Maximum Inspiratory Research Articles

Monitorización del destete ventilatorio en el paciente crítico

The weaning process can be classified as simple, difficult, or prolonged. The incidence of difficult or prolonged weaning varies from 15% to 25%, according to the series. In critically ill patients it accounts for up to 50% of the total time that they are connected to the ventilator. It is very important to monitor weaning to detect the patients in whom it will be prolonged, and to help us in their management and decision making. Firstly, gas exchange and ventilatory mechanics must be monitored, fundamental in all patients on mechanical ventilation (MV). In addition, monitoring specific parameters that provide information on the patient's respiratory effort is strategic in the weaning process. These parameters include occlusion pressure (P0.1), oesophageal pressure (Poes), Negative Inspiratory Force (NIF), also known as Maximum Inspiratory Pressure (MIP), diaphragmatic electric activity (Edi), total work of breathing (WOB), and its components, elastic WOB (eWOB), and resistive WOB (rWOB). Monitoring weaning from mechanical ventilation means we can establish when the conditions have been met to start the weaning process, propose a weaning protocol adapted to the conditions of the patient, and define our post-extubation respiratory care protocol to prevent weaning failure.

Functional assessment of respiratory muscles and lung capacity of CrossFit athletes.

CrossFit is a high-intensity training related to physical fitness and respiratory capacity that can promote changes in lung function. This cross-sectional study was aimed at evaluating respiratory muscle strength, electromyographic (EMG) activity, and lung capacity in CrossFit athletes. Thirty subjects aged between 25 and 35 years were divided into groups: CrossFit athletes (n=15) and sedentary individuals without comorbidities (n=15). Respiratory muscle strength was evaluated using maximal inspiratory and expiratory pressures, lung capacity, and EMG of the sternocleidomastoid, serratus anterior, external intercostal, and diaphragm muscles at respiratory rest, maximal inspiration and expiration, and respiratory cycle. Data were tabulated and subjected to statistical analyses (t-test and Spearman test, P<0.05). Respiratory muscle strength on EMG of the sternocleidomastoid, serratus, external intercostal, and diaphragm muscles at the respiratory cycle and maximal forced inspiration and expiration were higher in the CrossFit athletes group than in the sedentary group without comorbidities. CrossFit athlete group showed significantly strong positive correlation between maximal inspiratory and expiratory muscle strengths (Spearman rho= 0.903, P=0.000), with increasing muscle strength during inspiration favoring an increase in strength during expiration. The forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) also showed a significantly high positive correlation (Spearman rho=0.912, P=0.000) in the CrossFit athletes group, showing that higher FVC favors higher FEV1. The results of this study suggest that improved fitness is based on increased respiratory muscle strength on EMG in CrossFit athletes.

Assessment of Lung Efficiency of Individuals Exposed to Various Foundry Industries in Satara City

The airborne dust as pollutants plays a major role in the overall atmospheric pollution. Silica is a chemical term for silicon dioxide (SiO2). The term crystalline silica refers to a crystallized form of SiO2 known as quartz, crystobalite or tridymite; it is the most abundant compound on the earth’s crust capable of causing silicosis and lung cancer upon inhaling large doses in course of occupational exposure. The present study was aim to evaluate the lung efficiency of individuals who worked in various foundry industries in Satara city. Around 300 individuals were enrolled. From selected three locations, 100 individuals were enrolled. All the individuals from the test were given a pulmonary function test. Before the test, a questionnaire was given to them to collect their basic information. Their age, height and weight were also entered in the spirometer. The spirometer gives two values; one is the expected value and the other is actual value. The predicted values are based upon the age, height and weight of the person while the actual values are dependent upon the maximal inspiration and expiration of the person. All the parameters, i.e. FVC, SVC and MVV showed impairment in the large industry workers compared to other two industries workers. A significant difference (p &lt; 0.01) in the actual and expected values was observed in the pulmonary function test individuals of all the three selected industries. The percentage efficiency for all parameters for small industry workers, i.e. FVC (96.42 %), SVC (95.71 %) and MVV (88.69 %) was also good as compared to large and medium industries. At large industry, MVV efficiency was very less (59.66 %) as compared to the medium industry (68.61 %) and small industry (88.69 %) workers. In the SVC also, a large industry worker (69.72 %) showed less value as compared to the medium industry (79.99 %) and small industry (95.71 %) workers. Restrictive defect was 14 %, 36 %, 33 % and 17 % in the large industry workers which was normal, mild, moderate and severe, respectively. These values were very low as compared to small industry workers. Individuals exposed to heavy load of pollutants in air are susceptible for many respiratory disorders. Decrease in the FVC, MVV and SVC parameters were observed in the individuals of large industry assz compared to medium and small industry. This impairment in the pulmonary test parameters are indications of an accumulation of pollutants in the airways, which intern reduces inhalation and exhalation force. So, the people exposing continuously to such silica or particulate matter pollution should be made aware about pulmonary disorders.

