{"id":36536,"date":"2020-12-30T10:02:03","date_gmt":"2020-12-30T10:02:03","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=36536"},"modified":"2021-01-11T08:23:31","modified_gmt":"2021-01-11T08:23:31","slug":"peak-expiratory-flow-rate-in-children-with-multiple-neurological-disorder","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol13no4\/peak-expiratory-flow-rate-in-children-with-multiple-neurological-disorder\/","title":{"rendered":"Peak Expiratory Flow Rate in Children with Multiple Neurological Disorder"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

A neurological disorder is a structural, biochemical or electrical abnormalities in the brain or \u00a0spinal cord and peripheral1<\/sup> .Neurological disorders include autism, learning disabilities, mental retardation, cerebral palsy, and impairments in vision and hearing. Children with neurological disorders can experience difficulties with motor function, behaviour, memory, learning, language and speech2<\/sup>. The cause behind these neurological conditions may involve genetic involvement or any trauma during pre natal, natal, post natal periods and environmental contaminants3<\/sup>.The estimated prevalence of neurological disorders is nearly 1 in 8 among children in India. The studies also inference that children with severe neurological disorders have a high incidence of respiratory difficulties which is multi factorial4,5,6<\/sup>.Pathology- Those include neural connection to the respiratory system, structural abnormality like scoliosis, obstructive sleep apnea, respiratory tract infections due to decreased immune response and difficulty in clearing lung secretions19<\/sup>.<\/p>\n

Many children with cerebral palsy have scoliosis, an irregular curvature of the spine that can interfere with lungs ability to expand. Genetic condition including cerebral palsy, muscular dystrophy and familial dysautonomia can be associated with congenital airway abnormalities.7,8,9<\/sup> They can affect any part of a child\u2019s airway, including the nasal cavity, the mouth and tongue, the oesophagus, the tube that carries food to the stomach; the larynx, or voice box; the trachea, or windpipe; and the lungs. Peak expiratory flow rate could be a factor that analyse the respiratory difficulties in neurological disorder patients10,11,12<\/sup>.\u00a0\u00a0 The objective of the study is to find out the peak expiratory flow rate in children with cerebral palsy, Down\u2019s syndrome, autism and mentally retarded.<\/p>\n

Methodology<\/strong><\/p>\n

Study design non-experimental,13 subjects with\u00a0 age group of 7-17years was\u00a0 selected based on the inclusion and exclusion criteria.(subjects:3-cerebral palsy,3-down syndrome,2-autism,5-mental retardation). An informed consent was obtained from the parents and children with\u00a0 detailed explanation of the procedure. First the participant was made to sit in a comfortable position and was \u00a0asked to breath in and breath out normally and then breath in deeply as much as possible followed by quick expiration to the maximum into the peak expiratory flow meter. Three trials have been done and best of the three is adopted as PEFR.\u00a0 The value on the meter is monitored and recorded.\u00a0 The training was stopped whenever the subject feels dizziness .<\/p>\n

Results<\/strong><\/p>\n

Table 1: The table-1 depicts about the peak expiratory flow rate of the children with cerebral palsy, down\u2019s syndrome, autism and mentally retarded<\/strong><\/p>\n\n\n\n\n\n\n\n
Neurological Conditions<\/strong><\/td>\nNo. of Samples<\/strong><\/td>\n\u00a0Mean Pefr (l\/min)<\/strong><\/td>\n<\/tr>\n
Cerebral Palsy<\/td>\n3<\/td>\n121<\/td>\n<\/tr>\n
Down Syndrome<\/td>\n3<\/td>\n130<\/td>\n<\/tr>\n
\u00a0Autism<\/td>\n2<\/td>\n77.5<\/td>\n<\/tr>\n
Mentally Retarded<\/td>\n7<\/td>\n145<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Graph<\/td>\nGraph 1: The Graph-1 Shows the PEFR of Children with Cerebral\u00a0Palsy, Down\u2019s Syndrome, Autism and Mentally Retarded.<\/strong><\/p>\n

Click here to view Graph<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

This graph shows the\u00a0 peak expiratory flow rate of the\u00a0 children with multiple neurological disorder.15 children with previous episodes of lung infection, the data on height, age, sex, weight, were registered.The peak expiratory flow rate of normal children ranges from 182-565 l\/min.The mean value of PEFR in children with multiple neurological disorder was fcund to be :cerebral palsy-121 l\/min, Down\u2019s syndrome-130 l\/min, , autism-77.5 l\/min, mentally retarded-145 l\/min.For the data, complete action of\u00a0 PEFR measurement were performed in children with multiple neurological disorder.The PEFR values clearly depicts that the children with multiple neurological disorder have decreased PEFR.<\/p>\n

Discussion<\/strong><\/p>\n

The importance of peak expiratory flow among the neurologically impaired children is a variable of respiratory muscle function.Respiratory muscle dysfunction is a cause for morbidity and mortality among neurologically disabled children, because of uneffective cough produced.Patients with neurological disorder, can be associated for expiration by thoraco abdominal thrust.<\/p>\n

A study previously done by A. Hort et, al. on peak expiratory flow rate in healthy children of age 6-17 concluded that the peak expiratory flow (PEFR) is higher in boys than girls and increase with height, comparitvely PEFR is less among smaller age group and increase with age.13,14,15<\/sup><\/p>\n

Another study on peak expiratory flow rate in school , that as\u00a0 the early detection of airway obstruction in a symptomatic state. Early detection of children could have early intervention and improve quality of life.<\/p>\n

In peak expiratory flow, three flow manevourtake\u00a0 place , each manevour requires different respiratory muscle with glottis closure. The greater transpulmonary pressure is\u00a0 created by coughing\u00a0 rather than by peak expiratory flow results in 88.2% in patients and 78.9% of normal subjects.<\/p>\n

Howard B Punitch MD 2017 concluded that Several factors contribute to respiratory difficulties in neurological disorder includes, poor coordination of muscle in cerebral palsy. Immune problem in Down\u2019s syndrome. Clinical problem includes recurrent chest infection, persistant cough, airway obstruction, obstructive sleep apnea, respiratory failure with minor respiratory infections are common among neurologically impaired children.Intercostals muscles are affected, causes paradoxical breathing and progress to diaphragm weakness and onset of respiratory failure.16,17,18,<\/sup><\/p>\n

The peak expiratory flow rate (PEFR) of normal children\u00a0 ranges from 182-565 l\/min.There is a decreased PEFR among neurologically impaired children is a well known fact, but among the neurologically affected patient there is a decrease in PEFR among spastic diplegic whereas down syndrome accounts for higher PEFR. The underlying pathology and contributing factors could influence the PEFR.<\/p>\n

Yong Hyun Kwon et al. In spastic diplegia concluded that there is a motor dysfunction with abnormal muscle tone and movement pattern, poor postural control, which is a well established fact. Whereas down syndrome have presentation of structural abnormalities of airways and lungs leads to lower respiratory tract infection.19.20<\/sup><\/p>\n

The similarity of respiratory problems among spastic diplegic and cerebral palsy but the PEFR of spastic diplegic is lower compared to normal children. Since normal respiration requires normal function of nervous system, respiratory muscles, costovertebral joint, while there is a compromise in cerebral palsy.\u00a0 In spastic type cerebral palsy there is a\u00a0 significant difference in trunk expansion, respiratory strength and pulmonary function with hemiplegic cerebral palsy.<\/p>\n

The PEFR of autism is lower compared to mentally retarded children. Since autism children have low immunity they are more prone to get lung infections.<\/p>\n

Conclusion<\/strong><\/p>\n

The\u00a0 study conclude that there was a decreased PEFR in children with cerebral palsy, down\u2019s syndrome, autism and mentally retarded. The\u00a0 study can be repeated with large sample size \u00a0and this can be done by giving interventions like\u00a0 respiratory muscle training .<\/p>\n

