• Journal of the Korean Society of Physical Medicine
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• v.11 no.2
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• pp.123-130
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• 2016

PURPOSE: This study was conducted to determine correlations between grip and lower limb muscle strength and pulmonary function and respiratory muscle in children with cerebral palsy. METHODS: Subjects were 17 children with cerebral palsy. Inclusion criteria for participation were having GMFCS from I to III grade and ability to independently blow into a spirometer. Pulmonary function and respiratory muscle were measured with a spirometer. All subjects performed maximal expiratory flow maneuvers using a spirometer in order to determine their forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and FEV1/FVC, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Muscle strength was measured in terms of grip strength and lower limb muscle strength in terms of knee extension strength with a dynamometer and manual digital muscle tester respectively. Data were analyzed using Person product correlation. RESULTS: Grip strength significantly positively correlated with FVC (r=0.95, p<0.01), FEV1 (r=0.95, p<0.01), PEF (r=0.84, p<0.01), MIP (r=0.65, p<0.01) MEP (r=0.71, p<0.01) and lower limb strength with FVC (r=0.72, p<0.01), FEV1 (r=0.69, p<0.01), PEF (r=0.54, p<0.05), and MEP (r=0.69, p<0.01). CONCLUSION: Grip and lower limb muscle strengths of children with cerebral palsy were positively correlated pulmonary function and respiratory muscle.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.4
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• pp.155-161
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• 2020

Purpose : This study was conducted to investigate the effect of positive active pressure technique and active breathing technique on lung function in healthy adults. Methods : In this study, the passive lung expansion technique and active respiration enhancement technique using an air mask bag unit were conducted in 30 normal adults to observe changes in pulmonary function with forced vital capacity (FVC), Forced expiratory volume at one second (FEV1). In order to observe the change in the level of respiratory function, we would like to investigate the peak expiratory flow (PEF) and the forced expiratory flow (FEF 25-75 %). Results : As a result of this study, there was no significant difference in comparison between the passive lung expansion technique and the active breathing enhancement technique (p>.05). The passive lung expansion technique effectively increased the effortful expiratory volume and the median expiratory flow rate of 1 second (p<.05). And the passive lung expansion technique effectively increased the effortless lung capacity and the maximum expiration flow rate (p<.05). Conclusion : The passive lung expansion technique effectively increases the range of motion of the lungs and chest cages, intrathoracic pressure, and elasticity of the lungs, and the active breathing technique increases the muscle functions such as the diaphragm and the biceps muscles. It is expected that it will be able to selectively improve the respiratory function of patients with respiratory diseases or functional limitations as it is found to be effective.

• Physical Therapy Korea
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• v.25 no.1
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• pp.12-21
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• 2018

Background: Research efforts to improve the pulmonary function of children with cerebral palsy (CP) need to focus on their decreased diaphragmatic ability compared to normal children. Real-time ultrasonography is appropriate for demonstrating diaphragmatic mechanisms. Objects: This study aimed to compare diaphragm movement, pulmonary function, and pulmonary strength between normal children and children with CP by using ultrasonography M-mode. The correlation between general characteristics, diaphragm movement, pulmonary function, and pulmonary strength was also studied. Methods: The subjects of this study were 25 normal and 25 CP children between five and 14 years of age. Diaphragm movement was measured using real-time ultrasonography during quiet and deep breathing. Pulmonary function (such as forced expiratory volume in one second; FEV1 and peak expiratory flow; PEF) and pulmonary strength (such as maximum inspiratory pressure; MIP and maximum expiratory pressure; MEP) were measured. A paired t-test and Spearman's Rho test, with a significance level of .05, were used for statistical analysis. Results: The between-group comparison revealed that normal children had significantly greater diaphragm movement, FEV1, PEF, MIP, and MEP (p<.05) than CP children. The results showed that general characteristics were significantly related to FEV1, PEF, MIP, and MEP (p<.05). Conclusion: In clinical settings, clinicians need to concern decreased diaphragm movement, pulmonary function, and pulmonary strength in CP group compared to normal children.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.1
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• pp.121-128
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• 2018

PURPOSE: This study assessed the effect of exercise intervention methods on diaphragm movement, pulmonary function, and pulmonary strength in children with cerebral palsy (CP). METHODS: A total of 28 children with CP were randomly allocated to the general exercise group (n=9, GEG), respiratory exercise group (n=10, REG), and intensive exercise group (n=9, IEG). The exercise intervention was performed for 12 weeks. This study measured diaphragm movement, pulmonary function, and pulmonary strength under two different conditions before and after each exercise. Ultrasonography was used for measuring diaphragm movement, and Pony Fx was used to measure the forced expiratory volume in one second ($FEV_1$), peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). A Mann-Whitney test and ANOVA with a significance level of .05 were used for statistical analysis. RESULTS: Significant change was observed between the REG and the IEG as well as between the GEG and the IEG (p<.05). No significant difference was observed between the GEG and the REG. The diaphragm movement, $FEV_1$ PEF, MIP, and MEP were most improved in the IEG (p<.01). CONCLUSION: This study confirmed that intensive exercise is the most effective treatment method for improving diaphragm movement and respiratory function in CP children.

