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Pulmonary Rehabilitation Using Modified Threshold Inspiratory Muscle Trainer (IMT) in Patients with Tetraplegia.

Yasar F, Tasci C, Savci S, Tozkoparan E, Deniz O, Balkan A, Bilgic H - Case Rep Med (2012)

Bottom Line: It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions.After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test.As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.

View Article: PubMed Central - PubMed

Affiliation: Gulhane Medical School, Department of Pulmonary Medicine, Ankara, Turkey.

ABSTRACT
It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions. The treatment was applied through the tracheostomy cannula by a modified IMT device. After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test. As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.

No MeSH data available.


Related in: MedlinePlus

Implementation of the device on the patient.
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fig4: Implementation of the device on the patient.

Mentions: Our case is a 20-year-old male patient with C5-6-7 vertebrae fracture because of falling from height. Surgical operation has been applied to him; however, he did not benefit from the surgery. Following the development of tetraplegia, respiratuary failure occurred in the patient, and invasive mechanical ventilator (IMV) was needed. While the patient was placed on IMV, the follow-up was conducted by trials both with controlled mode and the BIPAP mode; however, adequate tidal volume could not be reached due to the lack of diaphragmatic movement. Diaphragmatic paralysis was confirmed by electromyography (EMG). After the hospitalization of the patient, respiratory physiotherapy was utilized (respiratory exercises, postural drainage, etc.) regularly. This therapy has been applied for almost three months. During this period, adverse complications of IMV (ventilator associated pneumonia (VAP)) occurred, which had an undesirable effects on the physiotherapy due to insufficient respiratory reserve, weak cough reflexes, and so forth VAP is one of the major complications which increase morbidity in patients receiving mechanical ventilation. In the third month of the follow-up, the patient remained stable for the duration of mechanical ventilation on CPAP mode, and we estimated that pulmonary rehabilitation with Threshold Inspiratory Muscle Trainer would be useful for pulmonary functions of him (Figure 1). However, we had a difficulty in operating the IMT device through the tracheostomy cannula. Upon this problem, we modified IMT device as seen in Figures 2 and 3. For three weeks, this modified device has been applied to the patient through 20–30 breaths per day (Figure 4). The relative pressure was 12 cm H2O (20% of MIP) in first week, 16 cm H2O (30% of MIP) in second week, and 20 cm H2O (50% of MIP) in third week. At the end of the three weeks, the diaphragmatic movements of the patient have been observed and adequate tidal volume has been obtained during spontaneously breathing in room air. Sporadic IMT treatment has been applied, and, as a result, sufficient ventilation by mere room air has been achieved.


Pulmonary Rehabilitation Using Modified Threshold Inspiratory Muscle Trainer (IMT) in Patients with Tetraplegia.

Yasar F, Tasci C, Savci S, Tozkoparan E, Deniz O, Balkan A, Bilgic H - Case Rep Med (2012)

Implementation of the device on the patient.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3318895&req=5

fig4: Implementation of the device on the patient.
Mentions: Our case is a 20-year-old male patient with C5-6-7 vertebrae fracture because of falling from height. Surgical operation has been applied to him; however, he did not benefit from the surgery. Following the development of tetraplegia, respiratuary failure occurred in the patient, and invasive mechanical ventilator (IMV) was needed. While the patient was placed on IMV, the follow-up was conducted by trials both with controlled mode and the BIPAP mode; however, adequate tidal volume could not be reached due to the lack of diaphragmatic movement. Diaphragmatic paralysis was confirmed by electromyography (EMG). After the hospitalization of the patient, respiratory physiotherapy was utilized (respiratory exercises, postural drainage, etc.) regularly. This therapy has been applied for almost three months. During this period, adverse complications of IMV (ventilator associated pneumonia (VAP)) occurred, which had an undesirable effects on the physiotherapy due to insufficient respiratory reserve, weak cough reflexes, and so forth VAP is one of the major complications which increase morbidity in patients receiving mechanical ventilation. In the third month of the follow-up, the patient remained stable for the duration of mechanical ventilation on CPAP mode, and we estimated that pulmonary rehabilitation with Threshold Inspiratory Muscle Trainer would be useful for pulmonary functions of him (Figure 1). However, we had a difficulty in operating the IMT device through the tracheostomy cannula. Upon this problem, we modified IMT device as seen in Figures 2 and 3. For three weeks, this modified device has been applied to the patient through 20–30 breaths per day (Figure 4). The relative pressure was 12 cm H2O (20% of MIP) in first week, 16 cm H2O (30% of MIP) in second week, and 20 cm H2O (50% of MIP) in third week. At the end of the three weeks, the diaphragmatic movements of the patient have been observed and adequate tidal volume has been obtained during spontaneously breathing in room air. Sporadic IMT treatment has been applied, and, as a result, sufficient ventilation by mere room air has been achieved.

Bottom Line: It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions.After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test.As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.

View Article: PubMed Central - PubMed

Affiliation: Gulhane Medical School, Department of Pulmonary Medicine, Ankara, Turkey.

ABSTRACT
It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions. The treatment was applied through the tracheostomy cannula by a modified IMT device. After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test. As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.

No MeSH data available.


Related in: MedlinePlus