ABSTRACT Objective: To compare the effectiveness of ab-dominal weights and incentive spirometry for improving the strength of diaphragm in tetra-plegics.
Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, Vel-lore, Tamil Nadu, India.
Study Design: Two group comparison study
Methods: Seventeen patients who fulfilled the inclusion criteria were assigned into an ABW or INS treatment groups using judgment sampling after obtaining an informed consent. Evaluation of the chest, respiratory status, vital signs and strength of diaphragm were done during initial assessment. ABW group underwent diaphrag-matic strengthening using Abdominal weights (ABW) and INT group with Incentive Spirometer (INS) for 15 minutes daily, 6 days a week, for a period of 6 weeks. The pre and post training values of peak amplitude in electro myogram (EMG) of the diaphragm, intercostals and ster-nocleidomastoid muscles were measured.
Statistical analysis: The analysis was done using SPSS 11. The pre and post-training values of peak EMG amplitudes of the diaphragm, inter- costals and sternocleidomastoid were com- pared within the groups using Wilicoxon’s sign test and between the two groups using Mann- Whitney’s test.
Results: The peak EMG of diaphragm of ABW group raised from 1.1289 to 1.3036 milli-volts with a significance of p&lt;0.001, whereas it fell from 1.7001 to 1.0441 milli-volts among INS group subjects with a significance of p&lt;0.001. Comparison between the 2 groups showed sta-tistically significant improvement in diaphrag-matic strength among the ABW group.
Conclusion: The results of this study sug-gests that, in the pulmonary rehabilitation of motor complete tetraplegic subjects abdominal weighted training of the diaphragm has better results in improving the strength of the muscle.Sponsorship: Fluid research grant of Christian Medical College, Vellore.
Cite this paper
nullWinser, S. , George, J. , Stanley, P. and Tharion, G. (2009) A comparison study of two breathing exercise techniques in tetraplegics. Health, 1, 88-92. doi: 10.4236/health.2009.12015.
 DeVivo, M.J., Black, K.J., and Stover, S.L. (1993) Causes during first twelve years after spinal cord injury. Arch Phys Med Rehabil, 74, 248-54.
Liaw, M.-Y., Lin, M.-C., and Cheng, P.-T. (2000) Resis-tive inspiratory muscle training: its effectiveness in pa-tients with acute complete cervical cord injury. Arch. Phys. Med Rehabil, 81, 747-751.
Garshiek, K.A. and Gross, E.R. (2003) Spirometry test-ing standards in spinal cord injury. Chest, 123, 725-730.
Ledsome, J.R. and Sharp, J.M. (1981) Pulmonary func-tions in acute cervical cord injury. Am Rev Respir Dis, 124, 41-44.
Lerman, R.M. and Weiss, M.S. (1987) Progressive resis-tive exercise in weaning high quadriplegic from the ven-tilator. Paraplegia, 25(2), 130-5.
Kisner, C. and Colby, L.A.. In: Therapeutic Exercises. Foundation and techniques, 3rd edn, 665-672.
Gross, D., Ladd, H.W., Riley, E.J. (1980) The effect of training on strength and endurance of the Diaphragm in quadriplegics. The American journal of Medicine, 68 (1), 27-35.
Wang, T.G., Wang, Y.H. (2002) Resistive inspiratory muscle training in sleep disordered breathing of trau-matic tetraplegia. Arch Phy Med Rehabil, 83(4), 491- 496.
Rutchik, A., Weissman, A.R. (1998) Resisitive inspira-tory muscle training in subjects with chronic spinal cord injury. Arch Phy Med Rehabil, 79 (3), 293-297.
Lane, C.S. (1982) Inspiratory muscle weight training and its effect on the vital capacity of patients with quadriple-gia. Boston (MA) Northern University.
Bodin, P., Fagevik Olsen, M., Bake, B. (2005) Effects of abdominal binding on breathing pattern during breathing exercises in persons with tetraplegia. Spinal Cord, 43, 117-122.
American spinal injury assosiation; standard for neuro-logical and functional classification of SCI. (1992) Re-vised 1992 Chicago ASIA.
Wetzel, J. L., Lunsford, B. R. In: Scot Irwin, Teclin (ed): Cardio Pulmonary Physical therapy, 3rd edn, 584-586.
Lin, H. and C.-C. Chung. (1999) Abdominal weight and Inspiratory resistance: Their immediate effects on inspi-ratory muscle functions during maximal voluntary breathing in chronic tertraplegic patients. Arch. Phys. Med. Rehabil, 80(7), 741-745.
Wetzel, J.L. and Lunsford, B.R. In: Scot Irwin, Teclin (ed): Cardio Pulmonary Physical therapy, 3rd edn, 588- 589.
Bodin, P., Kreuter, M., Bake, B., and Fagevik Olse, M. (2003) Breathing patterns during breathing exercises in persons with tetraplegia. Spinal Cord, 41, 290-295.
J. Derrickson, N. Ciesla, and N. Simpson. (1992) A com-parison of two breathing exercise programs for patients with Quadriplegia. Physical Therapy, 72(11), 763-769