The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study

ObjectiveThe main aim of this pilot study was to examine the effect of diaphragmatic breathing exercise on urinary incontinence treatment. The secondary purpose was to compare the effect of pelvic floor muscle exercises and diaphragmatic breathing exercises on urinary incontinence women.DesignParticipants were randomized into two groups: pelvic floor muscle exercises (Group PFM n = 20) and diaphragmatic breathing exercises (Group DB n = 20). Exercise programs consisted of 1 set of contractions per day and each set included 30 repetitions for 6 weeks. Women were asked to complete forms of Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), Incontinence Quality of Life (I-QOL), and Overactive Bladder (OAB-V3) before starting the program and again at the end of the 6-week program.ResultsIIQ-7, I-QOL, and OAB-V3 scores significantly improved in both groups, after exercises. There were no difference between groups in the post-exercise scores. Total score of the UDI-6 was statistically significantly decreased higher in the DB exercises group. UDI-6 Urge Symptoms decreased statistically significantly only in the DB exercises group. Even though there was a decrease in the PFM group, but it was not significant.ConclusionDiaphragmatic breathing exercises may be an alternative to pelvic floor muscle exercises in the treatment of urinary incontinence.ClinicalTrials.gov IDNCT04991675.     

Measuring diaphragm movement and respiratory frequency using a novel ultrasound device in healthy volunteers

PurposeTo evaluate the ability of a novel ultrasound (US) device, DiaMon, to monitor diaphragm movement via its proxy liver movement, and compare it with the respired flow measured with a flowmeter, in awake and healthy volunteers. We wanted to (1) establish the optimal anatomical position for attaching the DiaMon device to the abdominal wall, and (2) evaluate the accuracy of continuous monitoring of respiratory frequency.MethodsThirty healthy subjects were recruited. The DiaMon probe was applied subcostally in four different positions with the subjects in five different postures. The subjects breathed tidal volumes into a spirometer for 30–60 s with the DiaMon recording simultaneously.ResultsThe device detected a readable signal in 83–100% of the position/posture-combinations. The technical correlation between the two signals was highest in the anterior axillary-supine position (mean ± SD: 0.95 ± 0.03), followed by paramidline-supine (0.90 ± 0.09) and midclavicular-supine (0.89 ± 0.12). The frequency measurements yielded a mean difference of 0.03 (95% limits of agreement − 0.11, 0.16) breaths per minute in the anterior axillary-supine position.ConclusionThe DiaMon device is able to detect liver movement in most subjects, and it measures breathing frequency accurately.Electronic supplementary materialThe online version of this article (10.1007/s40477-019-00412-2) contains supplementary material, which is available to authorized users.     

Electromyographic study of sternocleidomastoid and scalene muscles in tetraplegic subjects during respiration

An electromyographic investigation of inspiratory respiratory muscles was carried out in six tetraplegic and two normal subjects using needle electrodes. When the normal subjects were using tidal breathing there was no activity present. In the majority of tetraplegic subjects, activity was present in the scalene muscle during tidal breathing. This activity became more marked during deep inspiration. The muscles were hypertrophied and these muscles filled an important respiratory role.     

Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism

Background

The roles of antagonistic activation of abdominal muscles and of intra-abdominal pressurization remain enigmatic, but are thought to be associated with both spinal unloading and spinal stabilization in activities such as lifting. Biomechanical analyses are needed to understand the function of intra-abdominal pressurization because of the anatomical and physiological complexity, but prior analyses have been over-simplified.

Methods

To test whether increased intra-abdominal pressure was associated with reduced spinal compression forces for efforts that generated moments about each of the principal axis directions, a previously published biomechanical model of the spine and its musculature was modified by the addition of anatomically realistic three-layers of curved abdominal musculature connected by fascia to the spine. Published values of muscle cross-sectional areas and the active and passive stiffness properties were assigned. The muscle activations were calculated assuming minimized muscle stress and stretch for the model loaded with flexion, extension, lateral bending and axial rotation moments of up to 60 Nm, along with intra-abdominal pressurization of 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight (340 N).