COMBINED EFFECT OF UPPER EXTREMITY PNF AND ELASTIC RESISTANCE BAND TRAINING ON INSPIRATORY MUSCLE STRENGTH IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS.

Aim: The study aims to evaluate the effect of unilateral upper extremity proprioceptive neuromuscular facilitation using an elastic resistance band on inspiratory muscle strength in chronic kidney disease patients undergoing hemodialysis. 7 patients (4 male; 3 female) were assessed for demogr Materials and Methodology: aphic data (age, weight, height, BMI) and Maximal Inspiratory Pressure (MIP) at baseline. All 7 patients underwent 8-week resistance training for the unilateral upper extremity. The intervention used was unilateral upper extremity proprioceptive neuromuscular facilitation (PNF) exercises combined with an elastic resistance band (ERB). Upper extremity PNF patterns (D1 exion, extension &amp; D2 exion, extension) were used in the training protocol. All the exercises were carried out on the dialysis bed during an intradialytic period. 2 sessions per week for 8 weeks; a total of 16 sessions were held. 3 sets of 6 repetitions were given. After completion of the training protocol, MIP was re-evaluated. In pre-and post-training comp Results: arison, there was statistically signicant improvement (p &lt; 0.0056) in the post-training Maximal Inspiratory Pressure (i.e., 62.71±27.85 cmH2O) compared to pre-training maximal inspiratory pressure (i.e.,55.71±24.39 cmH2O). Intradialytic unilateral upper Conclusion: extremity resistance training can improve the inspiratory muscle strength in chronic kidney disease patients undergoing hemodialysis.

Reliability and validity of the incremental shuttle walk test in patients with fully ambulatory multiple sclerosis.

Functional exercise capacity evaluation is crucial to monitor treatment effects and disease progression in people with multiple sclerosis (pwMS). Compared to other tests, the incremental shuttle walking test (ISWT), which more accurately reflects cardiovascular responses, may be more useful for assessing exercise capacity. The aim of the study is to investigate the reliability and validity of the ISWT. Thirty-six pwMS with an Expanded Disability Status Scale (EDSS) score<4.5 between the ages of 25 and 65 were included in the study. The subjects underwent practice (ISWT-p) before undergoing the test-retest protocol in order to rule out the ISWT learning effect (ISWT-1 - ISWT-2). ISWT-1 and ISWT-2 were administered with a 3-7 day interval for test-retest reliability. Six-minutes walking test (6MWT) were applied for concurrent validity. The EDSS, pulmonary function tests, Fatigue Impact Scale (FIS), respiratory muscle strength [maximum inspiratory and expiratory pressure (MIP-MEP)] measurements were made for convergent validity. ISWT was found to have excellent test-retest reliability with an ICC value of 0.97. The area under the curve value was 0.904 indicating that ISWT has a good performance for predicting disease severity. The moderate correlation between ISWT and 6MWT (rho: 0.68, p<0,001) proved concurrent validity. It was also moderately correlated with EDSS, MEP (rho: -0.58 and 0.47 respectively), weakly correlated with MIP and FIS (rho:0.37 and -0.36, respectively) while not correlated with pulmonary function tests. The ISWT had excellent test-retest reliability, acceptable criterion and construct validity in ambulatory MS patients.

