Breathing pattern in chronic quadriplegia.

The resting breathing pattern in 14 chronic C6 and C7 traumatic quadriplegics was compared with six age-matched healthy controls. All quadriplegics had complete motor loss below the lesion level and were at least two years postinjury. Tests were performed with subjects seated. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0), inspiratory capacity (IC), and maximum inspiratory mouth pressure (Pimax) were measured. Resting breathing pattern was assessed for 20 minutes using mercury in rubber strain gauges and a computer-assisted data acquisition and analysis program. Inspiratory time (Ti), expiratory time (Te), and tidal volume (Vt) were measured, and the remaining timing components were calculated from these values. The variability of breathing was assessed by comparing the coefficients of variation of each variable. The FVC, IC, and Pimax were significantly reduced; Vt was significantly lower (p less than 0.01) and frequency significantly elevated (p less than 0.05) in quadriplegics. The decreased Vt in quadriplegics was due entirely to a significantly decreased mean inspiratory flow (p less than 0.01); Ti was the same in quadriplegics as in controls. The ratio of mean Ti to total cycle time (Ti/Ttot) was significantly longer in quadriplegics (p less than 0.005). There was no difference in variability of breathing between the two groups for any timing component of ventilation. There was no significant difference in sighing frequency between groups for either breaths greater than 2x mean Vt or breaths greater than 3x mean Vt. Chronic quadriplegics demonstrated a rapid, shallow breathing pattern, probably due to the mechanical restrictions resulting from paralysis of the thorax musculature. They retained the ability to sigh, suggesting that chest wall afferents may not be required in this process.

Physiotherapy management of patients with chronic obstructive airways disease.

Various physiotherapy techniques have long been advocated as therapeutic tools for patients with chronic obstructive airways disease (COAD). The purpose of this review is to present an outline of the different techniques, a definition of the present controversies, and an illustration of the possible new directions for physiotherapy in the future. The following aspects of the disease are reviewed: pathophysiology; research; patient education; secretion removal (including techniques of coughing, postural drainage, and percussion); breathing control exercises (including use of the abdominal muscles, nasal inspiration, pursed lip breathing, positioning, alteration of regional ventilation, and the related short and long-term benefits); and thoracic mobility exercises. The authors conclude not only that the physical therapeutic techniques used with COAD patients are extremely diverse in nature, but that the investigations of their validity have been neither comprehensive nor conclusive. Immediate study is needed to define more specific physiological aims for each modality; more selective and effective treatment can then be performed and the true potential of chest physiotherapy realized.