• Speech Sciences
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• v.12 no.4
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• pp.203-213
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• 2005

This study was conducted to investigate the respiratory and aerodynamic function of adductor spasmodic dysphonia (ADSD) patients. Participants were (1) 18 females SD patients with non- Botulinum toxin injection (2) 14 females SD patients who had taken treatment of Botulinum toxin injection. (3) 14 age- and sex- matched normal female controls. Spirometer and phonatory function analyzer were used for respiratory muscle pressure (MIP: Maximum inspiratory pressure), MEP: Maximum expiratory pressure)& MPT(Maximum phonation time) and aerodynamic(F0:Fundamental frequency, intensity, MFR: Mean flow late, Psub: Subglottal pressure) measurement. The results were as follows: (1) Normal group was significantly higher in MIP, MEP, MPT than two SD groups (p < .05); (2) MPT was significantly lower in SD with non-Botulinum toxin injection group than SD with the treatment experience of Botulinum toxin injection (p < .05); (3) All aerodynamic parameters, F0, intensity, MFR, Psub, were not significantly different among three groups(p > .05).The reason of short MPT in ADSD may use lower respiratory pressure than normal group as strategy to decrease their tremulous voice quality. Moreover respiratory muscle pressure was lower than normal group regardless of botulinum toxin injection treatment.

• Phonetics and Speech Sciences
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• v.6 no.4
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• pp.195-203
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• 2014

The aim of this study was to investigate the effects of phonation types ([+/- aspirated], [+/- fortis]) on aerodynamic measures with Korean bilabial stops. Sixty-three healthy young adults (30 males, 33 females) participated to evaluate the VOEF (Voicing Efficiency) tasks with bilabial stop consonants /$p^h$/, /p/, /p'/ using Phonatory Aerodynamic System (PAS) Model 6600 (Kay PENTAX Corp, Lincoln Park, NJ). All VOEF measures were significantly influenced by phonation types except RANP(pitch range)(p <.01). For sound pressure, maximum SPL, mean SPL, and Mean SPL during Voicing have been shown to be significantly greatest in fortis stop /p'/ than aspirated /$p^h$/ and lenis stop /p/ (p<.001). On the other hand, mean pitch after lenis stop was significantly lower than after aspirated and fortis stops (p<.001). Peak expiratory airflow, Target airflow, and FVC (Expiratory volume) were significantly lowest in fortis stop /p'/ which might be associated with higher aerodynamic resistance while peak air pressure and mean peak air pressure during closure were significantly lower in lenis stop /p/. Additionally, AEFF (Aerodynamic efficiency) was significantly higher in fortis stop /p'/ than lenis stop /p/ as well as aspirated stop /$p^h$/ (p<.001). Thus, sound pressure, airflow parameters, and aerodynamic resistance made crucial roles in distinguishing fortis /p'/ from lenis stop /p/ and aspirated. Additionally, pitch and subglottal air pressure parameters were important aerodynamic characteristics in distinguishing lenis /p/ from fortis /p'/ and aspirated /$p^h$/. Therefore, accurate aspirated /p/ stop consonant should be elicited when collecting the airflow, intraoral pressure related data with patients with voice disorders in order to enhance the reliability and relevance or validity of aerodynamic measures using PAS.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.3
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• pp.25-33
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• 2023

Purpose : Stabilization exercise and respiratory muscle training are used to train trunk muscles that affect postural control and respiratory function. However, there have been no studies that combine stabilization exercise and respiratory muscle training. The purpose of this study is to investigate effects of stabilization exercise with and without respiratory muscle training on respiratory function and postural sway. Methods : Fifteen healthy adults were recruited for this experiment. All the subjects performed stabilization exercise with and without respiratory muscle training. For stabilization exercise with respiratory muscle training, the subjects sat on a gym ball wearing a stretch sensor. The subjects inspire maximally as long as possible during lifting one foot off the ground, alternately for 30 seconds. The stretch sensor was placed on both anterior superior iliac spine (ASIS), and the stretch sensor was used to monitor inspiration. For stabilization exercise without respiratory muscle training, the subjects sat on a gym ball and lifted one foot off the ground, without respiratory muscle training. Kinovea program used to investigate postural sway tracking during exercise. The maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using a spirometer to investigate changes of respiratory muscle strength before and after exercise. A paired t-test was used to determine significant differences postural sway tracking, MIP, and MEP between stabilization exercise with and without respiratory muscle training. Results : There were significantly lower a distance of postural sway tracking during stabilization exercise with respiratory muscle training, compared with stabilization exercise without respiratory muscle training (p<.05). The MIP and MEP were significantly increased after stabilization exercise with respiratory muscle training compared with before stabilization exercise with respiratory muscle trianing (p<.05). Conclusion : The results of this study suggest that stabilization exercise with repiratory muscle training would be recommended to improve postural control and respiratory muscle strength.

