Résumé :
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Background : Respiratory dysfunction is a major cause of morbidity in spinal cord injury (SCI). It leads to impairment of respiratory muscles, reduced ventilatory reserve, ineffective cough, reduction in lung and chest wall compliance, and excess oxygen cost of breathing due to distortion of the respiratory system. It has been demonstrated in healthy volunteers that the muscles of ventilation can be trained for both strength and endurance like other skeletal muscles. The best training regimen has not been established and dosing and resistance of training is variable in different studies. In principle, regimens that target both endurance and strength would seem most desirable. Objective : To demonstrate in a case report how resistance training of the inspiratory muscles may improve the strength and endurance capacity of respiratory muscles with resultant improvement in ventilatory reserve. Method : Single case report : 34 year old man with complete cervical spinal cord injury (CSCI) in C6/C7 -level performed strength and endurance training of the inspiratory muscles in 12 weeks, 5 times/week (monday-friday) with a resistance of 80%of the maximal strength capacity (1 x 15 rep) and 60% of maximal endurance capacity of the inspiratory muscles (5 x 1 min). Baseline was 3 months after injury. The American Spinal Injury Association (ASIA) score was determined at the baseline and at 12 weeks to observe spontaneous healing. Training was performed with Respifit S (Biegler Gmbh,Mauerbach, Austria) in supine position. The training resistance was evaluated and adjusted in every second week. SpO2, HR and dyspnoea (Borg scale) was monitored before, while and after training. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak Expiratory Flow (PEF) in seated and supine position, Pi max and the Pe max (top and plateau) were examined at baseline and 12 weeks. Results : After 12 weeks Respifit S had registered 33 successful strength training episodes and 28 successful endurance training episodes. Average of successful training episodes was 2-3 x / week, which is a half of the planned dose. ASIA score shows no muscular activity or sensibility belowC7 at the baseline and patient was unaltered neurologically from baseline to 12 weeks. This would indicate that abdominal muscles had no recovery and could not influence the results. The results of strength and endurance training at baseline and 12 weeks are presented in the table. Conclusion : Results show what we believe to be a significant improvement in the patient's respiratory strength and endurance. The results indicate that training of the inspiratory muscles may enhance the ventilatory reserve in this CSCI patient.
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