Thoracoabdominal asynchrony and paradoxical motion in middle stage amyotrophic lateral sclerosis

Publication date: Available online 30 June 2018Source: Respiratory Physiology &NeurobiologyAuthor(s): Antonio Sarmento, Guilherme Fregonezi, Mario Emílio Teixeira Dourado-Junior, Andrea Aliverti, Armele Dornelas de Andrade, Verônica Franco Parreira, Vanessa ResquetiAbstractAimTo assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,CW), breathing pattern and cough peak flow (CPF).MethodsPhase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPRCa) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons.ResultsDuring quiet breathing, significantly higher RCa and AB θ (p 
Source: Respiratory Physiology and Neurobiology - Category: Respiratory Medicine Source Type: research

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Introduction: Respiratory muscle weakness with increment of pulmonary infection is one of the main causes of mortality and morbidity in patients with Amyotrophic Lateral Sclerosis (ALS). The effectiveness of cough gradually decreased with the increase of the expiratory and bulbar muscle weakness. The indication for mechanical cough assistance is given when the CoughPEF is 160 l/min) or a maximal expiratory pressure (MEP)
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Rehabilitation and Chronic Care Source Type: research
Background: Mechanical assistance cough for patients with neuromuscular disorders (NMD) is commonly used, but there is no adaptation model established. Currently is performed subjectively by the physiotherapist following the pressures recommended in the current literature (LRP) as optimal (±40CmH2O).Aim: To check if LRP are the most optimal pressures to achieve the better peak cough flow (PCF).Method: Repeated measures study was performed to evaluate the effectiveness measured by PCF. Subjects adults with cough assist (CA) criteria (PCFbaseline
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Physiotherapists Source Type: research
Conclusion: In spite of the rarity of ALS, in our cohort, the observed incidence was double of that described in the literature, with predominance of the bulbar form, frequently associated with exposure to radioactive materials and asbestos.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Noninvasive Ventilatory Support Source Type: research
Respiratory complications are the major cause of death in amyotrophic lateral sclerosis (ALS). Bulbar muscle dysfunction complicates use of non-invasive respiratory therapies, such as mechanical insufflation-exsufflation (MI-E) and in ALS it can be present already at disease onset (bulbar onset), or later in the disease progression (spinal onset). This development is not well described, hampering an optimal longitudinal approach to non-invasive respiratory therapy in ALS.We aimed to examine laryngeal response patterns to MI-E in a longitudinal follow-up of ALS patients, using direct visualization with laryngoscopy.We condu...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Noninvasive Ventilatory Support Source Type: research
Conclusions: In our study the survival was slightly longer than reported, early pneumology evaluation may explain the difference. Age is the main independent prognostic factor. Bulbar form requires earlier respiratory therapies and shows more rapid progression to respiratory failure. They should be monitored more closely than other patients
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Noninvasive Ventilatory Support Source Type: research
Aim: To assess the effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of amyotrophic lateral sclerosis (ALS) versus age-matched healthy controls positioned at 45° trunk inclination.Methods: CPF, chest wall compartmental inspiratory capacity (ICCW), vital capacity (VCCW), tidal volume (VTCW) and breathing pattern were assessed by optoelectronic plethysmography during a protocol composed by VC maneuvers and CPF before and after air stacking.Results: Twelve ALS (7 males) were recruited (Age: 46±12; FVC%pred: 53±18; FEV1%pred: 49±13%; MIP%pred: 33±10.1; MEP%pre...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical Respiratory Physiology, Exercise and Functional Imaging Source Type: research
Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion (P+) in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall volume (VCW), breathing pattern and cough peak flow (CPF).Methods: Phase shift () between upper (RCp) and lower rib cage (RCa) and abdomen (AB) as well as the percentage of inspiratory time the RCa (IPRCa) and AB (IPAB) moved in opposite directions were quantified using optoelectronic plethysmography during quiet breathing and cough, using control data to define the normal range of movement.Results: Twelve ALS (7 males) were recruited (Age: 46...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical Respiratory Physiology, Exercise and Functional Imaging Source Type: research
CONCLUSIONS: Moderate-quality evidence from a single RCT of NIV in 41 participants suggests that it significantly prolongs survival, and low-quality evidence indicates that it improves or maintains quality of life in people with ALS. Survival and quality of life were significantly improved in the subgroup of people with better bulbar function, but not in those with severe bulbar impairment. Adverse effects related to NIV should be systematically reported, as at present there is little information on this subject. More RCT evidence to support the use of NIV in ALS will be difficult to generate, as not offering NIV to the co...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
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Source: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration - Category: Neurology Authors: Source Type: research
To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45 ° body inclination.
Source: Archives of Physical Medicine and Rehabilitation - Category: Rehabilitation Authors: Tags: Original research Source Type: research
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