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The Effect of Immersion on the Respiratory Parameters of Individuals with Cervical Cord Injury

Lesley sayliss MSc MCSP

Course: MSc in Physiotherapy, University of East London, 1995

Housed at: University of East London

Contact address: 15 Pentley Park, Welwyn Garden City, Hertfordshire AL8 7RT

The study aimed to investigate the effect of immersion on the respiratory parameters of tetraplegic subjects and to compare the effects with those seen in ‘healthy’ individuals. An additional aim was to demonstrate that the use of an arbitrary figure, FVC < 1.51, as the basis of a contra-indication to hydrotherapy is not appro- priate for people with a cervical cord injury.

All testing was performed with an Escort spirometer. Data were collected from nine tetraplegic and nine matched control subjects. Test positions were supine lying on land, sitting on land, float support lying in the pool and sitting immersed. Four tetraplegic subjects were repeat tested on two subsequent occasions.

The results showed that there was a significant

increase in the FVC (p < 0.0004), FEV, (p < 0.0056) and PEFR (p < 0.006) for tetraplegic subjects during seated immersion compared to measures taken on land. The effects of immersion on the FVC and FEVl of ‘healthy’ subjects showed, in contrast, a significant decrease (p < 0.005 and p < 0.0009 respectively). There was a significant difference for all results between the tetra- plegic and ‘healthy’ subject groups, except for the Tiffeneau index. Repeat testing of the tetraplegic subjects showed that all results were reproducible, t o the extent that 95% of the time any result would be within range of FVC f 0.31.

Discussion of the results showed that the findings were similar to previous research, where comparable, and also offered unique information regarding the effect of immersion on the respiratory function of tetraplegic subjects. Hypotheses for the effects of immersion on tetraplegic subjects were offered.

The study suggested future research proposals t o investigate further the effects of immersion on respi- ratory function and concluded that an arbitrary figure for forced vital capacity should not be used as a criterion t o exclude individuals with a cervical cord injury from hydrotherapy.

Effects of Rehabilitation in Patients with Cardiac Disease

Ann Taylor PhD MSc MCSP DipTP

Course: PhD, Cardiovascular Medicine, Queens Medical Centre, Nottingham, 1996

Housed at: Greenfield Medical Library, University of Nottingham

Contact address: King’s College London, Campden Hill Road, Kensington, London W8 7AH

Prospective randomised controlled trials were performed to investigate the benefits of cardiac rehabilitation in two selected patient groups. One group comprised patients in the early stage of recovery after an uncom- plicated myocardial infarction. The other consisted of patients with stable chronic heart failure, who are usually excluded from exercise programmes

The reliability and validity of a new method of measuring ambulatory activity was determined.

The rehabilitation programme for the post-myocardial infarction patients lasted six weeks and contained education and exercise components. Three groups were recruited: a control group, a group who undertook only

the education sessions and a group who also took part in a training programme. Comparison of changes in psychosocial parameters and physiological function was made between the groups after completing the programme and three months later. The education plus exercise group showed significantly greater improve- ments (p < 0.05) in anxiety, ambulatory activity and rehabilitation status compared t o the other groups. Indications of predominantly peripheral adaptation to training were observed, but no significant differences in physiological function were found between the three groups. The education only group did not show any significant differences from the control group in any areas.

A crossover design was used in the chronic heart failure study. This comprised a control and exercise period, each lasting two months. Assessments of psychosocial parameters and physiological function were made at monthly intervals. Exercise training produced a signif- icant decrease in depression, and improvement in quality of life and ambulatory activity. Both central and peripheral adaptations to training were observed, with significant benefits in peak cardiac index, oxygen uptake and resting heart rate. Improvements in venti- latory efficiency were also noted.

Physiotherapy, September 1996, vol82, no 9