Including Breathing Exercises Research Articles

Importance of Physiotherapy in Post Pneumonectomy Renal Transplant Recipient: A Case Report

Pulmonary mucormycosis is a rare but opportunistic fungal infection that complicates immunosuppressed solid organ transplant recipients. Although antifungal medication is the remedial dependence in management of pulmonary mucormycosis, early surgical intervention provides advantage over medical treatment alone. However, major impairments and complications such as altered pulmonary and physical function induced by surgery are known to occur. We report the case of a 25-year-old male post renal transplantation on immunosuppression who developed invasive pulmonary mucormycosis in right middle and lower lobe. Liposomal Amphotericin B therapy provided insufficient infection control and lesion invaded the adjacent chest wall, ribs and intercostal muscles. After right pneumonectomy combined with anterior chest wall resection, the initial post-operative physiotherapy assessment was carried out. The patient was found to have productive cough, dyspnoea, chest pain, reduced chest expansion and excursion, limited range of motion of shoulder on affected side and limited activities of daily living. Six weeks of inpatient physiotherapy regime was given which included breathing exercises, thoracic mobility exercises, incentive spirometry, active range of motion exercises, positioning, bed mobility and early ambulation. Follow up assessment showed reduced pain intensity and improvement in oxygen saturation, dyspnoea, Timed up and go test (TUG) time, handgrip strength, activities of daily living and quality of life [Short form 36 (SF-36)]. Keywords: Pneumonectomy, Thoracic Surgery, Renal Transplant, Physiotherapy

Development, validation, and feasibility testing of a yoga module for substance use disorder

ABSTRACT Introduction: Research evidence and theoretical models point to the need to implement yoga and mindfulness interventions as they impact different physiological and psychological functioning associated with addiction and relapse. To ensure the safe application of yoga, a standardized yoga module that can be practiced across any drug type of substance addiction is required. This study focuses on developing, validating, and testing a yoga module’s feasibility for the management of substance use disorder (SUD). Materials and Methods: The yoga module was developed for SUD by including specific yogic practices derived from research evidence from Google Scholar, PubMed, and traditional literature targeting symptoms related to SUD. Yoga experts validated the module using a 3-point Likert scale. Practices which scored a content validity ratio (CVR) score ≥0.33 were retained in the yoga module for SUD. A pilot assessment was done online to test the module’s feasibility. Participants in a 9-week residential rehabilitation center participated in the study. The module was taught as an add-on to their existing treatment. The motivation for seeking treatment was assessed at baseline, and quality of life was assessed at pre- and post-intervention using the questionnaire de motivation au traitement des toxicomanies and the World Health Organization Quality of Life BREF (WHOQOL BREF), respectively. Results: Thirty experts validated the developed module. Based on the CVR scoring, 37 yoga practices were retained. The final list of practices included breathing exercises, sukshmāvyāyāma (loosening exercise), āsana (postures), prāṇāyāma (breathing exercise), and dhyāna (meditation). In the feasibility study, all participants (n = 12) reported satisfaction and mentioned no adverse effects of the yoga intervention. The participants’ mean ± standard deviation (SD) of identified motivation was 26.6 ± 1.9, introjected amotivation 22.7 ± 5.1, external motivation 16.4 ± 6.2, and a motivation 15.1 ± 5.7. The Global score or Internalization coefficient mean ± SD was 29.1 ± 18.1. The participant’s total score on the WHOQOL-BREF was significant post intervention (P = 0.004). With the practice of the module, there was a significant change in the participant’s psychological (P = 0.008), social (P = 0.002), and environmental domains (P < 0.001) but not in physical health (P = 0.17). At 1 month follow-up, 11 participants (n = 12) maintained abstinence. Conclusion: The designed yoga module for SUD was validated by yoga experts and was considered safe and feasible by patients with SUD. In addition, patients reported an increase in their quality of life. This can be further studied in randomized controlled trials.

Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study

Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients.In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11).There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p < 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p < 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p < 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p < 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO3- (T: p < 0.05; G: p = 0.93; G*T; p = 0.36), Yet, Nijmegen score (T: p < 0.01; G: p = 0.32; G*T: p < 0.05) improvement was larger in NV+PR group. The exercise oronasal breathing shift during the 6MWT was significantly delayed in all patients (T: p < 0.05; G: p = 0.30; G*T: p = 0.32) and positively correlated with plasma HCO3-(r = 0.42; p < 0.05).Nasal exercise was not superior versus voluntary hypoventilation during PR in HVS patients. Yet, nasal exercise appeared feasible, leading to acquisition of a nasal breathing pattern during walking, improvement of PR outcomes and ventilatory alkalosis. The link between nasal breathing and hyperventilation is discussed in the light of the nasal ventilation rhythm in the limbic system and its role on the limbic emotional and ventilatory functions.

Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients.

Patients undergoing Coronary Artery Bypass Graft (CABG) surgery often develop pulmonary complications in the early post-operative period as result of decreased lung function and impaired cough. Conventional physiotherapy in early post-operative period aims at increasing lung volumes and airway clearance. This study aimed to determine the effectiveness of the addition of Acapella to conventional chest physiotherapy in improving lung volumes and secretion clearance in early post-operative CABG patients. Twenty patients of both genders (40-70 years) who had undergone CABG and were in Phase I of Cardiac Rehabilitation were involved in this pilot randomized control trial (9 control, 11 experimental). Post-surgery intervention commenced on post-operative day 2 (POD 2) and continued till POD 6. Patients in the control group were given conventional physiotherapy that included breathing exercises, incentive spirometry and manual techniques. Patient in the experimental group used an Acapella device along with the conventional intervention. Outcome measures considered were pulmonary function parameters (FVC, FEV1 & PEFR) and amount of sputum expectorated. A significant increase in lung volumes was observed in both the groups on POD 6 as compared to POD 2 (). However, the increase was significantly greater on POD 6 in experimental group than the control group [mean difference (95% CI) FVC: 0.44 L (0.24-0.63), FEV1: 0.43 L (0.19-0.66), PEFR: 0.86 L/s (0.57-1.14)]. The amount of sputum expectoration significantly greater in the experimental group as compared to the control group [2.71 mL (0.53-4.90)]. The addition of Acapella enhanced the effect conventional physiotherapy in improving lung volumes and airway clearance in the early post-operative period for CABG patients.

Task-related trunk training on balance, trunk control, pulmonary function and quality of life in patients with Parkinson's disease. A randomised controlled trial

Background/Aims Stooped posture and ‘en-bloc’ movement of the trunk in people with Parkinson's disease are related to balance issues, pulmonary dysfunction and difficulty in daily tasks. The primary objective of this study was to examine the effects of task-related trunk training on balance in people with Parkinson's disease. The secondary objective was to observe whether trunk control, thoracic rotation range, pulmonary function and quality of life would change for patients with Parkinson's disease after trunk training. Methods A total of 32 individuals participated in this randomised controlled trial. They had a mean age of 70.8 years, with a modified Hoehn and Yahr Scale grade of 1.5–3, could take more than six steps in the 360° turn test, were scored as grade I or II on the retropulsion test and had an absence of severe cognitive deficits. Task-related trunk training emphasised the thoracic spine's extension and rotation in prone position on elbows, hands and knees and in kneeling, sitting and standing positions. Standard physiotherapy included breathing exercises, stretching of shoulder and neck muscles, balance and walking training. Both groups practised for 1 hour a day, 3 days a week over 6 weeks. The primary outcome measure was the Mini-Balance Evaluation Systems Test. The secondary outcome measures were the Trunk Control Test, thoracic rotation range of movement, Pulmonary Function Test and Parkinson's Disease Questionnaire-39. Results Repeated measure analysis of variance revealed significant group by time interaction for the Mini-Balance Evaluation Systems Test and thoracic rotation range (P&lt;0.05), but not for the pulmonary function test and quality of life measures. Conclusions Task-related trunk training appears to be more beneficial in the balance capacity of individuals with Parkinson's disease than standard physiotherapy, but does not have any significant effects for pulmonary function and health-related quality of life.

The effects of spinal stabilization exercises in patients with myasthenia gravis: a randomized crossover study

