Changes of ventilatory parameters in the positional training of persons after cervical spinal cord injury

Background: Cervical spinal cord injury (CSCI) is followed by mixed respiratory dysfunction.Purpose: Evaluation of the ventilatory parameters of CSCI patients in postures typical for positional training. Material: 51 CSCI patients in a mean age of 34.4 (SD=14.6) years; complete motor deficite (CMD) 66.6%; injury of C5 level or above – 68.6%. Control group(CG): 10 healthy volunteers. Method: Spirometry and flow-volume examination in recumbent (R), sitting (S) and vetrical 60o tilt (V) positions. Main results: Expiratory reserve volume (ERV) undergoes significant positional changes in CG (R: 1.34 L, H: 0.25 L, V: 0.79 L; p=0.02), but not in CSCI patients. Transition from R to S in CMD persons results in a significant decrease in vital capacity (VC) (from 2.45 to 1.75 L; p=0.0008); inspiratory capacity (IC) (from 2.48 to 1.41 L; p=0.0008); forced expiratory volume in 1 second (FEV1) (from 2.21 to 1.64 L; p=0.002); forced vital capacity (FVC) (from 2.55 to 1.78 L; p=0.0004). The FEV1/FVC rate does not depend on positional changes ranging from 89.7% to 93.9% of the reference values. Ventilatory parameters in the incomplete motor deficite (ICMD) group do not differ significantly between the examined body positions. Transition between R and S in the CMD group results in a significant decrease in the peak expiratory flow (PEF) (from 4.23 to 3.53 L/s) and the peak inspiratory flow (PIF) (from 3.89 to 3.43 L/s), while in ICMD the PEF increases from 4.01 to 4.39 L/s and the PIF increases from 3.66 to 4.18 L/s.Conclusions: Transition from R to S in CSCI patients results in increased restriction. CMD patients express a reduction of peak flows while in the ICMD peak flows increase after transition between R and S. Shifting from S to a 60o vertical tilt with standard trunk stabilization does not change significantly the ventilatory parameters in CSCI patients.