Respiratory Physiotherapy in Patients with Spinal Cord Injury: A Systematic Review

Background: A spinal cord injury is a trauma or lesion to the spinal cord, which is made up of white matter (ascending and descending tracts) and grey matter (sensory neuron and motor neuron). It causes muscle paralysis and affects sensory abilities and other bodily processes below the level of the injury. Between 2,50,000 and 5,00,000 people worldwide experience spinal cord injuries each year, according to the WHO. In India, the prevalence of SCI is 0.15 million, with an average yearly incidence of 15,000 cases. Objective-To study the effect of respiratory physiotherapy in spinal cord injury patients . Method: A Systematic review according to PRISMA guidelines was conducted on 20 articles through different databases like PubMed, google scholar which were identified, sorted and screened according to the inclusion criteria and exclusion criteria post which the studies were assessed for quality. Result: Data from the selected studies were extracted under the headings of title /author, type of study design, intervention /device /technique elaborated in the study, and key highlights of the study and was tabulated systematically Conclusion: This study concludes that respiratory physiotherapy improves respiratory muscle strength and function in SCI Patients.

When examining SCI from the perspective of respiratory dysfunction, it helps to think of the condition in two stages: (1) the acute phase that occurs right after the injury and lasts for a year, and (2) the chronic phase that lasts for the remainder of the affected person's life.Damage to the phrenic motor neurons (C3, 4, and 5) or above results in nearly total paralysis of the breathing muscles, necessitating phrenic nerve stimulation or artificial ventilation. 8 People with long-term SCI frequently experience hypertension, and those who are paraplegic are more likely to experience it than those who are quadriplegic.Compared to individuals without spinal cord injuries, persons with SCI-particularly those who have paraplegia-had a higher prevalence of hypertension, according to earlier research.Following SCI, a sedentary lifestyle is linked to the development of hypertension.An increased risk of hypertension following SCI can also be caused by other risk factors, including age, smoking, diabetes, obesity, and high cholesterol.

Selection Criteria
The Inclusion criteria of the study were -full text articles, articles which are referred from last 13 years, cross sectional study and observational study, Systematic review, Case studies, Randomize control trial, Metaanalysis.The exclusion Criteria of the study were -Duplicate articles, Articles with only abstracts, Articles in other languages Procedure: Several articles from pubmed google scholar databases were reviewed the following keywords: pulmonary function in obese female, impact of obesity on pulmonary function, lung function in obese female were used studies that were completed and published in english focusing on respiratory physiotherapy in SCI patients were selected.

DISCUSSIONS
This systematic review is primarily aimed to provide an overview of effect of respiratory physiotherapy in SCI patients.The findings of this review has been drawn from the above summarized 10 articles, which had information on effect of respiratory physiotherapy in SCI patients.

CONCLUSION
This study concluded that respiratory physiotherapy intervention improves the performance of respiratory, pulmonary and cough muscle function in individuals with SCI, which aids in removing excessive secretions from the lungs and improves muscle strength, henceforth respiratory physiotherapy can be added to routine physiotherapy intervention for spinal cord injury patients.

FUNDING: None
The management techniques used in physiotherapy include postural drainage and secretion clearance procedure.Abdominal binders, positioning, deep breathing exercises, glossopharyngeal breathing, diaphragmatic breathing, thoracic expansion exercises, incentive spirometry, balloon blowing exercises, cough assisted techniques, and inspiratory muscle training are among the treatments used to improve ventilation 5 spirometry, balloon blowing exercises, cough assisted techniques, and inspiratory muscle training are among the treatments used to improve ventilation 5 MATERIALS AND METHODS Study design: Systematic review Study Setting: DR.APJ Abdul Kalam College of Physiotherapy Study Duration: August 2022 to January 2024 Sample Size and Method: Approximately 40.Participants: Spinal cord injury patients.

Volume 2 , 3 Data
Issue 2, March -April 2024 CrossRef DOI: 10.62127/aijmr.2024.v02i02.1033AIJMR24021033 Advanced International Journal of Multidisciplinary Research (www.aijmr.com)that VRT -MT can improve respiratory function and vocal function in patients with CSCI and that the neural regulation mechanisms of the respiratory center can be used as an effective basis for behavioral therapy.
According to a study by S. Burney et al. examined the immediate respiratory management of cervical spinal cord injury and the efficacy of several treatment approaches for acute tetraplegia over the first six weeks following the injury.There were 21 studies found, totaling 1263 patients.Using a respiratory protocol resulted in a significant reduction in the frequency of respiratory problems and the need for a tracheostomy.It also decreased the length of stay in the ICU by 6-8 days, the duration of mechanical ventilation, and the cost of intubation.According to a comparative study by Kyochul Seo et al examining the impact of balloon blowing exercise on the pulmonary function of twenty something female participants using a ball in the 90/90 bridge position.To improve lung function and respiratory system contractile activity, exercises such blowing balloons while in the bridge position with the knee and hip extended to ninety degrees and asking to hold a five-inch rubber ball between the knees are performed.The Controlled group remained in the same posture but underwent diaphragmatic exercises.The parameters were significantly changed for the experimental group.The controlled group's parameters remained unchanged.Hyun Ji Jun et al carried out The study examined how breathing exercises and balloon-blowing training affected older smokers' lung function.After four weeks, the lung function of both groups greatly rose, and after six weeks, it significantly reduced.Ultimately, the benefits of FBT and BBT extend to pulmonary function.A review of respiratory treatment for patients with spinal cord injuries was completed, according to Rita GaleirasVázquez et  al.In order to provide resistance during inspiration and permit expiration, it uses parts with spring-loaded valves.Based on expiratory muscle exercise, they concluded that early weaning and appropriate conservative treatment should be started.An experimental study by Kinjal Parmar et al, the effectiveness of a manual coughing technique for maximum cough flow was examined in individuals with spinal cord injuries.The intervention involved two sessions every day for four weeks, with each subject doing three sets of three repetitions.The study concluded that the Manually Assisted Cough Method ought to be regarded as a baseline physiotherapy treatment regimen, given the noteworthy enhancement in peak cough flow that transpired after the intervention.So we can say that inspiratory muscle training, expiratory muscle training, body weight supported treadmill training, vocal respiratory training, manually assisted cough technique, exercise training, abdominal bracing, abdominal muscle training, breathe training, electrical nerve stimulation, positioning, resistive inspiratory muscle training, respiratory muscle strengthening can be given to treat respiratory complications in spinal cord injury patients.