Effect of the Inspiratory Method and Timing of Voluntary Cough on Peak Cough Flow.

To define the effect of the inspiratory method and cough timing on peak cough flow (PCF). We investigated the effect of measurement conditions on PCF in healthy subjects (n=10). We then compared obstructive and restrictive pulmonary diseases (n=20) to assess for similar results in respiratory diseases. The PCF was measured under four conditions: before coughing, without maneuver 1 or with maneuver 2 a temporary respiratory pause (4-6 seconds) after rapid inspiration, and without maneuver 3 or with maneuver 4 a temporary respiratory pause after slow inspiration. After the measurements were completed, the PCF between the four conditions was compared for each subject group, and the effect size was calculated. PCF of maneuvers 1 and 3 were significantly higher than maneuver 4 in healthy subjects (476.34±102.05 L/min and 463.44±107.14 L/min vs. 429.54±116.83 L/min, p<0.01 and p<0.05, respectively) and patients with restrictive pulmonary disease (381.96±145.31 L/min, 354.60±157.36 L/min vs. 296.94±137.49 L/min, p<0.01 and p<0.05, respectively). In obstructive pulmonary disease, maneuver 1 was significantly higher than maneuver 4 (327.42±154.73 L/min vs. 279.48±141.10 L/min, p<0.05). The largest effect sizes were shown by maneuvers 4 and 1. PCF depends on changes in inspiratory speed before coughing and on temporary respiratory pauses after maximal inspiration. It will become necessary to unify the measurement methods for coughing strength and present appropriate coughing methods.

Cardiopulmonary and hematological effects of infrared LED photobiomodulation in the treatment of SARS-COV2.

COVID-19 disease is caused by SARS-CoV-2 which can trigger acute respiratory syndrome, which presents with dense alveolar and interstitial infiltrates and pulmonary edema, causing severe hypoxemia and significant alteration to pulmonary mechanics with reduced pulmonary compliance. The photobiomodulation technique alters cellular and molecular metabolism, showing promising results regarding the reduction of acute pulmonary inflammation. To compare the photomodulation technique using near-infrared LED to conventional respiratory physiotherapy treatment in patients with COVID-19 in reversing acute conditions, reducing hospitalization time, and decreasing the need for oxygen therapy. The cohort was comprised of 30 patients undergoing COVID-19 treatment who were divided and allocated into two equal groups randomly: the LED group (LED), treated with infrared LED at 940nm and conventional therapy, and the control group (CON), who received conventional treatment (antibiotic therapy for preventing superimposed bacterial infections, and physiotherapy) with LED irradiation off. Phototherapy used a vest with an array of 300 LEDs (940nm) mounted on a 36cm×58cm area and positioned in the patient's anterior thoracic and abdominal regions. The total power was 6W, with 15min irradiation time. Cardiopulmonary functions and blood count were monitored before and after treatment. The patients were treated daily for 7days. Statistical analysis was conducted using a two-tailed unpaired Student's t-test at a significance level of α=0.05. Post-treatment, the LED group showed a reduction in hospital discharge time and a statistically significant improvement for the following cardiopulmonary functions: Partial Oxygen Saturation, Tidal Volume, Maximum Inspiratory, and Expiratory Pressures, Respiratory Frequency, Heart Rate, and Systolic Blood Pressure (p<0.05). Regarding blood count, it was observed that post-treatment, the LED group presented with significant differences in the count of leukocytes, neutrophils, and lymphocytes. Photobiomodulation therapy can be used as a complement to conventional treatment of COVID-19, promoting the improvement of cardiopulmonary functions, and minimization of respiratory symptoms.