Purpose The effects of spinal stabilization exercises (SSE) on fatigue, muscle strength, respiratory functions, functional capacity, and quality of life (QoL) in myasthenia gravis (MG) patients were investigated. Materials and methods This study which was designed a single-blinded, randomized crossover trial were included mild to moderate 10 MG patients, aged between 18 and 65. SSE and home program were applied to the patients for six weeks, four weeks between each exercise program. Fatigue assessed with Fatigue Severity Scale (FSS) and Visual Analog Fatigue Scale (VAFS). Muscle strengths were assessed with dynamometric measures. Respiratory Function Test, 6 Minute Walk Test (6MWT), Quantitative Myasthenia Gravis Score (QMGS), Myasthenia Gravis Quality of Life Scale-15 (MGQOL-15) were used. Results All parameters were improved in SSE group, but not neck muscles strength, QMGS, and respiratory functions in home program group. FSS, VAFS, muscle strength, 6MWT, MGQOL-15 values were found significantly different in SSE group (p = .005 in all parameters). Conclusions SSE are safe and effective on fatigue, muscle strength, respiratory functions, functional capacity, and QoL for MG patients, so it may be suggested to include SSE in rehabilitation programs of MG patients. Implications For Rehabilitation Spinal stabilization exercises are safe and effective for Myasthenia Gravis patients. Home exercise program which included breathing exercises and callisthenic exercises tailored to the patients’ needs is safe and effective for Myasthenia Gravis patients. Rehabilitation programs of Myasthenia Gravis patients should include spinal stabilization exercises.

An evidence-based approach in the management of fatigue due to heart failure: breathing exercises

Fatigue is one of the common symptoms that adversely affect the quality of life of patients with heart failure. It has been reported that fatigue seen in heart failure is caused by conditions such as deterioration of peripheral circulation due to decrease in oxygen delivery, autonomic nervous system abnormalities and deterioration in the strength of the respiratory muscles. Breathing exercises are one of the integrative applications that can increase oxygen delivery due to the functional connection of the heart and lungs providing relief from fatigue. In the literature, breathing exercises have a wide range of breathing techniques that create changes in breathing form and rate. Many studies have found that breathing exercises reduce fatigue, and can have significant effects on patient care and clinical outcomes. Nurses have a major impact on patient outcomes such as reducing fatigue in heart failure patients and improving health-related quality of life. For this reason, it is very important to include breathing exercises in nursing practices. In this regard, the importance of breathing exercises in the management of fatigue due to heart failure has been addressed in this review.

The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD.

Near-infrared spectroscopy (NIRS) technology can evaluate muscle metabolism and oxygenation. NIRS-based oximeters can measure skeletal muscle oxygen delivery and utilization during static and dynamic work non-invasively. Our goal was to assess the value and usability of NIRS technology in chronic obstructive pulmonary disease (COPD) rehabilitation program. Forty patients with COPD participated in a 4-week inpatient rehabilitation program that included breathing exercises and personalized cycle/treadmill training adjusted to the functional capacity, physical activity and comorbidities of the patients. A NIRS muscle oxygen monitor was used to measure tissue oxygenation and hemoglobin levels. Total hemoglobin index, average muscle oxygenation, minimal and maximal muscle oxygenation were recorded before and after the rehabilitation program. Rehabilitation resulted improvement in 6 min walking distance (6MWD:335.3 ± 110. vs. 398.3 ± 126.2 m; P < 0.01), maximal inspiratory pressure (MIP: 57.7 ± 22.7 vs. 63.6 ± 18.0 cmH2O; P < 0.01), chest wall expansion (CWE: 2.84 ± 1.26 vs, 4.00 ± 1.76 cm; P < 0.01), breath hold time (BHT: 25.8 ± 10.6 vs. 29.2 ± 11.6 s; P < 0.01) and grip strength (GS: 24.9 ± 11.9 vs. 27.0 ± 11.4 kg; P < 0.01). Quality of life improvement was monitored by COPD Assessment Test (CAT: 17.00 ± 8.49 vs. 11.89 ± 7.3, P < 0.05). Total hemoglobin index (tHb: 12.8 ± 1.3% vs. 12.8 ± 1.4), average muscle oxygenation (SmO2: 67.5 ± 14.4% vs. 65.2 ± 20.4%) showed a tendency for improvement. Maximal muscle oxygenation decreased (SmO2 max: 98.0 ± 20.5% vs. 90.1 ± 14.3%; P < 0.01). Minimal muscle oxygenation increased (SmO2 min: 42.6 ± 12.6% vs. 54.8 ± 14.3%; P < 0.01). NIRS results showed that muscle oxygenation and microcirculation can be described as a high-risk factor in COPD patients. The 4-week rehabilitation improves functional parameters, quality of life and tissue oxygenation levels in COPD patients.

