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ORIJINAL ARAŞTIRMA

Servikal veya Torakal Düzey Omurilik Yaralanması Sonrası Hastalarda Solunum Egzersizlerinin Solunum Fonksiyonları ve Yaşam Kalitesi Üzerine Etkisi
The Effect of Breathing Exercises on Respiratory Functions and Quality of Life in Patients After Cervical or Thoracal Level Spinal Cord Injury
Received Date : 04 Apr 2023
Accepted Date : 24 Jun 2023
Available Online : 07 Jul 2023
Doi: 10.31609/jpmrs.2023-97107 - Makale Dili: EN
J PMR Sci. 2023;26(3):314-20
ÖZET
Amaç: Servikal veya torakal seviye omurilik yaralanması [spinal cord injury (SCI)] olan hastalarda solunum egzersizlerinin solunum fonksiyonu, fonksiyonel durum ve yaşam kalitesi üzerine etkilerini araştırmak ve 2 grupta bu parametrelerdeki değişiklikleri karşılaştırmak amaçlanmıştır. Gereç ve Yöntemler: Rehabilitasyon hastanemize başvuran nörolojik lezyon düzeyi C4-T12 olan 32 hasta çalışmaya dâhil edildi. Hastalar servikal ve torakal yaralanma olarak 2 gruba ayrıldı. Solunum fonksiyonları değerlendirildikten sonra tüm hastalara 4 hafta süreyle günde 3 kez 20 dk solunum egzersizleri ve nörolojik rehabilitasyon verildi. Dört hafta sonunda solunum fonksiyon testleri tekrarlandı. Sonuçlar temel verilerle karşılaştırıldı. Yaşam kalitesi kısa form-36 [short form-36 (SF-36)] ile değerlendirildi. Fonksiyonel durum, SCI ölçüm III (SCIM III) ile değerlendirildi. Bulgular: Rehabilitasyon programı sonunda solunum fonksiyonları anlamlı olarak arttı (p<0,05). Ancak solunum parametrelerindeki iyileşme torakal yaralanma grubunda servikal gruba göre daha yüksekti (p<0,05). Her iki grubun SCIM III değerlendirmesinde istatistiksel olarak anlamlı bir iyileşme saptandı. Torakal yaralanmalı grupta SF-36’nın sosyal fonksiyon alanı puanlarında istatistiksel olarak anlamlı bir iyileşme saptandı (p<0,05). Sonuç: Sonuç olarak konvansiyonel rehabilitasyon programına eşlik eden solunum egzersizleri, grupların solunum fonksiyonlarında iyileşme sağladı. Ayrıca torakal yaralanmalı hastalarda sosyal fonksiyonlarda düzelme sağlandı.
ABSTRACT
Objective: The aim was to investigate the effects of breathing exercises on respiratory function, functional status and the quality of life in the patients with cervical or thoracal level spinal cord injury (SCI) and to compare the changes in these parameters in 2 groups. Material and Methods: Thirty 2 patients with a neurological lesion level of C4-T12, who have been admitted to our rehabilitation hospital were included in the study. The patients were divided into 2 groups as cervical and thoracal injury. After the assessment of pulmonary functions, breathing exercises 3 times a day for 20 minutes, in addition to neurological rehabilitation were given to all patients for 4 weeks. At the end of 4 weeks, pulmonary function tests were repeated. The results were compared with the baseline data. Quality of life was assesed with the short form-36 (SF-36). Functional status was evaluated with SCI measure III (SCIM III). Results: Pulmonary functions were increased significantly at the end of the rehabilitation program (p<0.05). However, the improvement in the respiratory parameters were higher in the thoracal injury group than those of the cervical group’s (p<0.05). A statistically significant improvement was found in SCIM III evaluation of both groups. A statistically significant improvement was found in the social function domain scores of SF-36 in the thoracic injury group (p<0.05). Conclusion: As a result, breathing exercises accompaning the conventional rehabilitation program provided improvement in the pulmonary function of the groups. Moreover, social functions were improved in the patients with thoracal injuries.
REFERENCES
  1. Delisa JA, Bruca M, Gans BM, Walsh NE. Rehabilitation of spinal cord injury. Physical Medicine and Rehabilitation: Principles and Practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p.1715-51.
