Music therapy as a treatment method for improving respiratory muscle strength in patients with advanced multiple sclerosis: a pilot study.

Respiratory muscle weakness, predominantly of the expiratory muscles, is characteristic of individuals with advanced multiple sclerosis and can result in difficulty in clearing secretions and repeated episodes of pneumonia. This pilot study evaluated the effectiveness of music therapy in strengthening respiratory muscles through an emphasis on diaphragmatic breathing and coordination of breath and speech. Twenty patients were randomly assigned to one of two groups: one that received music therapy or one that attended music appreciation sessions. Participants' inspiratory and expiratory muscle strength was measured by testing mouth pressure before and after the intervention. The experimental group showed some improvement in terms of expiratory muscle strength, in contrast to the control group, which showed deterioration. The results were not statistically significant, however. Patients in both groups exhibited considerable weakness in their expiratory muscles, and results for 79% of the participants were below 30% of the predicted values. Variability, a major confounding factor that resulted in reduced statistical power, led the investigators to suggest an intercenter collaboration to amass sufficient numbers of patients for a future study. Early manifestation of respiratory muscle weakness warrants inclusion of respiratory muscle testing in examination protocols and early intervention efforts.

Effect of progesterone therapy on arginine vasopressin and atrial natriuretic factor in premenstrual syndrome.

OBJECTIVES: To explore the possible role of natriuretic peptides and vasopressin in luteal phase fluid retention in premenstrual syndrome (PMS) and to determine the effect of progesterone therapy on these hormones. DESIGN: Self-controlled prospective study. SETTING: University-based medical research centre. PATIENTS: Six patients with PMS were studied during the symptomatic luteal and asymptomatic follicular phases. The follicular phase response was used as the control for each subject. INTERVENTIONS: An intravenous infusion of 3% saline solution was administered on an early follicular and a late luteal phase day in 2 menstrual cycles. Progesterone was administered orally during the second luteal phase. OUTCOME MEASURES: Osmolality, arginine vasopressin (AVP), atrial natriuretic factor (ANF), and brain natriuretic peptide (BNP) levels in plasma, osmolality, sodium, potassium, cyclic adenosine monophosphate (cAMP) and cyclic guanosine 5'-phosphate (cGMP) concentrations in urine, and thirst sensation. RESULTS: Mean basal plasma ANF and osmolality levels and the threshold for AVP release and thirst were lower, and mean urinary cyclic nucleotide levels and AVP sensitivity (amount of AVP secreted per unit rise in plasma osmolality) were higher, in the luteal phase than in the follicular phase. With saline loading, there was an increase in plasma osmolality, AVP and ANF and in urinary sodium and cyclic nucleotide levels. Plasma ANF and osmolality levels remained lower in the luteal phase compared with the follicular phase, but AVP levels at the end of the saline infusion were higher in the luteal phase than in the follicular phase. Progesterone therapy caused an increase in plasma ANF and osmolality levels and the AVP threshold and a decrease in AVP levels and sensitivity and urinary cyclic nucleotide levels. BNP levels did not change with phase or treatment. The differences in AVP threshold with phase and treatment were statistically significant (p < 0.001). There was a significant phase effect for plasma ANF (p = 0.02) and a significant or near-significant interaction effect of phase and treatment for plasma ANF (p = 0.06) and urinary cAMP (p = 0.047) and cGMP (p = 0.066). The effect of phase and treatment was not significant for the other measurements. CONCLUSIONS: Luteal phase fluid retention may be due to a relative deficiency of ANF and a lower threshold for AVP release. The symptomatic improvement produced by progesterone treatment may be due to its stimulation of ANF and inhibition of AVP release or synthesis.