Effects of mento-physical exercises on mental fatigue of shift work

Objectives. This study aims to investigate whether mento-physical exercises can decrease mental fatigue during shift work. Methods. Research subjects including the control room staff of an urban train system were chosen randomly, for whom mental fatigue was assessed before and after rest breaks for control and experimental groups. A new protocol was applied in the experimental group, including breathing exercises, isometric and isotonic exercises, and progressive relaxation during the inter-shift break. A designed questionnaire and the Stroop test were used to evaluate fatigue and the reaction time, respectively. Results. Pre and post-test results showed that mental, visual and physical fatigue and reaction time decreased by 14.48, 49.22, 26.85 and 8.35% in the control group and 36.42, 48.48, 76.37 and 20.56% in the experimental group, respectively. Conclusions. At the 5% α level, Student’s t test showed that mento-physical exercises effectively decreased mental and physical fatigue as well as reaction time in the experimental group compared to the control group.

Axonal polineuropathy associated with Sars-CoV 2 infection: a case report.

World healthcare systems are dealing with the pandemic of the severe Coronavirus disease 19 (Covid-19). Covid-19 neurological manifestations affecting both central and peripheral nervous systems have been reported. We describe the case of 44-year-old patient, who was admitted to our Rehabilitation Unit after discharge from intensive care unit for severe Covid-19 related respiratory failure. Neurophysiological investigation revealed an axonal polineuropathy with impairment both of sensory and motor component. He underwent a comprehensive rehabilitation treatment, including breathing exercises and motor rehabilitation. Despite rapid and effective diagnosis and customized progressive rehabilitation treatment, significant improvement in sensory-motor abnormalities has begun but distal complete recovery was not achieved. Indeed, complete indipendence during walking has been partially reached: patient constantly needs two sticks and wears two ankle-foot orthosis during ambulatory function. Nowadays, exploring the neurologic manifestations of Covid-19 may represent a step towards better understanding the virus, preventing longterm sequela and rehabilitation concerns.

Effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease after lobectomy due to non-small cell lung cancer - a single-center retrospective study.

The procedure of lung parenchyma resection may result in impairment of physical capacity and quality of life. In patients with operable non-small cell lung cancer (NSCLC), lobectomy is an elective procedure. Chronic obstructive pulmonary disease (COPD) is a common coexisting condition in patients with NSCLC. Effectiveness of post-operative pulmonary rehabilitation (PR) in patients who underwent lobectomy due to NSCLC and suffering from COPD as compared to individuals without COPD has not been determined yet. The aim of the study was to compare effectiveness of post-operative PR in patients with COPD after lobectomy due to NSCLC (COPD[+] L [+]) with individuals with COPD without lung parenchyma resection (COPD(+) L(-)) and those who underwent lobectomy due to NSCLC and not suffering from COPD (COPD[-] L[+]). Thirty-seven patients with non-small cell lung cancer (21 patients with and 16 patients without COPD) who underwent lobectomy and 29 subjects with COPD referred to the Lung Diseases Treatment and Rehabilitation Centre in Lodz in 2018-2019 were included in this retrospective analysis. The patients participated in a 3-week inpatient pulmonary rehabilitation (PR) program which included breathing exercises, physical workout, relaxation exercises, education, psychological support and nutrition consulting. The evaluation included lung function measurements, six-minute walking test (6MWT) and the St. George's Respiratory Questionnaire (SGRQ) score. The results obtained before the rehabilitation were compared to those achieved after the 3-week PR program and compared between the study groups. A significant increase in the distance covered during 6MWT was observed in all the three groups studied: COPD(+) L(+) (Δ = 62.52 ± 14.58 m); COPD(-) L(+) (Δ = 73.67 ± 11.58 m); and COPD(+) L(-) (Δ = 59.93 ± 10.02 m) (p < 0.001 for all). Similarly, a statistically and clinically significant improvement in the total SGRQ score was recorded: COPD(+) L(+) ∆ = -12.05 ± 3.96 points; p < 0.05 and COPD(-) L(+) ∆ = -12.30 ± 4.85 points; p < 0.01 and COPD(+) (L-) ∆= -14.07 ± 3.36 points (p < 0.001). No significant differences in the outcome improvement between the study groups were identified. The results of the study show that COPD(+) L(+) patients gained benefits from post-operative PR comparable to COPD(+) L(-) and COPD(-) L(+) subjects by improving their physical capacity and quality of life.

