Implementation of inspiratory muscle training for individuals with acute tetraplegia admitted to a spinal cord injury service

Abstract

Aim: Implement inspiratory muscle training (IMT) for individuals admitted with acute tetraplegia and identify and address barriers to delivery. Respiratory morbidity secondary to respiratory muscle weakness affects individuals with tetraplegia. IMT safely and effectively increases inspiratory muscle strength, which may reduce incidences of respiratory tract infections.

Methods: Individuals with acute tetraplegia were eligible for IMT during their acute inpatient admission using a threshold device (three days per week, four sets of six breaths, intensity of 50% maximal inspiratory pressure). Reviews were conducted at 6 and 12 months. Rolling Plan-Do-Study-Act cycles were used to identify and address barriers. Consumer feedback was obtained via survey at 18 months.

Results: 19 individuals with acute tetraplegia (mean age 52±19, 84% male) were admitted over 12 months. 13 (mean age 51±21, 77% male) were admitted over the first 6 months and 5/13 (39%) received IMT. Barriers to provision of IMT included cognitive status in 3 individuals (23%), inability to engage 3 patients (23%) and limitations in team communication for 2 individuals (15%). Visual aids for the protocol and frequent team communication improved implementation, with all eligible individuals (6, 100%) in the following 6-months receiving IMT within 3 months of injury. Reduced upper limb function resulted in difficulty incorporating IMT into daily routines.

Conclusion: IMT was feasible for individuals with acute tetraplegia according to an evidence-based protocol using a quality improvement framework to support implementation. Consumer feedback led to use of assistive devices to support independence with IMT.

Impact: Following high spinal cord injury, individuals experience weakness in their breathing muscles. This increases their risk of developing respiratory complications, leading to poorer quality of life and is the main cause of death. Physiotherapists can strengthen these muscles using IMT, which has been shown to improve strength, lung volume and may reduce the risk of lung infections.