Findings

The analysis predicted a reduction in spinal compressive force with increase in intra-abdominal pressurization from 5 to 10 kPa. This reduction at 60 Nm external effort was 21% for extension effort, 18% for flexion effort, 29% for lateral bending and 31% for axial rotation.

Interpretation

This analysis predicts that intra-abdominal pressure produces spinal unloading, and shows likely muscle activation patterns that achieve this.     

Core stability exercises on and off a Swiss ball

OBJECTIVES: To assess lumbopelvic muscle activity during different core stability exercises on and off a Swiss ball. DESIGN: Prospective comparison study. SETTING: Research laboratory. PARTICIPANTS: Eight healthy volunteers from a university population. INTERVENTION: Subjects performed 4 exercises on and off a Swiss ball: inclined press-up, upper body roll-out, single-leg hold, and quadruped exercise. MAIN OUTCOME MEASURES: Surface electromyography from selected lumbopelvic muscles, normalized to maximum voluntary isometric contraction, and median frequency analysis of electromyography power spectrum. Visual analog scale for perception of task difficulty. RESULTS: There was a significant increase in the activation of the rectus abdominus with performance of the single-leg hold and at the top of the press-up on the Swiss ball. This led to changes in the relation between the activation levels of the lumbopelvic muscles measured. CONCLUSIONS: Although there was evidence to suggest that the Swiss ball provides a training stimulus for the rectus abdominus, the relevance of this change to core stability training requires further research because the focus of stabilization training is on minimizing rectus abdominus activity. Further support has also been provided about the quality of the quadruped exercise for core stability.     

Pain management of older people in care homes: a pilot study

This article presents the findings of a pilot study conducted within six care homes within a district of the UK. This is stage one of a programme of funded research designed to explore issues surrounding pain and older people living in care homes. The aim of the study was to determine the residents' perceptions of pain and identify their preferred pain management strategies. Staff working in the care homes were interviewed to identify their level of pain knowledge, and the problems perceived by them, as preventing their role in the management of pain within this group. A number of important issues were identified as barriers to reporting pain among the residents, along with important concerns for staff about communication and education. A serendipitous finding demonstrated some age-related differences in perceptions of pain. Recommendations are made for further research in this area.     

The Buteyko breathing technique in children with asthma: a randomized controlled pilot study

BackgroundEvidence supports the Buteyko breathing technique (BBT) as reducing medication and improving control and quality of life in adults with asthma, but having minimal impact on spirometry. For children with asthma, evidence addressing the utility of BBT is sparse. We evaluated the effectiveness of BBT in managing various aspects of asthma in children.MethodsThirty-two children with partly controlled asthma (age 6-15 years, 66% male) were randomized to either Treatment as Usual (TAU) or TAU combined with Buteyko training (Buteyko group, BG). Children in the BG received an intensive five-day training followed by three months of home practice. Primary outcome was bronchodilator reduction. Secondary outcomes were changes in physiological parameters FEV1_AR (at rest), FEV1_ER (after ergometry), FEV1_BR (after bronchospasmolysis), corticosteroid use, FeNO, SpO2, breath-hold test and questionnaire data [Asthma Control Questionnaire and Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ)]. All measures were collected at Baseline and a three-month follow-up.ResultsFor the primary outcome, no significant between-group difference was found. Regarding the secondary outcomes, children receiving treatment augmented with BBT revealed significantly greater improvement at the follow-up than those receiving TAU for FEV1_AR (p = .04, d=-0.50), FEV1_ER (p = .02, d=-0.52), and the emotional function subscale of the PACQLQ (p < .01, d = 1.03). No between-group differences were found for the remaining secondary measures of outcome.ConclusionsOur preliminary findings suggest that the addition of BBT to treatment as usual for children with asthma enhances outcomes with respect to spirometry and parental emotional function but does not lead to reductions in medication, at least over the short term.     

