Article

Lung volume recruitment (LVR) is a cough assistance technique used in
persons with neuromuscular disorders (NMDs), most typically in those requiring
noninvasive ventilation (NIV). Whether it may be useful in persons with NMDs who
have milder respiratory impairment is unknown. OBJECTIVE: To assess the
feasibility, impact on quality of life (QOL), and preliminary physiological
effects of daily LVR in different categories of persons with NMDs who have an
early stage of respiratory impairment.
DESIGN: Feasibility study. SETTING:
Academic tertiary care center. PARTICIPANTS: Outpatients diagnosed with
amyotrophic lateral sclerosis (n = 8), postpolio syndrome (n = 10), and myotonic
dystrophy (n = 6) who had restrictive respiratory defects but were not yet using
NIV. METHODS: Participants were asked to perform LVR up to 4 times daily and log
their LVR use in a diary. Physiological measurements and questionnaires were
completed at baseline and after 3 months. MAIN OUTCOME MEASUREMENTS: Compliance
with LVR use was assessed, along with QOL and willingness to continue the
treatment. Physiological measurements included forced vital capacity (FVC), lung
insufflation capacity (LIC), and the LIC minus FVC difference. RESULTS: Of the 24
recruited subjects, 7 with amyotrophic lateral sclerosis, 7 with postpolio
syndrome, and 5 with myotonic dystrophy completed the study
(n = 19). At
baseline, mean values for FVC and spontaneous peak cough flow were 59.9%
predicted and 373.1 L/min, respectively. For subjects completing the study, 74%
were willing to continue long-term LVR use, and QOL scores were not adversely
affected by LVR in any NMD subgroup. The LIC-FVC difference increased from
baseline to follow-up by a mean of 0.243 L (P = .006) in all subjects (n = 19),
suggesting a possible improvement in respiratory system mechanics. CONCLUSIONS:
In patients with NMDs who have early restrictive respiratory defects but do not
yet require NIV, regular use of LVR is feasible with no negative impact on QOL
over a 3-month period and may have physiological benefits. Further work is needed
to determine whether early institution of LVR can improve respiratory system
mechanics and help delay ventilatory failure in persons with NMDs.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS