Purpose: This project presents a case of an individual who was limited in his participation and mobility on an SCI unit due to the nature of his spinal cord injury. He, like many people with acute spinal cord injuries, are restricted to bed or sitting for long periods of time with minimal activity causing cardiopulmonary endurance issues and musculoskeletal weakness. These two problems for patients with spinal cord injury often lead to pulmonary complications causing respiratory secretions and infection of the pulmonary system. This individual case answers the following PICO question via evidence-based analysis: Does balloon therapy as a respiratory muscle training technique, added to standard of care physical therapy for patients with a spinal cord injury, improve outcomes? Background: Physical therapy for patients with spinal cord injury often focuses on transfer training, upper extremity strengthening and endurance, stretching for range of motion, and sometimes work on ambulation. It is not often physical therapists who work with patients with spinal cord injury focus on respiratory training improvements. Respiratory issues for this population as explained by Schilero, et al., (2009), "remain a major cause of morbidity and mortality"(p.130). Physical therapists have the time with these patients and the knowledge to intervene and help decrease the risk of these patients acquiring a pulmonary/respiratory complication. Adding a respiratory muscle training intervention, like balloon blowing, can be a highly beneficial exercise for patients with spinal cord injury. Case Description: Patient W is a 64-year-old hispanic male with history of low back pain and L1 discectomy in 2014. In 2015, patient W complained of low back pain near the site of his discectomy. An MRI was performed and found a ventral epidural abscess, L1-L2 discitis, and multiloculated left psoas abscess. The MRI also found osteomyelitis had completely degenerated his L3 vertebrae. This led to his recent spinal cord injury of incomplete paraplegia, and an ASIA C. Patient W was given precautions of only allowed to sit upright for 2 hours with the need of TLSO for support and no axial loading. He was sent to ABQ VA SCI unit and referred to PT for strengthening and endurance issues. Outcomes: A review of the literature shows respiratory muscle training in spinal cord injury patients does have a positive effect on pulmonary outcomes, but more research does need to be done. It also shows there are multiple ways to do this training. It can be done with different devices and expiratory and inspiratory training can be provided. Performing both with a patient who has a spinal cord injured is more appropriate as both muscle groups are necessary to have a good pulmonary/respiratory system. Improving pulmonary outcomes like Forced Expiratory Volume in 1 second (FEV1), Total Lung Capacity (TLC), Vital Capacity (VC), Maximum Inspiratory Pressure (MIP), and Maximum Expiratory Pressure (MEP) can help these patients have more efficient pulmonary/respiratory systems. These improvements can lead to a more productive cough thus decreasing the risks of acquiring pulmonary complications, like pneumonia. Research also shows that physical therapists spend a large amount of time with these patients working on strength, mobility, and wheelchair mobility but do not often incorporate respiratory training into their interventions. Discussion: This case presentation describes a patient with a L1-L2 spinal cord injury but due to necessary precautions was limited in his mobility and ability to exercise his pulmonary system. The focus of this search was to understand if respiratory muscle training through balloon blowing exercises could help improve his overall outcomes. The research for balloon blowing therapy is very limited and only has case reports and anecdotal evidence to support it. The topic of respiratory muscle training has more evidence, but still needs a greater amount of higher quality studies to solidify its use with spinal cord injury patients to improve pulmonary outcomes. Some studies report that expiratory muscle training is best for improving cough production in these patients and some report inspiratory training is better to improve efficiency of breathing. One study reports that performing both types of training is necessary in spinal cord injury population to attain an efficient and healthy pulmonary/respiratory system in SCI patients. Physical therapists dedicate most treatment time with these patients to strength and mobility improvement to increase the patient's participation in every day life. Adding respiratory muscle training could help improve patient participation further as well as keep them from acquiring respiratory illnesses better than present standard of care physical therapy alone.


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First Advisor

Kathy Dieruf

Available for download on Monday, March 14, 2118