Kineziterapija pagerina COVID-19 liga persirgusių asmenų kvėpavimo funkcijas, pusiausvyrą ir fizinį pajėgumą

The Coronavirus disease (COVID-19) is an infection caused by the coronavirus SARS-CoV-2. Although most patients with COVID-19 develop a mild form, approximately 14 per cent get a severe form of the disease, which requires hospitalisation and additional oxygen supply, and 5 per cent require to be treated in the intensive care unit. The patients who fell ill with COVID-19 and have disturbed biosocial functions are provided with rehabilitation services. Still, there is a lack of research that would reveal the effect of physiotherapy on respiratory system function, physical capacity, and balance. The study aims to evaluate the effect of physiotherapy on patients with COVID-19 disease. 15 participants (the mean age 56.00 ± 4.61 years) who had moderate COVID-19 disease and were hospitalised at least 30 days before the study participated in the research. All participants received physiotherapy for 4 weeks, 5 times a week, each session lasting 30 minutes. Participants were evaluated twice, before the study and after 4 weeks. The assessment methods included spirometry (forced vital capacity [FVC] and forced expiratory volume in the first second after maximal inspiration [FEV1]), the measurement of chest excursion, the assessment of balance on the Berg scale, and the assessment of physical capacity with a 6-minute walk test. After physiotherapy intervention, FVC (p&lt;0.05) and FEV1 (p&lt;0.05) increased, Berg test results improved (p&lt;0.05). It can be concluded that four-week physiotherapy, including breathing and balance exercises, can be used as an effective rehabilitation tool for individuals who have recovered from COVID-19 disease.

Reference Values of Chest Expansion among Healthy Children: A Cross-sectional Study

Abstract Background and Objective: Examination of the chest wall movement during breathing provides valuable insight into the function of a person’s respiratory system. Chest mobility and lung function may be altered due to growth, body composition, and respiratory disease. Preliminary baseline values for measuring chest expansion were obtained for healthy adult Indians. However, because the rib configuration of children differs from that of an adult, reference values for children need to be established. Materials and Methods: In the present study, chest expansion was measured at three levels – second rib, fourth rib, and xiphisternum (R2, R4, and xiphisternum level which was marked at the lower end of the body of the sternum) – in 720 children aged 5–12 years using a nonstretchable measuring tape. The difference between chest circumference at maximum expiration and maximum inspiration was recorded as the value of chest expansion. Out of three, one best value and not an average value was considered a chest expansion measurement at each level. Results: Three subgroups were made: 5–7 years, 8–10 years, and 11–12 years. Results were documented and presented as mean and standard deviation for each subgroup. The reference values for chest expansion among healthy children in the age group of 5–12 years are 2.5 cm–3.2 cm at the R2 level, 3.1 cm–3.7 cm at the R4 level, and 3.8 cm–4.1 cm at the xiphisternum level. Conclusions: The chest expansion for different age groups among healthy children was different.

딥벨트의 가로막 수축압력과 초음파영상의 가로막 움직임 및 폐활량과의 상관성

Purpose: This study was designed to determine the correlation between the diaphragmatic contraction pressure using diaphragmatic pressure belt (DiP Belt) and the ultrasound imaging of diaphragmatic motion and forced vital capacity. This study was conducted to confirm the usefulness of assessing the diaphragmatic function using the DiP Belt.&#x0D; Methods: This study included 41 healthy subjects (13 males and 28 females). The diaphragmatic motion was measured using sonography, and the forced vital capacity (FVC) was measured using a portable digital spirometer device. After 2 weeks, the diaphragmatic contraction pressure was measured during maximal inspiration using the DiP Belt.&#x0D; Results: The mean diaphragmatic contraction pressure (MDCP) and peak diaphragmatic contraction pressure (PMCP) using the DiP Belt were not significantly correlated with sonography imaging of diaphragmatic motion during quiet breathing but were significantly positively correlated with the diaphragmatic motion during deep breathing. Both the MDCP and PMCP were significantly positively correlated with FVC, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF). However, diaphragmatic motion was significantly positively correlated with FVC, FEV1, and PEF in only deep breathing.&#x0D; Conclusion: The Dip Belt can provide valuable information about the diaphragmatic function, particularly ultrasound imaging of diaphragmatic motion and lung capacity.

New reference values for maximum respiratory pressures in healthy Brazilian children following guidelines recommendations: A regional study.

To determine reference values for maximum static respiratory pressures in healthy children from a Brazilian region, following recommendations of the European Respiratory Society (ERS) and the Brazilian Society of Pneumology and Tisiology (SBPT). A cross-sectional observational study was conducted with healthy children (6 to 11 years) of both sexes. The maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) were measured using a digital manometer. Each child performed a minimum of three and a maximum of five maneuvers; three acceptable and reproducible maneuvers were considered for analysis. Minimum time for each maneuver was 1.5 seconds, with a one-second plateau, and one minute of rest between them. A stepwise multiple linear regression analysis was conducted for PImax and PEmax, considering correlations between independent variables: age, weight, and sex. We included 121 children (62 girls [51%]). Boys reached higher values for maximum respiratory pressures than girls. Respiratory pressures increased with age showing moderate effect sizes (PImax: f = 0.36; PEmax: f = 0.30) between the stratified age groups (6-7, 8-9, and 10-11 years). Age and sex were included in the PImax equation (PImax = 24.630 + 7.044 x age (years) + 13.161 x sex; R2 = 0.189). PEmax equations were built considering age for girls and weight for boys [PEmax (girls) = 55.623 + 4.698 x age (years) and PEmax (boys) = 82.617 + 0.612 x weight (kg); R2 = 0.068]. This study determined new reference equations for maximal respiratory pressures in healthy Brazilian children, following ERS and SBPT recommendations.

Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

BackgroundThe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has an affinity for the angiotensin-converting enzyme 2 (ACE2) receptors, which are present abundantly on the diaphragm. This study aims to describe temporal changes in diaphragmatic thickness and excursion using ultrasonography in subjects with acute COVID-19. MethodsThis prospective observational study included adults hospitalized with COVID-19 in the past 48 hours. The diaphragm thickness at end-expiration (DTE), diaphragm thickening fraction (DTF), and diaphragm excursion during tidal breathing (DE) and maximal inspiration (DEmax) were measured using ultrasonography daily for 5 days. The changes in DTE, DTF, DE, and Demax from day 1 to day 5 were assessed. ResultsThis study included 64 adults (62.5% male) with a mean (SD) age of 50.2 (17.5) years. A majority (91%) of the participants had mild or moderate illness. The median (IQR) DTE, DTF (%), DE and Demax on day 1 were 2.2 (1.9, 3.0) mm, 21.5% (14.2, 31.0), 19.2 (16.5, 24.0) mm, and 26.7 (22.0, 30.2) mm, respectively. On day 5, there was a significant reduction in the DTE (p=0.002) with a median (IQR) percentage change of -15.7% (-21.0, 0.0). The DTF significantly increased on day 5 with a median (IQR) percentage change of 25.0% (-19.2, 98.4), p=0.03. There was no significant change in DE and Demax from day 1 to day 5, with a median (IQR) percentage change of 3.6% (-5.2, 15) and 0% (-6.7, 5.9), respectively. ConclusionsNon-intubated patients with COVID-19 exhibited a temporal decline in diaphragm thickness with increase in thickening fraction over 5 days of hospital admission. Further research is warranted to assess the impact of COVID-19 pneumonia on diaphragmatic function.

Respiratory and Sound Pressures, Maximum Phonation Time, Cervical Disability and Voice-Related Quality of Life of Teachers

IntroductionMany teachers report discomfort and a decrease in the quality of aerodynamic, respiratory, and cervical vocal aspects as well as of vocal self-assessment. ObjectiveCharacterize and correlate measurements of Sound Pressure Levels, Maximum Phonation Time of /a/, Maximum Respiratory Pressures, Voice-Related Quality of Life and cervical pain in teachers with vocal and musculoskeletal complaints and no organic vocal fold lesions, and compare with normative values. MethodsRetrospective study with 56 teachers. Anamnesis, video laryngoscopy, hearing screening, measurements of sound pressure and maximum phonation time, and manovacuometry were performed. Self-assessment protocols for Voice-Related Quality of Life and Neck Disability Index were completed. Resultsthere was significant higher Sound Pressure Levels; significant lower Maximum Phonation Time of /a/, Maximum Expiratory Pressure, and total and physical scores of Voice-Related Quality of Life; most participants had mild cervical disability; there was a negative correlation between Maximum Expiratory Pressure and Neck Disability Index, between Maximum Inspiratory Pressure and Maximum Sound Pressure Level, and between Neck Disability Index and Voice-Related Quality of Life. ConclusionThe results showed that there are damages and inadequacies in teachers’ vocal production which affect their quality of life. Therefore, it is necessary to pay attention to the conditions of use of the voice by professionals, and to their health education.