  2. Jackson AB, Groomes TE. Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil. 1994;75:270-5. [Crossref]  [PubMed] 
  3. Liaw MY, Lin MC, Cheng PT, et al. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Arch Phys Med Rehabil. 2000;81:752-6. [Crossref]  [PubMed] 
  4. Rutchik A, Weissman AR, Almenoff PL, et al. Resistive inspiratory muscle training in subjects with chronic cervical spinal cord injury. Arch Phys Med Rehabil. 1998;79:293-7. [Crossref]  [PubMed] 
  5. Van Houtte S, Vanlandewijck Y, Kiekens C, et al. Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training. J Rehabil Med. 2008;40:119-25. [Crossref]  [PubMed] 
  6. van den Berg ME, Castellote JM, de Pedro-Cuesta J, et al. Survival after spinal cord injury: a systematic review. J Neurotrauma. 2010;27:1517-28. [Crossref]  [PubMed] 
  7. Kang SW, Shin JC, Park CI, et al. Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients. Spinal Cord. 2006;44:242-8. [Crossref]  [PubMed] 
  8. Mueller G, Hopman MT, Perret C. Comparison of respiratory muscle training methods in individuals with motor complete tetraplegia. Top Spinal Cord Inj Rehabil. 2012;18:118-21. [Crossref]  [PubMed]  [PMC] 
  9. Roth EJ, Stenson KW, Powley S, et al. Expiratory muscle training in spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2010;91:857-61. [Crossref]  [PubMed] 
  10. Çelik D, Çoban Ö. Short Form Health Survey version-2.0 Turkish (SF-36v2) is an efficient outcome parameter in musculoskeletal research. Acta Orthop Traumatol Turc. 2016;50:558-61. [Crossref]  [PubMed]  [PMC] 
  11. Anderson K, Aito S, Atkins M, et al; Functional Recovery Outcome Measures Work Group. Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med. 2008;31:133-44. [Crossref]  [PubMed]  [PMC] 
  12. Furlan JC, Noonan V, Singh A, et al. Assessment of impairment in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma. 2011;28:1445-77. [Crossref]  [PubMed]  [PMC] 
  13. Unalan H, Misirlioglu TO, Erhan B, et al. Validity and reliability study of the Turkish version of Spinal Cord Independence Measure-III. Spinal Cord. 2015;53:455-60. [Crossref]  [PubMed] 
  14. Linn WS, Adkins RH, Gong H Jr, et al. Pulmonary function in chronic spinal cord injury: a cross-sectional survey of 222 southern California adult outpatients. Arch Phys Med Rehabil. 2000;81:757-63. [Crossref]  [PubMed] 
  15. Roth EJ, Nussbaum SB, Berkowitz M, et al. Pulmonary function testing in spinal cord injury: correlation with vital capacity. Paraplegia. 1995;33:454-7. [Crossref]  [PubMed] 
  16. Spungen AM, Grimm DR, Lesser M, et al. Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury. Spinal Cord. 1997;35:652-7. [Crossref]  [PubMed] 
  17. Brown R, DiMarco AF, Hoit JD, et al. Respiratory dysfunction and management in spinal cord injury. Respir Care. 2006;51:853-68;discussion 869-70. [PubMed]  [PMC] 
  18. Cotton BA, Pryor JP, Chinwalla I, et al. Respiratory complications and mortality risk associated with thoracic spine injury. J Trauma. 2005;59:1400-7; discussion 1407-9. [Crossref]  [PubMed] 
  19. Fishburn MJ, Marino RJ, Ditunno JF Jr. Atelectasis and pneumonia in acute spinal cord injury. Arch Phys Med Rehabil. 1990;71:197-200. [PubMed] 
  20. McBain RA, Boswell-Ruys CL, Lee BB, et al. Abdominal muscle training can enhance cough after spinal cord injury. Neurorehabil Neural Repair. 2013;27:834-43. [Crossref]  [PubMed] 
  21. Klebine P, Lindsey L. Understanding and Managing Respiratory Complications After SCI. Birmingham, AL: Office of Research Services; 2007. p.57-91. [Link] 
  22. Nici L, Donner C, Wouters E, et al; ATS/ERS Pulmonary Rehabilitation Writing Committee. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390-413. [PubMed] 
  23. Stiller K, Huff N. Respiratory muscle training for tetraplegic patients: a literature review. Aust J Physiother. 1999;4:291-9. [Crossref]  [PubMed] 
  24. Breslin EH. The pattern of respiratory muscle recruitment during pursed-lip breathing. Chest. 1992;101:75-8. [Crossref]  [PubMed] 
  25. Gürses HN. Astımlı hastaların tedavisinde fizyoterapi rehabilitasyon. Astımla Birlikte Sorunsuz Yaşamak. 1.Baskı. İstanbul: Türkiye Fizyoterapistler Derneği İstanbul Bölge Temsilciliği Yayını; 1995. p.10-25.
  26. Shin JC, Han EY, Cho KH, et al. Improvement in pulmonary function with short-term rehabilitation treatment in spinal cord injury patients. Sci Rep. 2019;9:17091. [Crossref]  [PubMed]  [PMC] 
  27. Wang X, Zhang N, Xu Y. Effects of respiratory muscle training on pulmonary function in individuals with spinal cord injury: an updated meta-analysis. Biomed Res Int. 2020;2020:7530498. [Crossref]  [PubMed]  [PMC] 
  28. Silva AC, Neder JA, Chiurciu MV, et al. Effect of aerobic training on ventilatory muscle endurance of spinal cord injured men. Spinal Cord. 1998;36:240-5. [Crossref]  [PubMed] 
  29. Jain NB, Sullivan M, Kazis LE, et al. Factors associated with health-related quality of life in chronic spinal cord injury. Am J Phys Med Rehabil. 2007;86:387-96. [Crossref]  [PubMed]  [PMC] 
  30. Craig A, Nicholson Perry K, Guest R, et al. Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation. Br J Health Psychol. 2015;20:807-23. [Crossref]  [PubMed] 
  31. Piatt JA, Nagata S, Zahl M, et al. Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life. J Spinal Cord Med. 2016;39:693-8. [Crossref]  [PubMed]  [PMC]