Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury

Study design: A prospective cohort study. Objectives: To evaluate whether patients with cervical spinal cord injury (CSCI) are able to learn the technique of glossopharyngeal pistoning (breathing) for lung insufflation (GI) and if learned, to evaluate the effects of GI on pulmonary function and chest expansion after 8 weeks. Setting: Karolinska University Hospital, Stockholm, Sweden. Methods: Twenty-five patients with CSCI (21 men, four women) with a mean age of 46 years (21-70), from the Stockholm area, were used in this study. The participants performed 10 cycles of GI four times a week, for 8 weeks. Pulmonary function tests made before and after the GI training included vital capacity (VC), expiratory reserve volume (ERV), functional residual capacity (FRC; measured with nitrogen washout), residual volume (RV) and total lung capacity (TLC). Chest expansion was measured before and after training. Results: Five of the twenty-five participants had difficulty in performing GI and were excluded in further analysis. Performing a GI maneuvre increased participants' VC on average by 0.88 +/- 0.5 I. After 8 weeks of training, the participants had significantly increased their VC 0.23 I, (P < 0.001), ERV 0.16 I, (P < 0.01), FRC 0.86 I, (P < 0.001), RV 0.70 I, (P < 0.001) and TLC 0.93 I, (P < 0.001). Chest expansion increased at the level of the xiphoid process by 1.2 cm (P < 0.001) and at the level of the fourth costae by 0.7 cm (P < 0.001). Conclusions: After using GI for a period of 8 weeks, the participants with CSCI who could perform GI were able to improve pulmonary function and chest expansion. Spinal Cord (2009) 47, 418-422; doi:10.1038/sc.2008.138; published online 11 November 2008