Effects of creative dance on functional capacity, pulmonary function, balance, and cognition in COPD patients: A randomized controlled trial

BackgroundExercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Creative dance can be an innovative approach as effective as traditional exercise training. ObjectivesThis study aimed to investigate effect of creative dance-based exercise (CDE) training on functional capacity, postural stability and balance, pulmonary and cognitive functions, respiratory and peripheral muscle strength in COPD patients. MethodsTwenty-four patients with COPD were randomly allocated to either “chest physiotherapy and home-based walking program” (PT) or “CDE alongside home-based chest physiotherapy group” (PT+CDE). Both groups performed chest PT program twice a day for 5 days per week for 8 weeks. PT+CDE group received CDE training 2 days a week for 8 weeks. Primary outcome was six minute walk test (6MWT). Secondary outcomes were postural stability and balance, pulmonary function, maximum inspiratory (MIP) and expiratory (MEP) pressure, peripheral muscle strength, Montreal Cognitive Assessment (MoCA), COPD Assessment Test (CAT), and BODE index. Outcome measures were assessed at baseline and after 8 weeks of training. ResultsBoth groups showed statistically significant improvements in 6MWT distance, MIP, MEP, MoCA score, CAT, and BODE index (p < 0.05). Only with CDE training was achieved improvements in postural stability and balance scores, pulmonary function, and peripheral muscle strength (p < 0.05). The improvements in 6 MWT distance, MEP, MoCA score, and CAT were greater in PT+CDE group (p < 0.05). ConclusionUse of creative dance training in addition to home-based chest PT program was more effective than chest PT program regarding primary and secondary outcomes in COPD patients.

Performance Analysis of Emergency Ventilator #BPPT3S-LEN for In-Hospital Use

Covid-19 is a global pandemic that originated in Wuhan, China in 2019. It spread very fast around the globe. Many countries suffer from this disease. About 532.2 million people were confirmed and 6.3 million patients were reported dead globally. People infected by this disease will suffer from breathing problems, ranging from light problems to respiration failure. Mechanical ventilators are commonly used to treat patients with respiration failure. However, the increasing number of Covid-19 patients staying in the hospitals, caused the hospitals to lack mechanical ventilators. The emergency ventilator was a choice need to be developed to respond to the lack of mechanical ventilators in the hospitals. It is easy to develop, electronics and medical components available in the local market. Emergency Ventilator #BPPT3S-LEN is an automatic BVM-based resuscitator. This medical device was developed based on the Emergency Use Ventilator Design Guidance of AAMI/CR501:2020 of the USA and MHRA of the UK. It consists of a mechanical part for squeezing, airbag, breathing circuit, pressure gauge, one-way valve, relief valve, flow sensor, PEEP valve, mask or endotracheal tube. Ventilation parameters need to be set in this device including tidal volume, respiration rate, inspirations/expiration time ratio, and PEEP (positive end-expiratory pressure). Measured parameters were tidal volume, respiration rate, peak inspiratory pressure, inspiration/expiration time ratio. Alarm systems were set for maximum inspiration pressure, minimum battery voltage, AC power failure. Self-calibration software was installed in this device. Medical doctors tested about 5 emergency ventilators in regional public hospital RSUD Dr. Saiful Anwar Malang, Indonesia. It was reported that the devices gave better results than manual bagging for measurement results of tidal volume, respiration rate, and peak inspiratory pressure.

