#012- Articles on Tetraplegia and Muscular Dystrophy

ByAl-Jallad

Covered Topics:

1. Progressive Respiratory Muscle Training Increases Inspiratory Muscle Strength in People with Tetraplegia.

2. The Effect of Muscular Exercise on Facio-Scapulo-Humeral Dystrophy and Myotonic Dystrophy.

Estimated reading time: 3 minutes, 42 seconds.

Articles

Progressive Respiratory Muscle Training Increases Inspiratory Muscle Strength in People with Tetraplegia

After tetraplegia, the highest incidence of mortality occurs in the first year with respiratory causes accounting for 28% of deaths.

This RCT (PEDro score 10/10) tested the effectiveness of progressive respiratory muscle training program on lung function, quality of life and respiratory health.

62 participant, 30 participant allocated to respiratory muscle training group (RMT), 32 participant allocated to sham RMT.

RMT was done using a single threshold RMT device. The primary outcome was maximal inspiratory pressure (PImax).

Results:

After 6 weeks of RMT

  • PImax was significantly better in the active group than in the sham group.
  • Respiratory symptom severity (SGRQ) score for all participants improved more in the active group compared with the sham group.
  • Borg scores for breathlessness during 10 inspiratory loaded breaths reduced more in the active group compared with the sham group for all participants.
  • There was no significant difference between the sham and active groups in maximal expiratory pressure (PEmax), lung function, number of respiratory complications, remaining SF-36ww fields and SGRQ domains.

At 1-year follow-up, (Participants were asked to perform RMT by themselves).

  • Participants in the active group had less respiratory complications than participants in the sham group.
  • No difference between groups in all other outcome measures was found at the 1-year follow-up.

Learned from this article

6 weeks of using a respiratory muscle training device can

  1. Improve inspiratory muscle strength in acute and chronic tetraplegia.
  2. Decline the respiratory related morbidity.
  3. Improve quality of life.

The authors concluded that RMT should be implemented as a routine therapy for people with tetraplegia.

The Effect of Muscular Exercise on Facio-Scapulo-Humeral Dystrophy and Myotonic Dystrophy

This systematic review and meta analysis investigated the effect of muscular exercise vs no exercise on muscular dystrophy.

Spoiler alert, the conclusion is that muscular exercise did not improve muscle strength and barley improved endurance during walking in patients with facio-scapulo-humeral and myotonic dystrophy.

11 Trials including 584 participant, with most trials being low risk of bias.

Type of exercises in the included studies:

  • Dynamic strength training with weights.
  • Isometric strength training.
  • Aerobic exercise.
  • Balance exercise with music.
  • Hand training program.
  • Cycling exercise on an ergometer.
  • Assisted bicycle home training program.
  • Physical fitness programs.
  • Treatment duration ranged between 8 and 52 weeks.

Results

  • Muscle Strength:
    • Global muscle strength: No significant difference between groups based on low quality evidence from 7 studies including 239 participant.
    • Extensor muscle strength: No significant difference between groups based on very low quality evidence from 4 studies including 115 participant.
    • Knee flexors and elbow flexors: No significant difference between groups.
  • Endurance during walking: Muscular exercise can improve endurance during walking, low quality evidence from 5 studies and 380 participant.
  • Fatigue: muscular exercise did not reduce fatigue, very low quality evidence from 5 studies including 373 participant.

Note

  • The authors stated that due to paucity of trials, they were unable to provide clear answer and that exercise might have been useful, not useful or even detrimental.
  • In conclusion, they stated that muscular exercise is not recommended for strength improvement, management of motor abilities or fatigue reduction.
  • And, muscular exercise can be recommended to improve endurance during walking in most patients with muscular dystrophy.
  • Another systematic review that included the trials except for one trial also, found similar results.

Good Note

  • A simple and cheap device as respiratory muscle training can improve inspiratory muscle strength, improve quality of life and decline the respiratory related morbidity in patients with tetraplegia.

Bad Note

There is a serious lack of evidence regarding effective physiotherapy interventions for muscular dystrophy.

Recommended Reads:

References

  1. Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial. (Open Access)
  2. Effect of Muscular Exercise on Patients With Muscular Dystrophy: A Systematic Review and Meta-Analysis of the Literature. (Open Access)

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