Active Cycle Breathing Technique Terhadap Fungsional Paru Pasien Post CABG (Laporan Kasus Berbasis Bukti)

Coronary Artery Bypass Graft (CABG) is an operative action in cases of coronary heart disease (CHD) by cutting and replacing clogged coronary arteries from healthy vessels taken from the legs, arms, or chest. The main clinical problem that arises in post-CABG patients is decreased lung functional capacity, this is due to shortness of breath, pain, decreased thoracic expansion, sputum retention, and decreased pulmonary ventilation. Active Cycle of Breathing Technique (ACBT) is a physiotherapy modality that can be applied in cardiovascular cases. ACBT is a series of exercises that include breathing exercises, coughing exercises, and exercises to expand the chest. To determine the effectiveness of ACBT in increasing lung functional capacity in Post CABG patients, an electronic database search was performed, namely Pubmed, Cochrane, and Google Schoolar. From the search results, 6 articles were selected that met the criteria, namely 1 article on Pubmed and 5 articles on Google scholar. Based on the results of the research that has been presented, it can be concluded that ACBT can increase the functional capacity of the lungs in post CABG patients as evidenced by the evaluation of the results of the 6 minutes walking test, borg scale, and breath holding time.

Could routine race-adjustment of spirometers exacerbate racial disparities in COVID-19 recovery?

Could routine race-adjustment of spirometers exacerbate racial disparities in COVID-19 recovery?

O17 Physiotherapy experience of treating patients with PIMS-TR COVID-19 following stepdown from PICU

O17 Physiotherapy experience of treating patients with PIMS-TR COVID-19 following stepdown from PICU

PND30 Breathing Training HAS Positive Effect on Attention in Children with ADHD

It is known that children with ADHD have deficit in executive abilities and attention. We have revealed that body-oriented training has positive effect on executive abilities in 6-7 years age children with ADHD (Kiselev & Parshakova, 2018). The goal of this study was to reveal the effect of breathing training on attention in 6-7 years of age children with ADHD. We compared the efficacy of two methods of treatment (breathing training for children vs. conventional motor exercises) in a randomized controlled pilot study. 14 children with ADHD between 6 and 7 years of age were included and randomly assigned to training conditions according to a 2×2 cross-over design. The training included breathing exercises from yoga. Both groups of children have participated in 12 weeks of training (breathing training vs. conventional motor exercises). A total of 36 training sessions lasting 30 minutes were performed. We used 3 subtests from NEPSY (Auditory Attention and Response Set, Visual Attention, Statue) to assess attention in children. Effects of training were analyzed by means of an ANOVA for repeated measurements. The ANOVA has revealed (p<.05) that for all used subtests (Auditory Attention and Response Set, Visual Attention, Statue) the breathing training was superior to the conventional motor training, with effect sizes in the medium-to-high range (0.51-0.89). The findings from this pilot study suggest that breathing training has a positive effect on attention in 6-7 years age children with ADHD. However, it is necessary to do further research into the impact of breathing training on ADHD children.

Effects of inspiratory muscle training and breathing exercises in children with asthma: a systematic review

Introduction: Asthma is characterized by a narrowing and inflammation of the bronchi, with symptoms of dyspnea, fatigue and exercise limitation. Physical therapy includes inspiratory muscle training and breathing exercises, given that an increase in inspiratory muscle strength and resistance can improve the symptoms of the disease. Objective: To describe the effects of inspiratory muscle training (IMT) and breathing exercises in children with asthma. Methods: This is a systematic review of the literature using the Cochrane, PubMed Scopus e Web of Science databases. The following descriptors were used: asthma, inspiratory muscle training, breathing exercises and child in Portuguese, English and Spanish. Two independent evaluators screened studies that used breathing exercises and IMT in children with asthma. Results: Of a total of 312 titles, eight studies were included, of which six are randomized clinical trials and two are observational studies All the studies included breathing exercises, with the objective of adjusting breathing patterns and pulmonary ventilation, reducing pulmonary hyperinflation, bronchospasm and sensation of dyspnea. However, as these exercises were not performed solely, the effects of this intervention could not be verified. Two studies performed IMT and showed an increase in maximal respiratory pressure. Conclusion: Breathing exercises are widely used in clinical practice as part of the management of asthma in children; however it is not possible to measure the effects in this population. IMT seems to improve inspiratory and expiratory muscle strength, but its indication in the pediatric population is not a standard procedure.

Smartphone Apps for Tinnitus Management

Smartphone Apps for Tinnitus Management

Role of Breathing Exercises and Yoga/Pranayama in Childhood Asthma: A Systematic Review.