Effects of mouthpiece shape and expiratory threshold loading on contraction of the lateral abdominal muscles: A cross-sectional study

BackgroundExpiratory tasks may facilitate transversus abdominis (TrA) activity for spinal stabilization. The purpose of this study was to verify whether a combination of pursed-lip breathing (PLB) and use of an expiratory threshold loading (ETL) device to increase expiratory resistance would promote TrA contraction comparable to that for a stabilization exercise.MethodsTwenty healthy men performed expiratory tasks or an abdominal drawing-in maneuver (ADIM). Expiratory tasks comprised combinations of ETL settings with 0%, 5%, or 15% of maximum expiratory pressure, and mouthpieces with a normal shape or pursed-lip shape. B-mode ultrasound imaging of the TrA, internal oblique, and external oblique muscles was performed to determine percentage changes in muscle thickness. Percentage changes among tasks were statistically compared for each muscle.FindingsTrA thickness increased with normal lips at 15% ETL, with PLB with 5% ETL, and with ADIM (p < 0.01 each). Internal oblique thickness increased under all PLB conditions (p < 0.01 each). No significant differences in external oblique thickness were seen for any tasks. The total thickness of the lateral abdominal muscles was significantly increased not only for 15% ETL tasks and ADIM, but also for PLB with 5% ETL (p < 0.02 each).InterpretationThese results indicated that PLB with 5% ETL could facilitate the same level of TrA activity as the ADIM. PLB with 5% ETL was the only task that simultaneously increased overall lateral abdominal muscles, including the internal obliques, and might be readily applicable in clinical situations.     

Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation

Objective: We designed a new ventilatory mode to support spontaneously breathing, intubated patients and to improve weaning from mechanical ventilation. This mode, named Automatic Tube Compensation (ATC), compensates for the flow-dependent pressure drop across the endotracheal tube (ETT) and controls tracheal pressure to a constant value. In this study, we compared ATC with conventional patient-triggered inspiratory pressure support (IPS). Design: A prospective, interventional study. Setting: A medical intensive care unit (ICU) and an ICU for heart and thoracic surgery in a university hospital. Patients: We investigated two groups of intubated, spontaneously breathing patients: ten postoperative patients without lung injury, who had a normal minute ventilation (V_E) of 7.6 ± 1.7 l/min, and six critically ill patients who showed increased ventilatory demand (V_E = 16.8 ± 3.0 l/min). Interventions: We measured the breathing pattern [V_E, tidal volume (V_T), and respiratory rate (RR)] and additional work of breathing (WOB_add) due to ETT resistance and demand valve resistance. Measurements were performed under IPS of 5, 10, and 15 mbar and under ATC. Results: The response of V_T, RR, and WOB_add to different ventilatory modes was different in both patient groups, whereas V_E remained unchanged. In postoperative patients, ATC, IPS of 10 mbar, and IPS of 15 mbar were sufficient to compensate for WOB_add. In contrast, WOB_add under IPS was greatly increased in patients with increased ventilatory demand, and only ATC was able to compensate for WOB_add. Conclusions: The breathing pattern response to IPS and ATC is different in patients with differing ventilatory demand. ATC, in contrast to IPS, is a suitable mode to compensate for WOB_add in patients with increased ventilatory demand. When WOB_add was avoided using ATC, the patients did not need additional pressure support. Received: 24 April 1996 Accepted: 17 February 1997     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

Effects of Diaphragmatic Breathing Patterns on Balance: A Preliminary Clinical Trial

Objective

The purpose of this study was to determine the feasibility of performing a larger study to determine if training in diaphragmatic breathing influences static and dynamic balance.

The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain

Background

Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain.

Methods

Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement.

Findings

In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition, electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements.

Interpretation

The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.     

The effect of kinesiotaping on hand function in stroke patients: A pilot study

Upper extremity motor impairment is one of the most prevalent problems following stroke. Considering the functional importance of the upper extremity in the daily life, the purpose of this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity in individuals following a stroke. Eight individuals who had experienced a stroke, with their age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of tape was placed on the extensor muscles of the forearm. Primary outcome measures were the Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the immediate assessment, there were significant differences between two hand function tests scores. Secondary assessment was done after one week and the results showed significant differences between two hand function test scores. There was no significant change in flexor muscles spasticity after the intervention. This pilot study indicated that KT in the direction of the extensor muscles could result in better hand function in stroke patients.     

