Authors (including presenting author) :
Lau HCS(1), Hui WW(1), Chan MYR(1), Poon MC(1), Leung KKY(2), Cheong KN(2), Choi F(2), Chan WW(1)
Affiliation :
(1) Allied Health Department, Hong Kong Children’s Hospital
(2) Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital
Introduction :
Inspiratory muscle training (IMT) serves as the “dumbbell” for the diaphragm, providing resistance training for inspiratory muscles. IMT requires active participation and cognitive engagement to ensure compliance with treatment protocols. Unlike conventional incentive spirometry, digitalised IMT incorporates computer software and adjustable resistance, providing real-time visual bio-feedback and dynamic graphics that enhance engagement through vibrant colours and visuals. This makes it beneficial for adolescents with suboptimal engagement and inconsistent cognitive ability. Improved respiratory function through IMT prepares patients for further functional training, expediting their return to home.
Objectives :
A 15-year-old male was diagnosed with mixed connective tissue disease, a rare systemic autoimmune disease with multisystem vasculitis and myositis, leading to encephalopathy, interstitial lung disease and generalised muscle atrophy, requiring prolonged hospitalisation in the Paediatric Intensive Care Unit (PICU). The patient was initially bed bound, experiencing significant muscle weakness, poor respiratory effort and functional dependence. Digitalised IMT was introduced to address his respiratory complications, aiming to enhance training effectiveness and compliance through visual cues, while concurrently improving functional capacity and independence.
Methodology :
Initially, the patient presented in a state of confusion, displaying incoherent response, low morale and reduced respiratory muscle strength. Digitalised IMT training was conducted in a seated position, where the patient inhaled against 30% of his maximum inspiratory pressure (MIP) daily for 30 repetitions or as tolerated. The software provided real-time visual feedback through graphs, serving as motivation for subsequent attempts. MIP served as the metric for evaluating inspiratory muscle strength, while Six-Minute Walk Test (6MWT) assessed the patient’s functional capacity.
Result & Outcome :
Patient’s initial MIP was 17 cmH2O, significantly below the normative value of 95 cmH2O for his age. He could only tolerate standing at bedside with 2 moderate assistance for 1 minute and was unable to perform 6MWT. Over two months, the MIP increased to 51 cmH2O and he achieved 480 metres in 6MWT, demonstrating improved ambulatory status and functional capacity. Digitalised IMT with real-time feedback has proven to effectively encourage early engagement in our patient with limited cognitive function and enhancing respiratory muscle strength, thereby facilitating patient in achieving greater independence and improved functional capacity. By embracing modern technology, this approach overcomes the constraints of traditional IMT methods, meeting the needs of 21st century adolescents through modern technology.
