tracheostomy;Pulmonary rehabilitation

References

  1. Statistics Korea, Cause of Death statistics, 2009
  2. C. Y. Kwak, E. S. Yim, and A. R. Kim, "A Analysis of inappropriate reimbursement claims from the LTC insurance plan in South Korea", Journal of the Korean Data Analysis Society, 13(5), 2377-2390, 2011.
  3. Y. J. Son, Y. S. Kim, H. M. Jung, and K. H. Shon, "Effect of the upper meridian massage of the upper extremity function and ADL in stroke patients", Journal of the Korean Data Analysis Society, 8(5), 1747-1764, 2006.
  4. P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker, "Management of Adult Stroke Rehabilitation Care: a clinical practice guideline", Stroke, 36(9), e100-143, 2005. https://doi.org/10.1161/01.STR.0000180861.54180.FF
  5. J. H. Lee, "The effect of pulmonary function in the stroke patients after feeback breathing exercise", Daegu university, Dissertation of Master's Degree, 2008.
  6. R. L. Mori, A. E. Bergsman, M. J. Holmes, and B. J. Yates, "Role of the medial medullary reticular formation in relaying vestibular signals to the diaphragm and abdominal muscles", Brain Research, 902(1), 82-91, 2001. https://doi.org/10.1016/S0006-8993(01)02370-8
  7. U. Agnarsson, G. Thorgeirsson, H. Sigvaldason, and N. Sigfusson, "Effects of leisure-time physical activity and ventilatory function on risk for stroke in men: the Reykjavik Study", Annals of Internal Medicine, 130(12), 987-990, 1999. https://doi.org/10.7326/0003-4819-130-12-199906150-00006
  8. U. Walter, "Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit", Journal of Neurology, 254(10), 1323-1329, 2007. https://doi.org/10.1007/s00415-007-0520-0
  9. K. Ward, "Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough", The European Respiratory Journal, 36(6), 1383-1390, 2010. https://doi.org/10.1183/09031936.00010510
  10. J. R. Bach, "Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure", Chest, 110(6), 1566-1571, 1996. https://doi.org/10.1378/chest.110.6.1566
  11. P. Sivasothy, L. Brown, I. E. Smith, and J. M. Shneerson, "Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness", Thorax, 56(6), 438-444, 2001. https://doi.org/10.1136/thorax.56.6.438
  12. S. W. Kang, H. H. Ryu, J. C. Shin, Y. R. Kim, and J. E. Kim, "The relationships of coughing to the respiratory muscle strength and pulmonary compliance in tetraplegic patients", The Journal of Korean Academy of Rehabilitation Medicine, 26(6), 704-708, 2002.
  13. A. Vianello, "Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections", American Journal of Physical Medicine & rehabilitation, 84(2), 83, 2005. https://doi.org/10.1097/01.PHM.0000151941.97266.96
  14. C. I. Park, J. C. Shin, S. W. Kang, B. H. Lee, Y. S. Choi, Y. R. Kim, and S. C. Jeon, "The Efficacy of pulmonary rehabilitaton using mechanical in-exsufflator in cervical cord injured patients, The Journal of Korean Academy of Rehabilitation Medicine, 26(4), 403-408, 2002.
  15. M. Y. Liaw, M. C. Lin, P. T. Cheng, M, K. Wong, and F. T. Tang, "Resistive inspiratory muscle training: it is effectiveness in patients with acute complate cervical cord injury", Archives of Physical Medicine and Rehabilitation, 81, 752-756, 2000. https://doi.org/10.1016/S0003-9993(00)90106-0
  16. E. Cohen, "Diaphragmatic movement in hemiplegic patients measured by ultrasonography", Thorax, 49(9), 890-895, 1994. https://doi.org/10.1136/thx.49.9.890
  17. A. De Troyer, D. B. D. Zegers, and M. Thirion, "Function of the respiratory muscles in acute hemiplegia", The American review of respiratory disease, 123(6), 631-632, 1981.
  18. S. Ogiwara, "Antero-Posterior Excursion of the Hemithorax in Hemiplegia", Journal of Physical Therapy Science, 13(1), 11-15, 2001. https://doi.org/10.1589/jpts.13.11
  19. B. Lanini, "Chest wall kinematics in patients with hemiplegia" American Journal of Respiratory and Critical Care Medicine, 168(1), 109-113, 2003. https://doi.org/10.1164/rccm.200207-745OC
  20. E. M. Khedr, "Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients", European Journal of Neurology, 7(5), 509-516, 2000. https://doi.org/10.1046/j.1468-1331.2000.00104.x
  21. R. R. Britto, "Inspiratory Muscular Training in Chronic Stroke Survivors: A Randomized Controlled Trial", Archives of Physical Medicine and rehabilitation, 92(2), 184-190, 2011. https://doi.org/10.1016/j.apmr.2010.09.029
  22. K. Kim, "Feedback Respiratory Training to Enhance Chest Expansion and Pulmonary Function in Chronic Stroke: A Double-Blind, Randomized Controlled Study", Journal of Physical Therapy Science, 23(1), 75-79, 2011. https://doi.org/10.1589/jpts.23.75
  23. L. J. Miske, "Use of the Mechanical In-Exsufflator in Pediatric Patients With Neuromuscular Disease and Impaired Cough", Chest, 125(4), 1406-1412, 2004. https://doi.org/10.1378/chest.125.4.1406
  24. J. R. Bach, "Continuous noninvasive ventilation for patients with neuromuscular disease and spinal cord injury", Seminars in respiratory and critical care medicine, 23(3), 283-292, 2002. https://doi.org/10.1055/s-2002-33037
  25. B. R. Kim, M. H. Chun, and S. H. Kang, "Change of respiratory function following rehabilitation in acute hemiplegic stroke", The Journal of Korean Academy of Rehabilitation Medicine, 33(1), 21-28, 2009.
  26. M. J. Walshaw, "Hypoxia in patients with acute hemiplegia", British Medical Journal, 288(7), 15-17, 1984. https://doi.org/10.1136/bmj.288.6410.15
  27. M. K. Kim, H. H. Kim, and G. Bo Hwang, "The effects of the mechanical insufflation-exsufflation method on lung function in patients with spinal cord injury(C5, C6)", Journal of the Korean Data Analysis Society, 13(4), 1905-1914, 2011.
  28. J. A. Ekstrum, "Effects of a Thoracic Mobility and Respiratory Exercise Program on Pulmonary Function and Functional Capacity in Older Adults", Physical & Occupational Therapy in Geriatrics, 27(4), 310-327, 2009. https://doi.org/10.1080/02703180902803895
  29. R. Bianchi, "Chest Wall Kinematics and Breathlessness During Pursed-Lip Breathing in Patients With COPD", Chest, 125(2), 459-465, 2004. https://doi.org/10.1378/chest.125.2.459
  30. M. T. Putt, "Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease", Archives of Physical Medicine and Rehabilitation, 89(6), 1103-1107, 2008. https://doi.org/10.1016/j.apmr.2007.11.033
  31. G. Dechman, "Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease", Physical Therapy, 84(12), 1189-1197, 2004.
  32. L. M. Gauld, "Relationship between peak cough flow and spirometry in Duchenne muscular dystrophy", Pediatric Pulmonology, 39(5), 457-460, 2005. https://doi.org/10.1002/ppul.20151