Development of a rapid, safe, fiber-optic guided, single-incision cricothyrotomy using a large ovine model: A pilot study

Study aim

We present a pilot study in which we use an ovine model to develop a rapid, safe cricothyrotomy technique using a Melker cuffed 5.0 cricothyrotomy catheter loaded over a fiberoptic stainless steel optical stylet. The technique requires a single incision. The stylet allows easy placement and facilitates visual, tactile, and transillumination confirmation of intratracheal placement. We recorded this process on video to facilitate the development of the procedure and to allow others to replicate it for further research or refinement. All devices used in this technique are currently employed in clinical practice.

Methods

We performed the procedure in four anesthetized sheep, varying the technique to maximize speed, demonstrate pitfalls, and optimize video recording of confirmation methods. We recorded each case using a 4-channel digital video recorder.

Results

After making a single scalpel incision we inserted the stylet and confirmed placement by visualization, transillumination, “click” palpation, and gentle stylet-driven tracheal displacement. We passed the cricothyrotomy tubes without difficulty and easily ventilated the animals.

Conclusion

The procedure is rapid, incorporates redundant safety features, and uses equipment increasingly available to anesthesiologists, emergency physicians, intensivists and surgeons. The promising outcome of this pilot study should be verified in a larger controlled, comparative trial.     

Estimation of breathing rate in thermal imaging videos: a pilot study on healthy human subjects

Diverse studies have demonstrated the importance of monitoring breathing rate (BR). Commonly, changes in BR are one of the earliest and major markers of serious complications/illness. However, it is frequently neglected due to limitations of clinically established measurement techniques, which require attachment of sensors. The employment of adhesive pads or thoracic belts in preterm infants as well as in traumatized or burned patients is an additional paramount issue. The present paper proposes a new robust approach, based on data fusion, to remotely monitor BR using infrared thermography (IRT). The algorithm considers not only temperature modulation around mouth and nostrils but also the movements of both shoulders. The data of these four sensors/regions of interest need to be further fused to reach improved accuracy. To investigate the performance of our approach, two different experiments (phase A: normal breathing, phase B: simulation of breathing disorders) on twelve healthy volunteers were performed. Thoracic effort (piezoplethysmography) was simultaneously acquired to validate our results. Excellent agreements between BR estimated with IRT and gold standard were achieved. While in phase A a mean correlation of 0.98 and a root-mean-square error (RMSE) of 0.28 bpm was reached, in phase B the mean correlation and the RMSE hovered around 0.95 and 3.45 bpm, respectively. The higher RMSE in phase B results predominantly from delays between IRT and gold standard in BR transitions: eupnea/apnea, apnea/tachypnea etc. Moreover, this study also demonstrates the capability of IRT to capture varied breathing disorders, and consecutively, to assess respiratory function. In summary, IRT might be a promising monitoring alternative to the conventional contact-based techniques regarding its performance and remarkable capabilities.     

Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups

Background

Antagonistic activation of abdominal muscles and increased intra-abdominal pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation regimens have been proposed to improve spinal stability via selective recruitment of certain trunk muscle groups. This biomechanical analytical study addressed whether lumbar spinal stability is increased by such selective activation.

Methods

The biomechanical model included anatomically realistic three-layers of curved abdominal musculature, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The muscle activations were calculated with the model loaded with either flexion, extension, lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of muscle activation were studied by forcing activation of selected abdominal muscles to at least 10% or 20% of maximum.

Findings

Spinal stability increased by an average factor of 1.8 with doubling of intra-abdominal pressure. Forcing at least 10% activation of obliques or transversus abdominis muscles increased stability slightly for efforts other than flexion, but forcing at least 20% activation generally did not produce further increase in stability. Forced activation of rectus abdominis did not increase stability.

Interpretation

Based on analytical predictions, the degree of stability was not substantially influenced by selective forcing of muscle activation. This casts doubt on the supposed mechanism of action of specific abdominal muscle exercise regimens that have been proposed for low back pain rehabilitation.