Chest
Clinical Investigations: Pulmonary Function Tests: ArticlesMaximal Expiratory Pressures in Spinal Cord Injury Using Two Mouthpieces
Section snippets
Level of Injury
The level and degree of completeness of SCI was determined for each subject by a Rehabilitation Medicine Service physician (C.G.T.). Injury level was determined as follows: (1) incomplete level—the highest level on each side of the body at which there was any loss of motor function; and (2) complete level—the lowest level on each side of the body at which the motor function was graded 3 of 5 or more with a subsequent caudal loss of all motor function. Sensory function was used in the place of
Results
There were 29 individuals with complete SCI and 21 with incomplete SCI. Among those individuals with complete SCI, 8 had cervical, 11 had high thoracic, and 10 had lower injuries. Among those with incomplete SCI, 13 had cervical, 2 had high thoracic, and 6 had lower injuries.
For each level of injury, the difference in PEmax between mouthpieces was greater than zero (Table 1). The mean difference for the entire group was 20.7±26.4 cm H2O, range was —24 to 110 cm H2O (p=0.0001). The lower the
Discussion
Owing to the clinical utility of using PEmax to quantify the loss of expiratory muscle strength, it is important to determine correctly the PEmax that a given individual is capable of producing. This study of SCI subjects confirmed prior results found in normal subjects whereby a tube-style mouthpiece yielded higher expiratory pressures than a flange-style mouthpiece.
The best method must accommodate several concerns. In previous studies, patients with generalized neuromuscular disease were
ACKNOWLEDGMENTS
We acknowledge gratefully the advice of David Leith, MD, the advice of Robert Harrington, and the assistance of the Brockton/West Roxbury VAMC Spinal Cord Injury Service in conducting this study.
References (5)
- et al.
Comparison of two different mouthpieces for the measurement of Pimax and Pemax in normal and weak subjects
Eur Respir J
(1988) - et al.
Static volume-pressure characteristics of the respiratory system during maximal efforts
J Appl Physiol
(1964)
Cited by (24)
Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management
2018, Clinics in Chest MedicineCitation Excerpt :For measurement of maximal inspiratory and expiratory pressures (MIP and MEP, respectively), a flange-style mouthpiece is generally used. However, in a study of 50 subjects with tetraplegia, MEP values obtained using a tube-style mouthpiece were significantly greater than those obtained by use of an intraoral flange-style mouthpiece due to perioral air leaks around the latter device.51 Neuromuscular weakness in persons with chronic tetraplegia and high paraplegia is classically associated with spirometric and lung volume measurements demonstrating restrictive ventilatory defects highlighted by reduction in VC, peak expiratory flow, TLC, expiratory reserve volume (ERV) and IC, as well as an increase in residual volume (RV) and little change in FRC.40,52–61
Respiratory muscle training for respiratory deficits in neurodegenerative disorders: A systematic review
2013, ChestCitation Excerpt :Depending its style, people are encouraged to maintain a tight seal around the mouthpiece using the buccal muscles.47 Given this, MEP can show improvements after training due to enhancement in buccal muscle performance.47 Although all the studies included in this review described the proper and standardized measurement of MIP/MEP as described by Black and Hyatt48 and the American Thoracic Society guidelines,42 seven7,9,13,27–30 detailed the technical characteristics of the equipment and the procedures used to prevent unnecessary contraction of the buccal muscles and uncontrolled air leaking.
Pulmonary function and spinal cord injury
2009, Respiratory Physiology and NeurobiologyDeterminants of Forced Expiratory Volume in 1 Second (FEV<inf>1</inf>), Forced Vital Capacity (FVC), and FEV<inf>1</inf>/FVC in Chronic Spinal Cord Injury
2006, Archives of Physical Medicine and RehabilitationCitation Excerpt :In our study, we used the highest values of FEV1 and FVC from the expiratory efforts. MIP and maximum expiratory pressure (MEP) were reported as the maximum of 3 values, but MEP was not assessed in our analysis because it was measured in fewer participants (n=230).20 Lung volumes were measured by helium dilution.
Dyspnea during daily activities in chronic spinal cord injury
2005, Archives of Physical Medicine and RehabilitationCitation Excerpt :Maximum inspiratory pressures (MIP) and expiratory pressures (MEP) were measured 3 times with either a Validyneb pressure transducer connected to a Hewlett Packard strip chart recorder,c or a Dataq computerized data acquisition systemd with a microchip pressure transducer. Maximal values were reported.7 We used t tests to compare means, and we compared ratios using chi-square tests, using the Fisher exact test when appropriate.
A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury
2005, Archives of Physical Medicine and RehabilitationCitation Excerpt :A pneumatic pressure gaugee and a hard, oval mouthpiece were used to determine maximal static respiratory pressures. Tubular mouthpieces have been shown to give significantly higher measures of MIP and MEP in both able-bodied23 and spinal injury populations.24 At each testing session, neck circumference was measured at the level of the hyoid bone, and abdomen girth was measured at the level of the umbilicus.
Supported by a Department of Veterans Affairs Health Services Research and Development Merit Review Grant.