Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Sep 17;6(1):87.
doi: 10.1038/s41394-020-00337-7.

A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Anne E Palermo  1 , Lawrence P Cahalin  2 , Mark S Nash  3
Affiliations
Review

A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Anne E Palermo et al. Spinal Cord Ser Cases. .

Abstract

Introduction: Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI.

Case presentation: A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively).

Discussion: The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.

PubMed Disclaimer

Conflict of interest statement

This research was supported through funding by the Craig H. Neilsen Foundation in conjunction with the American Spinal Injury Association and the Foundation for Physical Therapy Research. The Miami Project to Cure Paralysis offered space and access to a database of possible participants for recruiting purposes.

Figures

Fig. 1
Fig. 1. User interface during Inspiratory Muscle Training with the PrO2FIT device and accompanying tablet application.
The FIT score is a measure created by the PrO2 manufacturer and was not investigated in this case study.
Fig. 2
Fig. 2. Total Power plotted throughout the training period.
The summed sustained maximal inspiratory pressures (SMIPs) created during a training session with 42 breaths with a target of 80% of a maximum effort baseline breath.
Fig. 3
Fig. 3. The change in MIP and SMIP throughout the training period.
Plots depicting the highest maximal inspiratory pressure (MIP) (a) and sustained MIP (SMIP) (b) reached by P1 throughout each training session. These data may or may not include baseline measures.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017;55:891–97. doi: 10.1038/sc.2017.64. - DOI - PubMed
    1. McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury. J Spinal Cord Med. 2018:1–8. 10.1080/10790268.2018.1432307. - PMC - PubMed
    1. Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and protective factors for cause-specific mortality after spinal cord injury. Arch Phys Med Rehabil. 2016;97:1669–78. doi: 10.1016/j.apmr.2016.07.001. - DOI - PubMed
    1. Berlly M, Shem K. Respiratory management during the first five days after spinal cord injury. J Spinal Cord Med. 2007;30:309–18. doi: 10.1080/10790268.2007.11753946. - DOI - PMC - PubMed
    1. Kopp MA, Watzlawick R, Martus P, Failli V, Finkenstaedt FW, Chen Y, et al. Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology. 2017;88:892–900. doi: 10.1212/WNL.0000000000003652. - DOI - PMC - PubMed

MeSH terms