Usability and Effectiveness Evaluation of a Game-Based Biofeedback System to Strengthen Respiratory Muscles

The assessment and training of respiratory muscles are two essential tasks for indirect screening of status and improvement of lung function, respectively, especially in times of COVID-19. To perform both tasks, we have designed an innovative handheld mouth pressure biofeedback system for assessment and personalized game-based training of respiratory muscle strength. Thirty recovered COVID-19 patients were involved in an across-ages pilot study to evaluate their respiratory muscle strength and the system’s usability, and eight of the thirty patients were involved in a home inspiratory training program of 3 weeks to assess its effectiveness. Results revealed that participants rated the system’s overall usability as excellent (91.3 ± 6.4) and consistently performed respiratory cycles along with the game-based training program in terms of mouth pressure. Furthermore, patients involved in the home training program showed a 40% increase in their Maximal Inspiratory Pressure (Pimax). These results indicate that the proposed system stands for a proper healthcare solution for the initial diagnosis of respiratory muscle dysfunction or disease and for guiding the correct performance of tailored and consecutive threshold load breathing cycles playfully and engagingly. Furthermore, it stands for an attractive and personalized biofeedback solution to promote adherence to at-home therapy. Finally, it can be used to investigate new and effective training protocols that improve respiratory muscle performance.

Functional disorders of the respiratory system after a new coronavirus infection COVID-19

COVID-19 (Coronavirus disease 2019) is an infectious disease caused by the coronavirus SARS-CoV-2, characterized by a high level of morbidity and mortality. A new coronavirus infection affects all organs and systems and often occurs with lung damage and respiratory failure. In a significant part of patients after the acute period of COVID-19, the symptoms of the disease persist, but the most problematic symptoms are the ones regarding lung damage that persists for a long amount of time.&#x0D; This review summarizes the results of our research in 20202021. The purpose of the conducted studies was to estimate the functional parameters of the respiratory system in patients that have been infected by COVID-19. Along with conventional pulmonary function tests (spirometry, body plethysmography and diffusion test), impulse oscillometry, the multiple-breath nitrogen washout test, determination of the maximum inspiratory and expiratory pressures were performed in all patients. Thus, we evaluated the ventilation and gas exchange function of the bronchopulmonary system, the functional state of the peripheral parts of the lungs, including the small airways, the uniformity of pulmonary ventilation and the strength of the respiratory muscles in different periods of recovery after COVID-19, including the follow-up after medical rehabilitation.&#x0D; To sum up, comprehensive functional assessment of the respiratory system is an important clinical tool that allows the planning of pharmacotherapy and to create individual programs of medical rehabilitation of patients who had COVID-19.

Normative Value of Chest Expansion in Healthy Children Between 5 to 12 Years of Age Group

Background: Chest expansion measurement is included as a standard mode of measurement to evaluate patient’s baseline status of respiratory function. There are various anatomical and physiological differences between adult and paediatric respiratory system hence, adult values of chest expansion cannot be used as reference values in paediatric population. Also, there is lack of recent data that has evaluated chest expansion values in paediatric age group. So, the present study was undertaken to find out normal chest expansion values in children between 5-12 years of age. It is important to know the reference value for precise interpretation. Methodology: A cross sectional observational study was carried out in 600 children between age group of 5-12 years and with normal BMI(without H/O any cardiac/respiratory illness, musculoskeletal or neurological diseases, spinal deviations, cough and cold). Chest expansion measurements were assessed in sitting position at three levels that is, 2nd, 4th and 6th intercostal spaces(ICS), using an non- elastic measuring tape. It was taken as thoracic circumference at the end of maximum exhalation and inspiration. An average of three such readings at each level was taken into consideration. Results: To find value of chest expansion at 2nd, 4th and 6th ICS levels a average values of the three measurements taken at each level at same time was taken into consideration. Conclusion: The normative values of chest expansion in healthy children between age group of 5-12 years is 2nd Intercostal space- 1 inch/ 2.5 cm, 4th Intercostal space- 1 inch/2.5 cm, 6th Intercostal space- 1.7 inch/ 4.25cm. KEY WORDS: Chest Expansion, Normative Values, Children, Paediatric.

