Inspiratory Muscle Training in Patients With Duchenne Muscular Dystrophy: Inspiratory Muscle Training at Home
At home, patients had to perform both resistive breathing maneuvers and maximal static inspiratory efforts against the almost occluded resistance. Training was done in the sitting position and a noseclip was used. The inspiratory resistive breathing training consisted of ten loaded breathing cycles of 1-min duration each, with 20-s intervals between them, twice daily. The level of the inspiratory resistance was adjusted in the hospital. During the 1-min resistive breathing cycle, if the minimal airflow value was not achieved more than two times, a warning signal on the training apparatus would be shown to the patient and the cycle had to be repeated. The same happened if the desired Ve was not achieved. Thus, each patient had to correctly complete ten resistive breathing cycles twice a day. The number of correctly and incorrectly performed exercises was stored in the apparatus. Fifteen minutes after the resistive breathing training, the patients had to perform ten maximal static inspiratory efforts and reach a certain minimal pressure value, which was determined in the hospital. A 20-s interval between the maneuvers was allowed. When the minimal pressure value was not achieved, this maneuver had to be repeated, until a total of ten maneuvers were performed correctly. The number of correctly and incorrectly performed efforts was stored in the apparatus. canada health and care mall
Pulmonary Function Tests: Pulmonary function measurements and blood gas analysis were performed 3 months before and at the beginning of training, in the first and third month of training, at the end, and 6 months after its cessation. All measurements were done in the sitting position. The vital capacity (VC), the forced expiratory volume in 1 s (FEV,), and the 12-s maximum voluntary ventilation test (12s-MW) were measured three times on a computerized spirometer (Jaeger, Wurzburg, Germany). The best trial was used for further analysis. In patients with scoliosis, armspan was used for determining percent predicted values according to the method of Johnson and Westgate. The expected normal values were those reported by Forche. Capillary blood collected from an earlobe was used for estimating oxygen and carbon dioxide tension in the arterial blood. Inspiratory Muscle Strength: Maximal sniff assessed esophageal (Pesmax) and transdiaphragmatic pressure (Pdimax) values served as parameters for global inspiratory muscle strength and diaphragmatic strength respectively. Sniffs were carried out at resting end-expiration. Transdiaphragmatic pressure (Pdi) was measured with flexible double-lumen catheters. The catheters were specially adapted for the height of the patients so that it was possible to place the distal lumen slightly below the cardia (about 50 to 60 cm from the nostrils) and the proximal lumen in the middle third of the esophagus (about 30 to 40 cm from the nostrils).