Layana Marques1,2, Guilherme Augusto de Freitas Fregonezi1,2, Ilsa Priscila Santos1,2, Ana Aline Marcelino1,2, Jéssica Danielle Medeiros da Fonsêca1,2, Mario Emílio Teixeira Dourado-Júnior3, Andrea Aliverti4, Antonio Sarmento1,2, Vanessa Regiane Resqueti5,2. 1. PneumoCardioVascular Lab, Hospital Universitario Onofe Lopes, Empresa Brasileira de Serviços Hospitalares, Natal, Brazil. 2. Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil. 3. Ambulatório de Neurologia, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Brazil. 4. Laboratorio di Tecnologie Biomediche, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy. 5. PneumoCardioVascular Lab, Hospital Universitario Onofe Lopes, Empresa Brasileira de Serviços Hospitalares, Natal, Brazil. vanessaresqueti@hotmail.com.
Abstract
BACKGROUND: Advanced stages of Duchenne muscular dystrophy (DMD) result in muscle weakness and the inability to generate an effective cough. Several factors influence the effectiveness of cough in patients with DMD. The aim of this study was to assess whether differences in positioning affect cough peak flow (CPF) and muscular electromyographic activation in subjects with DMD compared with paired healthy subjects. METHODS: Optoelectronic plethysmography and surface electromyography were used to assess chest wall volumes, chest wall inspiratory capacity, CPF, breathing pattern, and electromyographic activity of sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles during inspiratory and expiratory cough phases in the supine position, supine position with headrest raised at 45°, and sitting with back support at 80° in 12 subjects with DMD and 12 healthy subjects. RESULTS: Subjects with DMD had lower CPF (P < .01) in comparison to control subjects in all positions; the DMD group also exhibited lower CPF (P = .045) in the supine position versus 80°. Moreover, the relative volume contributions of the rib cage and abdominal compartments to tidal volume modified significantly with posture. The electromyographic activity during inspiratory and expiratory cough phases was lower in subjects with DMD compared to healthy subjects for all evaluated muscles (P < .05), but no significant differences were observed with posture change. CONCLUSIONS: In subjects with DMD, posture influenced CPF and the relative contribution of the rib cage and abdominal compartments to tidal volume. However, muscular electromyographic activation was not influenced by posture in subjects with DMD and healthy subjects.
BACKGROUND: Advanced stages of Duchenne muscular dystrophy (DMD) result in muscle weakness and the inability to generate an effective cough. Several factors influence the effectiveness of cough in patients with DMD. The aim of this study was to assess whether differences in positioning affect cough peak flow (CPF) and muscular electromyographic activation in subjects with DMD compared with paired healthy subjects. METHODS: Optoelectronic plethysmography and surface electromyography were used to assess chest wall volumes, chest wall inspiratory capacity, CPF, breathing pattern, and electromyographic activity of sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles during inspiratory and expiratory cough phases in the supine position, supine position with headrest raised at 45°, and sitting with back support at 80° in 12 subjects with DMD and 12 healthy subjects. RESULTS: Subjects with DMD had lower CPF (P < .01) in comparison to control subjects in all positions; the DMD group also exhibited lower CPF (P = .045) in the supine position versus 80°. Moreover, the relative volume contributions of the rib cage and abdominal compartments to tidal volume modified significantly with posture. The electromyographic activity during inspiratory and expiratory cough phases was lower in subjects with DMD compared to healthy subjects for all evaluated muscles (P < .05), but no significant differences were observed with posture change. CONCLUSIONS: In subjects with DMD, posture influenced CPF and the relative contribution of the rib cage and abdominal compartments to tidal volume. However, muscular electromyographic activation was not influenced by posture in subjects with DMD and healthy subjects.
Authors: Alison M Barnard; Donovan J Lott; Abhinandan Batra; William T Triplett; Rebecca J Willcocks; Sean C Forbes; William D Rooney; Michael J Daniels; Barbara K Smith; Krista Vandenborne; Glenn A Walter Journal: Chest Date: 2021-09-15 Impact factor: 10.262
Authors: Brenda Morrow; Andrew Argent; Marco Zampoli; Anri Human; Lieselotte Corten; Michel Toussaint Journal: Cochrane Database Syst Rev Date: 2021-04-22