• Tuberculosis and Respiratory Diseases
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• v.85 no.2
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• pp.137-146
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• 2022

Background: Farinelli breathing (FB) exercise is a typical breathing exercise used by singers. This study aimed to compare effects of FB exercise and diaphragmatic breathing (DB) exercise on respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD). Methods: Sixteen patients aged 51-80 years with mild or moderate COPD were recruited for this study. They were divided into two groups: DB group (n=8) and FB group (n=8). Both groups received complete breathing exercise training five times per week for 8 weeks. Their respiratory functions, COPD symptoms, cytokine levels, and oxidative stress variables were analyzed during pre- and post-tests. Dependent variables were compared between pre- and post-tests using paired t-tests. An independent t-test was used to compare variables between the groups. Differences were considered significant at p<0.05. Results: The maximal expiratory pressure (MEP), maximum oxygen consumption (VO₂max), and COPD Assessment Test (CAT) scores changed significantly in the DB group after the 8-week intervention compared to those at pre-test, whereas force vital capacity, forced expiratory volume in the first second, maximum voluntary ventilation, maximal inspiratory pressure (MIP), MEP, VO₂max, CAT score, tumor necrosis factor-α, and malondialdehyde level changed significantly in the FB group at post-test compared to those at pre-test. Moreover, both MIP and MEP in the FB group were significantly higher than those in the DB group. Conclusion: FB exercise improved respiratory functions and COPD symptoms of patients with COPD. It might be an alternative breathing exercise in pulmonary rehabilitation programs for patients with COPD.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.2
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• pp.29-40
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• 2022

PURPOSE: This study examined the effects of an exercise program for the thoracic spine and scapula rather than the neck, which is the primary site of pain. METHODS: Thirty-two elementary school teachers with a forward head posture (FHP) were assigned randomly to either the experimental group (n = 16) or the control group (n = 16). The experimental group performed scapular stabilization exercise (SSE) and thoracic extension exercise (TEE), and the control group performed cervical self-myofascial release exercise and stretching exercise. The pulmonary functions, pain, craniovertebral angle (CVA), and cervical range of motion (CROM) were measured before the intervention and six weeks after. RESULTS: The within-group comparisons showed that the VAS and CROM (except for extension) in both groups were significantly different before and after the intervention (p < .05). The changes in the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume at 1 sec (FEV1), and CVA were significant only in the experimental group (p < .05). The between-group comparisons showed a significant difference in the FVC, FEV1, VAS, CVA, and left lateral flexion (p < .05). CONCLUSION: The combination of SSE and TEE in the experimental group was more effective in improving the FHP and breathing ability. Moreover, the experimental group and control combination appeared to be effective in reducing pain and improving the CROM. The combination of SSE and TEE, which are exercises that do not target the cervical spine directly, was effective in improving the posture, respiration, neck pain, and CROM in elementary school teachers with FHP.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1310-1316
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• 2005

Mechanical ventilation in children has some differences compared to in neonates or in adults. The indication of mechanical ventilation can be classified into two groups, hypercapnic respiratory failure and hypoxemic respiratory failure. The strategies of mechanical ventilation should be different in these two groups. In hypercapnic respiratory failure, volume target ventilation with constant flow is favorable and pressure target ventilation with constant pressure is preferred in hypoxemic respiratory failure. For oxygenation, fraction of inspired oxygen($FiO_2$) and mean airway pressure(MAP) can be adjusted. MAP is more important than FiO2. Positive end expiratory pressure(PEEP) is the most potent determinant of MAP. The optimal relationship of $FiO_2$ and PEEP is PEEP≒$FiO_2{\times}20$. For ventilation, minute volume of ventilation(MV) product of tidal volume(TV) and ventilation frequency is the most important factor. TV has an maximum value up to 15 mL/kg to avoid the volutrauma, so ventilation frequency is more important. The time constant(TC) in children is usually 0.15-0.2. Adequate inspiratory time is 3TC, and expiratory time should be more than 5TC. In some severe respiratory failure, to get 8TC for one cycle is impossible because of higher frequency. In such case, permissive hypercapnia can be considered. The strategy of mechanical ventilation should be adjusted gradually even in the same patient according to the status of the patient. Mechanical ventilators and ventilation modes are progressing with advances in engineering. But the most important thing in mechanical ventilation is profound understanding about the basic pulmonary mechanics and classic ventilation modes.