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Meta-Analysis
. 2023 Apr;19(4):340-355.
doi: 10.1007/s12519-022-00642-1. Epub 2022 Nov 15.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis

Thálita Raysa de Lima Crispim  1   2 , Mansueto Gomes Neto  3   4 , Tafnes Rayane Lima Crispim  5 , Renivaldo Batista Dias  5 , Maria Déborah Monteiro de Albuquerque  5 , Micheli Bernardone Saquetto  3   4 , Paulo André Freire Magalhães  5   6
Affiliations
Meta-Analysis

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis

Thálita Raysa de Lima Crispim et al. World J Pediatr. 2023 Apr.

Abstract

Background: Respiratory dysfunctions are an important cause of morbidity and death in cerebral palsy (CP) populations. Respiratory exercises in addition to conventional rehabilitation have been suggested to improve respiratory status in CP patients. The objective of this systematic review and meta-analysis was to verify the effects of the addition of respiratory exercises to conventional rehabilitation on pulmonary function, functional capacity, respiratory muscle strength, gross motor function and quality of life in children and adolescents with CP.

Methods: We searched for randomized controlled clinical trials in PubMed/Medline, Lilacs, SciELO, EMBASE and Physiotheraphy Evidence (PEDro) from their inception until July 2022 without language restrictions. Studies that included respiratory exercises (breathing exercise program; feedback respiratory training; incentive spirometer exercise; inspiratory muscle training; and combination of respiratory exercises + incentive spirometer exercise) in combination with conventional rehabilitation for children and adolescents with CP were evaluated by two independent reviewers. The mean difference (MD) and 95% confidence interval (CI) were estimated by random effect models.

Results: Ten studies met the eligibility criteria, including 324 children aged from 6 to 16 years. The meta-analysis showed an improvement in inspiratory muscle strength of 22.96 cmH2O (18.63-27.27, n = 55) and pulmonary function of 0.60 (0.38-0.82, n = 98) for forced vital capacity (L); 0.22 (0.06-0.39, n = 98) for forced expiratory volume at 1 second (L); and 0.50 (0.05-0.04, n = 98) for peak expiratory flow (L/min). Functional skills in daily living activities improved in the intervention group. Caregivers' assistance of daily living activities, functional capacity, gross motor function and expiratory muscle strength showed a nonsignificant improvement. Social well-being and acceptance and functioning domains improved in only one study.

Conclusions: Emerging data show significant enhancements in inspiratory muscle strength and pulmonary function in CP patients after respiratory training in addition to conventional rehabilitation. There is no consensus on the frequency, type or intensity of respiratory exercises for children with and adolescents with CP.

Keywords: Breathing exercises; Cerebral palsy; Inspiratory muscle training; Pediatrics; Rehabilitation; Respiratory exercise.

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Conflict of interest statement

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Figures

Fig. 1
Fig. 1
Flow diagram of included studies
Fig. 2
Fig. 2
a Forest plot of FVC (forced vital capacity) (L) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. b Forest plot of FVC (%) (L) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 3
Fig. 3
a Forest plot of FEV1 (forced expiratory volume at 1 s) (L) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. b Forest plot of FEV1 (%) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 4
Fig. 4
a Forest plot of PEF (peak expiratory flow) (L/min) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. b Forest plot of PEF (%) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 5
Fig. 5
Forest plot of functional capacity after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 6
Fig. 6
Forest plot of Pimax (maximal inspiratory pressure) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 7
Fig. 7
Forest plot of Pemax (maximal expiratory pressure) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
Fig. 8
Fig. 8
Forest plot of GMFM (Gross Motor Function Measure) after respiratory exercise plus conventional rehabilitation versus conventional rehabilitation. RE respiratory exercise, CR conventional rehabilitation, SD standard deviation, CI confidence interval
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References

    1. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9:125–135. doi: 10.21037/tp.2020.01.01. - DOI - PMC - PubMed
    1. Gkaraveli M, Skordilis E, Grammatopoulou E, Karteroliotis K, Dania A, Morfis P, et al. The effect of inspiratory muscle training on respiratory pressure, pulmonary function and walking ability in preschool children with cerebral palsy. Ann Physiother Clin. 2019;2:1–8.
    1. Boel L, Pernet K, Toussaint M, Ides K, Leemans G, Haan J, et al. Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol. 2019;61:646–653. doi: 10.1111/dmcn.14060. - DOI - PubMed
    1. Wang HY, Chen CC, Hsiao SF. Relationships between respiratory muscle strength and daily living function in children with cerebral palsy. Res Dev Disabil. 2012;33:1176–1182. doi: 10.1016/j.ridd.2012.02.004. - DOI - PubMed
    1. Kwon YH, Lee HY. Differences in respiratory pressure and pulmonary function among children with spastic diplegic and hemiplegic cerebral palsy in comparison with normal controls. J Phys Ther Sci. 2015;27:401–403. doi: 10.1589/jpts.27.401. - DOI - PMC - PubMed