Effect of respiratory muscle proprioceptive neuromuscular facilitation on respiratory muscle strength in spinal cord injury individuals

Spinal cord injury (SCI) can lead to significant respiratory complications due to impaired function of respiratory muscles. Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation technique used to strengthen these muscles, showing efficacy in various populations, including those with COPD and weaning failure. While inspiratory muscle training (IMT) has proven beneficial in patients with tetraplegia, the combination of respiratory PNF and IMT on respiratory strength in SCI patients remains unexplored.

Study procedure

After baseline assessment and allocation of 20 quadriplegic subjects (C5-C8), participants will be divided into two groups: the experimental group, which will receive inspiratory muscle training (IMT) combined with respiratory muscle proprioceptive neuromuscular facilitation (PNF) and conventional physiotherapy, and the control group, which will receive sham training (PNF + IMT) along with conventional physiotherapy.In the experimental group: IMT: Participants will perform 3-5 sets of 12 breaths, followed by 2 minutes of quiet breathing. The intensity will start at 30% of their maximum inspiratory pressure (MIP/PI max) and will increase by 10% weekly, or by 5% if the higher increase is not tolerated. The training will take place 4 days per week for 4 weeks. PNF: Participants will perform 10-12 repetitions per set, for 3 sets per session. Each set will be followed by a 30-60 second rest period. This will also be conducted 4 days per week for 4 weeks.In the control group:Sham training (PNF + IMT): The same frequency, intensity, and time frame will be followed as the experimental group, but using sham techniques instead.The total session time will be approximately 30-40 minutes, and the primary outcome, respiratory muscle strength, will be assessed using MIP and MEP measurements.

Assessment: Primary Outcome: Respiratory muscle strength (measured by MIP and MEP) using a respiratory pressure manometer.

Statistical Analysis Plan:

Descriptive statistics will summarize data. Depending on data distribution, independent t-tests or Mann-Whitney U tests will compare groups, and paired t-tests or Wilcoxon signed-rank tests will evaluate pre- and post-intervention differences. Analysis will be performed using SPSS 21, with significance set at 5%.