title: Independent cough flow augmentation by glossopharyngeal breathing plus table thrust in muscular dystrophy.
abstract: OBJECTIVE
  The purpose of the present study was to compare the unassisted cough peak flow (CPF) of patients affected by muscular dystrophy with CPF augmented by various techniques, including maximal depth glossopharyngeal breathing (GPB) combined with a subsequent self-induced thoracic or abdominal thrust.
  
  
  METHODS
  All of the motorized wheelchair-dependent patients with muscular dystrophy who had previously mastered GPB were trained at home to increase their cough efficacy. This training involved maneuvering their wheelchair against the edge of a specially built table to autonomously produce a thoracic and/or abdominal thrust timed to the opening of the glottis for an independently assisted cough. Both unassisted and variously assisted CPFs were compared.
  
  
  RESULTS
  The 18 patients (17 men/1 woman) with muscular dystrophy, aged 21.1 ± 5.4 yrs, achieved variously assisted CPFs that were significantly higher than the spontaneous CPF (P < 0.001), with assisted CPFs but not unassisted CPFs that significantly exceeded a reported efficacious cough threshold value of 160 liters/min (P < 0.001). Moreover, increases in the CPFs by personal assistance including air stacking by manual resuscitator and thoracoabdominal thrust (326.4 ± 79.5 liters/min) or by GPB and thoracoabdominal thrust (326.4 ± 87.5 liters/min) were not significantly different (P = 0.07) from the CPFs independently attained by GPB plus independently maneuvering a wheelchair for a table thrust (310.3 ± 74.7 liters/min).
  
  
  CONCLUSIONS
  The independently assisted (GPB plus table thrust) CPF was comparable to the CPFs that required personal assistance for air stacking and abdominal thrusts. Therefore, for patients with muscular dystrophy, this physical medicine technique and cough-assisted techniques that require personal intervention are strongly recommended.
authors.affiliation: From the Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Centro IRCSS Santa Maria Nascente, Milan, Italy (CB); Servizio Assistenza Domiciliare, ASL di Bergamo, Bergamo, Italy (RC); Pediatric Pulmonology, Hôpital Armand Trousseau, Paris, France, and S2A Santé, Ivry sur Seine, France (SK); and Neurorehabilitation Unit, Department of Neuroscience, University of Pisa, Pisa, Italy (MCT).
authors.forename: Carlo
authors.initials: C
authors.lastname: Bianchi
authors.forename: Raniero
authors.initials: R
authors.lastname: Carrara
authors.forename: Sonia
authors.initials: S
authors.lastname: Khirani
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Tuccio
mesh_terms: D000328:Adult; D001945:Breathing Exercises / Q000379:methods*; D015331:Cohort Studies; D003371:Cough / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005930:Glossopharyngeal Nerve / Q000502:physiology; D059746:Heimlich Maneuver / Q000379:methods*; D006801:Humans; D008297:Male; D009136:Muscular Dystrophies / Q000175:diagnosis / Q000534:rehabilitation*; D010101:Oxygen Consumption / Q000502:physiology*; D010366:Peak Expiratory Flow Rate; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D015656:Respiratory Mechanics; D012132:Respiratory Muscles / Q000294:innervation / Q000503:physiopathology*; D018570:Risk Assessment; D013147:Spirometry; D016896:Treatment Outcome; D014910:Wheelchairs; D055815:Young Adult