Article

The purpose of the present study was to compare the unassisted cough
peak flow (CPF) of patients affected by muscular dystrophy with CPF augmented by
various techniques, including maximal depth glossopharyngeal breathing (GPB)
combined with a subsequent self-induced thoracic or abdominal thrust. DESIGN: All
of the motorized wheelchair-dependent patients with muscular dystrophy who had
previously mastered GPB were trained at home to increase their cough efficacy.
This training involved maneuvering their wheelchair against the edge of a
specially built table to autonomously produce a thoracic and/or abdominal thrust
timed to the opening of the glottis for an independently assisted cough. Both
unassisted and variously assisted CPFs were compared. RESULTS: The 18 patients
(17 men/1 woman) with muscular dystrophy, aged 21.1 +/- 5.4 yrs, achieved
variously assisted CPFs that were significantly higher than the spontaneous CPF
(P < 0.001), with assisted CPFs but not unassisted CPFs that significantly
exceeded a reported efficacious cough threshold value of 160 liters/min (P <
0.001). Moreover, increases in the CPFs by personal assistance including air
stacking by manual resuscitator and thoracoabdominal thrust (326.4 +/- 79.5
liters/min) or by GPB and thoracoabdominal thrust (326.4 +/- 87.5 liters/min)
were not significantly different (P = 0.07) from the CPFs independently attained
by GPB plus independently maneuvering a wheelchair for a table thrust (310.3 +/-
74.7 liters/min). CONCLUSIONS: The independently assisted (GPB plus table thrust)
CPF was comparable to the CPFs that required personal assistance for air stacking
and abdominal thrusts. Therefore, for patients with muscular dystrophy, this
physical medicine technique and cough-assisted techniques that require personal
intervention are strongly recommended.

Langue : ANGLAIS