Evaluation of primary and accessory respiratory muscles and their influence on exercise capacity and dyspnea in pulmonary arterial hypertension

BackgroundSkeletal and respiratory muscle disfunction has been described in pulmonary arterial hypertension (PAH), however, involvement of accessory respiratory muscles and their association with symptomatology in PAH is unclear. ObjectivesTo assess the primary and accessory respiratory muscles and their influence on exercise tolerance and dyspnea. Methods27 patients and 27 healthy controls were included. Serratus anterior (SA), pectoralis muscles (PM) and sternocleidomastoid (SCM) muscle strength were evaluated as accessory respiratory muscles, maximal inspiratory (MIP) and expiratory pressures (MEP) as primary respiratory muscles, and quadriceps as peripheral muscle. Exercise capacity was evaluated with 6-min walk test (6MWT), dyspnea with modified Medical Council Research (MMRC) and London Chest Activity of Daily Living (LCADL) scales. ResultsAll evaluated muscles, except SCM, and 6MWT were decreased in patient group (p < 0.01). SA was the most affected muscle among primary and accessory respiratory muscles (Cohen's-d = 1.35). All evaluated muscles significantly correlated to 6MWT (r = 0.428–0.525). A multivariate model including SA, SCM and MIP was the best model for predicting 6MWT (R = 0.606; R2 = 0.368; p = 0.013) and SA strength had the most impact on the 6MWT (B = 1.242; β = 0.340). None of the models including respiratory muscles were able to predict dyspnea, however PM and SA strength correlated to LCADL total (r = -0.493) and MMRC (r = -0.523), respectively. ConclusionSCM may be excessively used in PAH since it retains its strength. Considering the relationship of accessory respiratory muscles with exercise tolerance and dyspnea, monitoring the strength of these muscles in the clinical practice may help providing better management for PAH.

Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis

ObjectiveThe main objective was to assess the relationship between inter-recti distance (IRD) and abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with Diastasis Recti Abdominis (DRA). Additionally, the secondary purpose of the study is to investigate the independent predictors of IRD in women with DRA. Study designFifty-one women who were diagnosed with DRA participated to the study. IRD assessment with a caliper, abdominal muscle endurance test, Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), maximum inspiratory and expiratory pressure (MIP and MEP, respectively) tests, Clinical Test of Sensory Integration of Balance (m-CTSIB) under eyes open on a firm surface (EOFS), eyes closed on a firm surface (ECFS), eyes open on a foam surface (EOFoS), and eyes closed on a foam surface (ECFoS) conditions, and Limits of Stability (LOS) tests were performed for all subjects. Pearson or Spearman correlation analyses were used to determine the relationship between IRD and static abdominal flexion endurance test, PFDI-20, MIP and MEP, m-CTSIB, and LOS scores depending on the distribution properties of the data. Additionally, linear regression analysis was utilized for analyzing the independent predictors of IRD among the age, BMI, parity, time since last birth, birth weight, weight gains last pregnancy, and mode of delivery. ResultsIRD had correlations with Colorectal–Anal Distress score of PFDI-20 (r = -0.317, p = 0.03) and EOFS, ECFS, EOFoS, ECFoS and composite score of m-CTSIB (r = 0.356, p = 0.01; r = 0.337, p = 0.02, r = 0.279, p = 0.04; r = 0.265, p = 0.04; r = 0.413, p = 0.004, respectively) and LOS scores (r = 0.422, p = 0.003). Increased IRD did not influence abdominal muscle endurance and respiratory muscle strength in women with DRA (p < 0.05). Age, BMI, time since last birth, weight gains last pregnancy, and mode of delivery were not determined as the factors that influence IRD in women with DRA (p < 0.05). ConclusionWe concluded that increased IRD is associated with worse postural control, but better colorectal functions in women with DRA. Additionally, IRD does not show a clear association with abdominal muscle endurance, pelvic floor functions, and respiratory muscle strength. According to our results, postural stability assessments may perform in the physiotherapeutic management of women with DRA.