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

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

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.

Cerebral palsy, Diaphragm, Manual diaphragmatic stretching technique, Respiratory function, Ultrasonography
0954-6111
Bennett, Surussawadi
7e08834c-c0d8-4ca3-9b90-a0878662528b
Siritaratiwat, Wantana
d2770ba4-a682-488b-bacf-31e89b39d23d
Tanrangka, Nittaya
0aa5bc8f-e5e5-4343-9f7d-c09f504cc491
Bennett, Michael John
6df5585a-3d93-4870-8797-389759fc82c7
Kanpittaya, Jaturat
39dcf83a-378e-4f73-a67f-4c8cd4ab739c
Bennett, Surussawadi
7e08834c-c0d8-4ca3-9b90-a0878662528b
Siritaratiwat, Wantana
d2770ba4-a682-488b-bacf-31e89b39d23d
Tanrangka, Nittaya
0aa5bc8f-e5e5-4343-9f7d-c09f504cc491
Bennett, Michael John
6df5585a-3d93-4870-8797-389759fc82c7
Kanpittaya, Jaturat
39dcf83a-378e-4f73-a67f-4c8cd4ab739c

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).

Record type: Article

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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More information

Accepted/In Press date: 29 April 2021
Published date: 19 May 2021
Additional Information: Funding Information: This work was supported by the Thailand Research Fund for the new researcher in 2019 [grant number MRG6280064 ]. Publisher Copyright: © 2021 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Cerebral palsy, Diaphragm, Manual diaphragmatic stretching technique, Respiratory function, Ultrasonography

Identifiers

Local EPrints ID: 450716
URI: http://eprints.soton.ac.uk/id/eprint/450716
ISSN: 0954-6111
PURE UUID: 1ea7d65d-41e8-4cf5-ab86-d51d9acaf0db

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Date deposited: 09 Aug 2021 16:30
Last modified: 17 Mar 2024 12:48

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Contributors

Author: Surussawadi Bennett
Author: Wantana Siritaratiwat
Author: Nittaya Tanrangka
Author: Michael John Bennett
Author: Jaturat Kanpittaya

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