title: Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury.
abstract: METHODS
  A prospective cohort study.
  
  
  OBJECTIVE
  To evaluate whether patients with cervical spinal cord injury (CSCI) are able to learn the technique of glossopharyngeal pistoning (breathing) for lung insufflation (GI) and if learned, to evaluate the effects of GI on pulmonary function and chest expansion after 8 weeks.
  
  
  METHODS
  Karolinska University Hospital, Stockholm, Sweden.
  
  
  METHODS
  Twenty-five patients with CSCI (21 men, four women) with a mean age of 46 years (21-70), from the Stockholm area, were used in this study. The participants performed 10 cycles of GI four times a week, for 8 weeks. Pulmonary function tests made before and after the GI training included vital capacity (VC), expiratory reserve volume (ERV), functional residual capacity (FRC; measured with nitrogen washout), residual volume (RV) and total lung capacity (TLC). Chest expansion was measured before and after training.
  
  
  RESULTS
  Five of the twenty-five participants had difficulty in performing GI and were excluded in further analysis. Performing a GI maneuvre increased participants' VC on average by 0.88+/-0.5 l. After 8 weeks of training, the participants had significantly increased their VC 0.23 l, (P<0.001), ERV 0.16 l, (P<0.01), FRC 0.86 l, (P<0.001), RV 0.70 l, (P<0.001) and TLC 0.93 l, (P<0.001). Chest expansion increased at the level of the xiphoid process by 1.2 cm (P<0.001) and at the level of the fourth costae by 0.7 cm (P<0.001).
  
  
  CONCLUSIONS
  After using GI for a period of 8 weeks, the participants with CSCI who could perform GI were able to improve pulmonary function and chest expansion.
authors.affiliation: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden. malin.nygren-bonnier@karolinska.se
authors.forename: M
authors.initials: M
authors.lastname: Nygren-Bonnier
authors.forename: K
authors.initials: K
authors.lastname: Wahman
authors.forename: P
authors.initials: P
authors.lastname: Lindholm
authors.forename: A
authors.initials: A
authors.lastname: Markström
authors.forename: N
authors.initials: N
authors.lastname: Westgren
authors.forename: B
authors.initials: B
authors.lastname: Klefbeck
mesh_terms: D000328:Adult; D000368:Aged; D001945:Breathing Exercises; D002574:Cervical Vertebrae / Q000293:injuries*; D005105:Expiratory Reserve Volume; D005260:Female; D005652:Functional Residual Capacity; D006801:Humans; D007320:Inspiratory Capacity; D007327:Insufflation; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012115:Residual Volume; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D013548:Sweden; D013997:Time Factors; D014109:Total Lung Capacity; D014797:Vital Capacity; D055815:Young Adult