Effectiveness of the manual diaphragmatic stretching technique on respiratory function in cerebral palsy: a randomised controlled trial

Bennett, Surussawadi, Siritaratiwat, Wantana, Tanrangka, Nittaya, Bennett, Michael John and Kanpittaya, Jaturat (2021) Effectiveness of the manual diaphragmatic stretching technique on respiratory function in cerebral palsy: a randomised controlled trial. Respiratory Medicine, 184, [106443]. (doi:10.1016/j.rmed.2021.106443).

Abstract

Background: respiratory failure resulting from diaphragmatic muscle weakness is a major cause of long-term hospitalization in children with cerebral palsy (CP). Manual diaphragmatic stretching technique (MDST) can be directly applied to stretch diaphragmatic muscle and has been reported to improve respiratory function in patients with asthma and COPD. However, there have been no studies among CP. This study aimed to examine the effects of a six-week MDST course on respiratory function among CP. 

Methods: fifty-three children with spastic CP were randomly assigned to experimental (n = 27) and control (n = 26) groups. The experimental group received MDST on non-consecutive days, three days per week for six weeks alongside standard physiotherapy (SDPT), while the control group received only SDPT. The outcome variables were diaphragmatic mobility, pulmonary function and chest wall expansion. 

Results: MDST significantly improved diaphragmatic mobility on both sides of the body, with a between-group difference of 0.97 cm (95% CI 0.55–1.39 cm, p < 0.001) for the right side and 0.82 cm (95% CI 0.35–1.29 cm, p = 0.001) for the left side. MDST significantly improved chest wall expansion at the xiphoid process and umbilical levels, with between-group differences of 0.57 cm (95% CI 0.12–1.20 cm, p = 0.013) and 0.87 cm (95% CI 0.31–1.43 cm, p = 0.003), respectively. There was no significant difference in pulmonary function testing between the groups. 

Conclusion: MDST could significantly improve diaphragmatic mobility, and lower and abdominal chest wall expansion, among children with CP. Therefore, MDST could be considered as an additional technique for physiotherapy programmes, to improve diaphragmatic function in spastic CP.

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