Conflict\u00a0of Interest<\/strong><\/p>\n

The authors declare that there is no conflict of interest exist<\/p>\n

Funding Source<\/strong><\/p>\n

The authors received no specific funding for this work.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Howard B Panitch MD et,al.Respiratory Implications Of Pediatric Neuromuscular Disease Respir Care 2017:62(6):826-848.
    \n    CrossRef<\/a><\/li>\n
  2. Host A, Host AH, Ibsen T. Peak expiratory flow rate in healthy children aged 6-17 uears.ActaPaediatr 1994;83:1255-7. Stockholin. Issn 0803-5253.
    \n    CrossRef<\/a><\/li>\n
  3. Dikshit MB, Raje S, Agarwal MJ Lung functions with spirometry an Indian perspective-1 Peak expiratory flow rsates. Indian J Physical Pharmacol 2005; 49(1): 8-18.<\/li>\n
  4. Swaminathan S, Venkatesan P, Mukunthan R. Peak expiratory flow rate in south Indian children. Indian Pediatr 1993; 30(2): 207-11.<\/li>\n
  5. Sharma r. Jain A .Arya A, Chowdhary BR. Peak expiratory flow rate of school going rural children aged 5-14 years from Ajmer district Indian Pediatr 2002; 39(1): 75-8.<\/li>\n
  6. Lee HS Serial Peak expiratory flow rate monitoring a useful tool in epidemiological studies on occupational asthma. Ann Acad Med Singapore 1994, 23(5) 725-30<\/li>\n
  7. Kang SW, Bach JR: Maximum insufflations capacity: The relationships with vital capacity and cough flows for patients with neuromuscular disease, Am J Phys Med Rehabil 2000;79:222-7
    \n    CrossRef<\/a><\/li>\n
  8. Fanhurg BL, Sicilian L, Respiratory dysfunction in neuromuscular disease. Clin Chest Med 1994;15;607-15<\/li>\n
  9. Baydur A; Respiratory muscle strength and control of ventilation in patients with neuromuscular disease. Chest 1991;99:330-8
    \n    CrossRef<\/a><\/li>\n
  10. Bach JR: Mechanical insufflations-exsufflation: Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques, Chest 1993;104;1553-62.
    \n    CrossRef<\/a><\/li>\n
  11. Giggs RG. Donohoe KM, Utell MJ, et al: Evaluation of pulmonary function in neuromuscular disease. Arch Neural 1981;38:9-12.
    \n    CrossRef<\/a><\/li>\n
  12. Plioplys AV, Kasnicka l, Lewis S, et al. Survival rates among children with severe neurological disabilities. South Med J 1998;91:161-72.
    \n    CrossRef<\/a><\/li>\n
  13. Ones U, Somer A, Sapan N, et al. Peak expiratory flow rate in healthy Turkish children living in Istanbul, Turkey, Allergy Asthma Proc 2004;25;313-20.<\/li>\n
  14. Suarez AA, Pessolano FA, Monteiro SG, et al: Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease. Am J Phys Med Rehabil 2002;81:506-11.
    \n    CrossRef<\/a><\/li>\n
  15. Paramesh H. Normal peak expiratory flow rate in urban and rural children. Indian J Pediatr 2003; 70(5): 375-7.
    \n    CrossRef<\/a><\/li>\n
  16. Cb M, Sc K, Babu M. Peak expiratory flow rate in healthy rural school going children(5-16 years) of bellar region for construction of nomogram. J ClinDiagn Res 2013; 7(12): 2844-6.
    \n    CrossRef<\/a><\/li>\n
  17. Jain P, Kavuru MN, Emerman CL, et al: Utility of peak expiratory flow monitoring. Chest 1998;114:861-76.
    \n    CrossRef<\/a><\/li>\n
  18. Lechtzin N, Wolfe LF, Frock KD. The impact of high frequency chestv wall oscillation or health care utilization in patients with neuromuscular diseases. Ann Am ThoracSoc 2016;13(6):904-909.
    \n    CrossRef<\/a><\/li>\n
  19. Perrin C, Unterborn JN, Ambrosio CD, Hill NS. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve 2004;29(1);5-27.
    \n    CrossRef<\/a><\/li>\n
  20. Bharati Mehta, Kunal Garg, Sneha Ambwani et,al.Peak expiratory flow rate a useful tool for early detection of Airway Obstruction IN School Children.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction A neurological disorder is a structural, biochemical or electrical […]<\/p>\n","protected":false},"author":14,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[80],"tags":[],"class_list":["post-36536","post","type-post","status-publish","format-standard","hentry","category-vol13no4"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/36536","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=36536"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/36536\/revisions"}],"predecessor-version":[{"id":36871,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/36536\/revisions\/36871"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=36536"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=36536"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=36536"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}