Manuscript accepted on :17 Sep 2019
Published online on: 30-09-2019
Plagiarism Check: Yes
Reviewed by: Rajendra Kumar Jangde
Second Review by: Sudhan Sundersion George
Final Approval by: Prof. Juei-Tang Cheng
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905B. S. Santhosh Kanna1*
and K.Balabaskar2
1SRM Institute of Science and Technology , Chennai, India, 603203.
2National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD ), Chennai, India, 603112.
Corresponding Author E-mail: b2skanna@gmail.com
DOI : https://dx.doi.org/10.13005/bpj/1782
Abstract
Cerebral palsy is a group of condition characterized by motor dysfunction due to non-progressive brain damage early in life. They may also have decreased mobility, restriction in physical activity and limitation in functional capacities, Along with motor dysfunction, children with cerebral palsy can have abnormality of respiratory function This study was intended to study the efficacy of Respiratory exercises along with Neurodevelopmental treatment in Pulmonary function of children with Spastic quadriplegic cerebral palsy.
Keywords
Cerebral Palsy; Neuro Developmental Treatment (NDT); Pulmonary Function; Respiratory Exercises; Ventilatory Parameters
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| Copy the following to cite this article: Kanna B. S. S, Balabaskar K. A Study on Efficacy of Respiratory Exercises Coupled With Neurodevelopmental Treatment on Pulmonary Function of Children With Spastic Quadriplegic Cerebral Palsy. Biomed Pharmacol J 2019;12(3). |
| Copy the following to cite this URL: Kanna B. S. S, Balabaskar K. A Study on Efficacy of Respiratory Exercises Coupled With Neurodevelopmental Treatment on Pulmonary Function of Children With Spastic Quadriplegic Cerebral Palsy. Biomed Pharmacol J 2019;12(3). Available from: http://biomedpharmajournal.org/?p=28544 |
Introduction
Cerebral palsy is a group of condition characterized by motor dysfunction due to non-progressive brain damage early in life. Along with motor dysfunction, children with cerebral palsy can have abnormality of respiratory function such as poor airway clearance, decreased chest wall mobility, respiratory muscle weakness and lung distensibility.
Prevalence of cerebral palsy is in the range of 1.5 to 2.5 per 1000 live births. The rate is higher in males than in females. It is 1.3 times more common in males, 8 to 10 % of the cases are due to perinatal damage, while genetic factors contribute to 2% of the cases, birth asphyxia, especially a prolonged one, increases the risk of cerebral palsy, accounting for about 10% of the cases, preterm birth and underlying pathological lesions, such as periventricular hemorrhage; venous infarcts are also contributory.
Children with cerebral palsy breath in a poorly coordinated fashion, relying on the abdominal muscle instead of the chest muscles, eventually movement of the chest is restricted and the chest muscles weaken resulting in reduced expansibility of the lungs, as a result the ability to take a larger breath is impaired.
Normal breathing is slow, regular, nasal only, diaphragmatic, invisible and inaudible consisting of a small inhalation and relax for the exhalation and the exhalation is followed by an automatic pause of about 2 seconds. Normal breathing at rest is about 18-30 breaths per minute. Children with Cerebral Palsy breath more slowly when compared to normal children, and at rest the phase of their respiratory muscle activity appears to be different. In healthy children, the maximal activity of the abdominal muscles occurred later after maximal chest expansion, whereas in children with Cerebral Palsy, abdominal muscle activity occurred earlier, due to decreased firing of muscles of the chest. Normal breathing is not just a matter of inhaling the good air and exhaling the bad used air, the entire respiratory parameters such as rate, depth, timing; pattern and consistency of breath are all important to the delicate balance of respiratory and metabolism.
Children with Cerebral Palsy who have respiratory problems show a poorly coordinated pattern of respiratory muscles, shallow and low breathing volume, and decreased cardiopulmonary capacity. All the factors increase the risk for respiratory complications such as recurrent pneumonia, atelectasis; bronchiectasis, chronic obstructive and restrictive lung disease in these children. Respiratory dysfunction is known to be a leading cause of death among children with Cerebral Palsy. However respiratory dysfunction in children with Cerebral Palsy has not been well studied, possibly due to difficulty in testing the respiratory parameters as the child will not cooperate for it.
Young Hyun et al in their study concluded that understanding respiratory functional level of children with Cerebral Palsy will be important for clinical assessment and therapeutic intervention. Respiratory training may improve the respiratory functional level of the children with Cerebral Palsy.
Procedure
From the special school of NIEPMD, 30 children with spastic quadriplegic Cerebral Palsy who met the inclusion and exclusion criteria was selected. They were randomly allocated into 2 groups. Group A (Control group) consists of 15 participants who were given Neuro-developmental Therapy for 45 minutes, 5 days in a week for 6 weeks. Group B (Experimental Group) consists of 15 participants who were given Neurodevelopmental Treatment along with Respiratory Exercises for 45 minutes (30 min and 15 min), 5 days in a week for 6 weeks. Informed consent is obtained from the parents of the participants. Pre and post values of FVC, FEV1, FEV1/FVE % and PEF were obtained using pulmonary function tests and statistical analysis was done. Paired-t test value of pretest and post-test of FEV1 & FVC shows statistically very significant (p<0.01) and FEV1/FVC % & PEF shows statistically significant (p<0.05) in experimental group. The results on analysis between groups on improvement of FVC, FEV1, FEV1/FVC% & PEF shows significant improvement by independent sample t test value (p<0.05).
Methodology
Study design: Experimental study
Sample Size: 30
Group A Control Group – 15 Nos
Group B Experimental Group – 15 Nos
Sampling method: Convenient sampling (Random Sampling)
Study setting : NIEPMD Special school
Study Duration : 6 weeks
Inclusion criteria
Children with spastic quadriplegic Cerebral Palsy
Age of children ranging between 6-14 years of both gender.
Children who could understand and follow commands given by the therapist
Children who were able to sit independently or with support using assistive devices
Children who blow air independently
Exclusion criteria
Children with spastic diplegia; athetoid; ataxic; flaccid Cerebral Palsy
Children with impaired cognitive function
Children who received any recent surgical procedures or botulinum toxin injections
Convulsion
Materials
Computerised spirometer
Computer
Weighing machine
Incentive spirometry
Variables
Dependent variable: Pulmonary function test
Independent Variable: Respiratory exercises; Neuro Developmental
Treatment
Outcome measure
1.FVC 2.FEV1 3. FEV1/FVC Ratio 4. PEF
Procedure
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Graph 1
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From the special school of NIEPMD, 30 children with spastic quadriplegic Cerebral Palsy who met the inclusion and exclusion criteria was selected. They were randomly allocated into 2 groups. Group A (Control group) consists of 15 participants who were given Neuro-developmental Treatment and general movements for 45 minutes (30 min and 15 min), 5 days in a week for 6 weeks. The exercise program follows the basics principles of Neuro-developmental therapy such as key points of control, handling methods; facilitatory and inhibitory techniques. And general movements include moving of shoulders, rotation exercises and elbow movements. Group B (Experimental Group) consists of 15 participants who were given Neurodevelopmental treatment along with Respiratory Exercises for 45 minutes (30 min and 15 min), 5 days in a week for 6 weeks. Respiratory Exercises includes breathing exercises, Active shoulder/ shoulder girdle ROM exercises; Diaphragmatic breathing exercise; thoracic expansion exercise and incentive spirometry. Informed consent is obtained from the parents of the participants. Pre and post values of FVC, FEV1, FEV1/FVC % and PEF were obtained using pulmonary function tests and were taken statistical analysis.
Data Analysis
The outcome values obtained were tabulated in Microsoft Excel 10 spread sheet, and were exported to SPSS statistics 20.0 version for windows 7 for statistical analysis.
The effects of the intervention on the changes from pre to posttest values in both groups were analyzed using Paired ‘T’ test for within group analysis and independent sample ‘T’ test for between group analyses.
The P value was chosen as per the description given by SPSS statistics for windows 7 ultimate version.
Table 1 : Description of P value
| P value | Description | Summary |
| < 0.001 | Extremely significant | *** |
| 0.001 to 0.01 | Very significant | ** |
| 0.01 to 0.5 | Significant | * |
| > 0.05 | Not Significant | NS |
Table 2 : Within group analysis of ‘ T’ test in FVC of Experimental and Control group
| S.No | Group | Analysis | Mean +
SD |
T- Value | Significance |
| 1 | Experimental Group | Pre -test | 1.03687 + 0.780385 | -3.232 | 0.006** |
| Post – test | 1.65553 + 0.976147 | ||||
| 2 | Control Group | Pre -test | 0.471301 + 0.121689 | -2.842 | 0.013* |
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