Randomised Clinical Trial Inspiratory muscle training in children with neuromuscular disorders

Anri Human, Lieselotte Corten, Eleonora Lozano-Ray, Brenda M. Morrow

South African Journal of Physiotherapy | Vol 80, No 1 | a2055 | DOI: https://doi.org/10.4102/sajp.v80i1.2055 | © 2024 Anri Human, Lieselotte Corten, Eleonora Lozano-Ray, Brenda M. Morrow | This work is licensed under CC Attribution 4.0
Submitted: 15 March 2024 | Published: 08 August 2024

About the author(s) Anri Human, Department of Physiotherapy, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; and, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Lieselotte Corten, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom
Eleonora Lozano-Ray, Department of Physiotherapy, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Brenda M. Morrow, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, 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 ] 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

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

Sustainable Development Goal

Goal 3: Good health and well-being

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