Various complementary or alternative medicines (including breathing exercises and yoga/pranayama) have been tried as an attractive option to pharmacotherapy in childhood asthma. To evaluate the role of breathing exercise and yoga/pranayama as add on therapy to the "pharmacologically recommended treatment" of childhood asthma. We searched the published literature in the major databases: Medline via Ovid, PubMed, CENTRAL, Embase, and Google Scholar till June 2018. Randomized trials comparing breathing exercises and yoga/ pranayama versus control or as part of a composite intervention versus control were included. The primary outcome measures were quality of life and change in asthma symptoms. Secondary outcomes were: decrease in medication use, number of exacerbations, change in lung function and immunological parameters, school absenteeism and adverse events. A total of 10 trials (466 children, 6-14 years age) were included. The severity of asthma varied among the trials. The data for primary outcome measures could not be pooled, there were mixed results for both primary and secondary outcomes. No significant benefit was obtained in acute asthma and the lung function tests [except PEFR % at 4-6 weeks, PEF absolute at 3 months, and FVC absolute at 3 months] in chronic asthma. One trial compared breathing exercise versus yoga and found no difference. Adverse events were not significant. Breathing exercise and yoga/ pranayama may have some additive role in the treatment of childhood asthma. However, at present, it cannot be recommended as a standard of care due to insufficient data.

Effects of physical therapy on lung function in children with asthma: Study protocol for a systematic review and meta-analysis.

Background:Morbidity of asthma in children is increasing, which is significantly affecting children's life quality. Despite the medication therapy, physical therapies, including breathing exercises, inspiratory muscle training and physical training, are widely used to improve children's condition. However, the effectiveness of physical therapy remains unclear. This systematic review and meta-analysis is aiming to evaluate the effects of physical therapy on lung function in children with asthma and to assess which physical therapy is more effective.Methods:Three main databases (PubMed, Embase, and the Cochrane Library) will be searched from inception to November 30, 2018 for randomized controlled trials investigating the effects of physical therapy on lung function in children (age < 18 years old) with asthma published in English. In addition, a manual search of the references of relevant published studies in English will also be considered.Two independent reviewers will conduct studies selection, data extraction, and risk of bias assessment. Outcome measures will be the Peak Expiratory Flow (PEF), the Forced Expiratory Volume in the first second (FEV1), and the Forced Vital Capacity (FVC). Subgroup analyses will be performed according to the physical therapy (breathing exercises, inspiratory muscle training, and physical training) and the outcome (PEF, FEV1, FVC).Results:The results will provide useful information about the effect of physical therapy on lung function in children with asthma and demonstrate which physical therapy is more effective.Conclusion:The findings of this study will be published in a peer-reviewed journal.Prospero registration number:CRD42019121627

Restoring voice function after open diagonal resection of the larynx

The study objectiveis to perform the acoustic analysis of voice in patients after open diagonal resection of the larynx.Materials and methods. A total of 112 patients underwent diagonal resection of the larynx; of them 73 hadfrontolateral resection and 39 had expanded frontolateral resection. Primary laryngeal cancer was diagnosed in 107 patients; five patients had relapses after radiation therapy. Fifty-six participants underwent acoustic analysis of voice before surgery, 52 participants underwent it 1 month postoperatively, and 112 participants had it after completing their rehabilitation (6 months to 10 years postoperatively). To determine normal acoustic characteristics of voice, we examined 80 men with normal voice. We measured voice fundamental frequency (FF), maximum and minimum FF, FF variability, jitter, shimmer, voice intensity, amplitude of fundamental tone’s harmonics and their difference. Speech rehabilitation included breathing exercises according to E. Ya. Zolotareva and speech training according to S.L. Taptapova.Results.Patients with laryngeal cancer demonstrated significant changes in the acoustic characteristics of their voice (p &lt;0.05) compared to healthy individuals, including increased mean FF (f0) (up to 143 ± 45 Hz vs 118 ± 18 Hz in controls), decreased voice intensity (from 60 ± 8 to 43 ± 8dB), and almost 2-fold decrease in the amplitude of fundamental tone’s harmonics (ω0, 2 ω0, 3 ω0). We also found an increased dispersion and variability of acoustic characteristics assessed compared to healthy individuals. The analysis of long-term treatment outcomes demonstrated more significant improvement of voice acoustic characteristics in patients who underwent speech rehabilitation compared to those who had no rehabilitation.Conclusion.Open resection of the larynx with endoscopic removal of granulations and ligatures and laser restoration of the laryngeal lumen by dissecting the scars complemented by speech rehabilitation allow restoring respiratory function in 91.1 % of patients and restoring voice in 91.8 % of patients (to achieve acoustic characteristics close to normal).