Category: Clinical Sciences/Health Conditions
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder leading to respiratory failure, which results from ineffective removal of airway secretions. In particular, vocal cord abductor paralysis is a specific feature of patients with MSA, and it can cause a reduction in their peak cough flow (PCF). Mechanical in-exsufflator (MI-E) application is an effective method than manually assists coughing following maximum insufflation by air stacking, for improved PCF in patients with neuromuscular disease, as reported in numerous studies. However, it is unknown whether these methods can be applied in MSA. The purpose of this study was to demonstrate a short-term increase in PCF after MI-E application in a patient with MSA.
A 61-year-old male patient with MSA took training in accordance with our hospital protocol. An ABA’B’ single-subject design was adopted, and each phase lasted 1 week. Phases A and A’ consisted of manually assisted coughing training following maximum insufflation by air stacking only. Phases B and B’ consisted of a combination with the above training and MI-E application. The PCF and vital capacity (VC) were measured across the four phases. Data were plotted, analyzed visually, and a two-standard deviation band method was used to evaluate improvement.
During A phase, the mean and standard deviation PCF value was 48 ± 24.6 L/min. Increases in the PCF in phases B (101 ± 37.8 L/min) and B’ (154 ± 32.9 L/min) were observed. There were no changes in VC during any of the phases.
Based on visual analysis and a two-standard deviation band method, MI-E application seemed to be useful for improving PCF over the study period in a patient with MSA. MI-E application could be effective in preventing respiratory complications in patients with MSA.
Ryoma Taniuchi– Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center
Mayu Ueki– Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center
Yoshinobu Sato– Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center
Takako Makino– Department of Neurology, National Hospital Organization Hiroshima-Nishi Medical Center
Chigusa Watanabe– Department of Neurology, National Hospital Organization Hiroshima-Nishi Medical Center
Toshihide Harada– Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima