Inspiratory muscle training in children with neuromuscular disorders

Anri Human; Lieselotte Corten; Eleonora Lozano-Ray; Brenda M Morrow

doi:10.4102/sajp.v80i1.2055

Inspiratory muscle training in children with neuromuscular disorders

S Afr J Physiother. 2024 Aug 8;80(1):2055. doi: 10.4102/sajp.v80i1.2055. eCollection 2024.

Authors

Anri Human^{1

2

3}, Lieselotte Corten^{2

4}, Eleonora Lozano-Ray⁵, Brenda M Morrow^{2

6}

Affiliations

¹ Department of Physiotherapy, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
² Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
³ Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
⁴ Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom.
⁵ Department of Physiotherapy, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
⁶ Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

Abstract

Background: Progressive respiratory muscle weakness and ineffective cough contribute to morbidity and mortality in children with neuromuscular disorders (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength and reduce respiratory morbidity. This study aimed to determine the safety and efficacy of IMT in children with NMD.

Methods/design: A randomised cross-over study compared a 3-month intervention (IMT) with control periods (no IMT). Children diagnosed with NMD (5 years - 18 years) performed 30 breaths (at 30% of maximum inspiratory mouth pressure [Pimax]) with an electronic threshold device, twice daily. During the control period, participants did not perform any IMT.

Discussion: Twenty three children (median [interquartile range {IQR}] age of 12.33 [10.03-14.17] years), mostly male (n = 20) and non-ambulant (n = 14) participated. No adverse events related to IMT were reported. No difference in median patient hospitalisation and respiratory tract infection (RTI) rates between non-training and intervention periods (p = 0.60; p = 0.21) was found. During IMT, Pimax and peak cough flow improved with a mean ± standard deviation (s.d.) of 14.57 ± 15.67 cmH₂O and 32.27 ± 36.60 L/min, compared to 3.04 ± 11.93 cmH₂O (p = 0.01) and -16.59 ± 48.29 L/min (p = 0.0005) during the non-training period. Similar to other studies, spirometry did not show a significant change.

Conclusion: A 3-month IMT programme in children with NMD appears safe and well-tolerated, with significant improvement in respiratory muscle strength and cough efficacy.

Clinical implications: Inspiratory muscle training could be considered a cost-effective adjunct to respiratory management in children with NMD.

Trial registration: Pan African Clinical Trial Registry, PACTR201506001171421, https://pactr.samrc.ac.za.

Keywords: adolescents; children; inspiratory muscle strength; inspiratory muscle training; neuromuscular disorders.

Publication types

Clinical Trial

Grants and funding

Funding information This work was supported by the URC Equipment Grant (Western Cape), Sefako Makgatho Health Sciences University Research Development Grant (Gauteng), and the South African Society of Physiotherapy (PhD grant).