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Tantisuwat A1, Kruapanich C1, Ubolnuar N1, Thaveeratitham P1, Mathiyakom W2,3
1Faculty of Allied Health Sciences, Chulalongkorn University, Department of Physical Therapy, Bangkok, Thailand, 2California State University, Department of Physical Therapy, Northridge, United States, 3University of Southern California, Department of Biological Sciences, Los Angeles, United States
Background: Patients with chronic obstructive pulmonary disease (COPD) usually experience the difficulty of breathing or dyspnea during activities involving shoulder elevation as observed during activities of daily living (ADLs). Active shoulder flexion has been shown to change activation patterns of the respiratory muscles and kinematics of the chest wall. An increase in chest wall stiffness associated with increased respiratory muscle activation decreases rib cage expansion and lung volume. As a result, the ventilatory demand is increased leading to the sensation of dyspnea and upper limb fatigue (UL fatigue). To successfully perform ADLs, patients with COPD must elevate their shoulders in various directions including scaption (abduction in the scapular plane) and abduction. Unfortunately, the impact of shoulder scaption and abduction on ventilation, lung volume, dyspnea, and UL fatigue in patients with COPD is lacking.
Purpose: This study aimed to compare ventilation, lung volume, the sensation of dyspnea, and UL fatigue between shoulder flexion, scaption, abduction, and baseline in patients with COPD.
Methods: Twenty, stable mild to moderate patients with COPD performed three trials of shoulder flexion, scaption, and abduction to their self-selected full range of motion. During resting (baseline) and the experimental tasks, kinematic data of the chest and abdominal walls were captured using a non-invasive optoelectronic plethysmography with 89 markers placed on the chest and abdominal walls. Ventilation and lung volume were then derived from the kinematic data. The sensation of dyspnea and upper limb fatigue were also obtained. Repeated measures ANOVA was used to compare between tasks and Bonferroni post-hoc analysis was used to control for type I error.
Results: The mean±SD age, height, and weight of the subjects were 64.10±6.05 years, 64.54±8.90 kg., 166.35±5.85 cm., respectively. Overall, active shoulder elevation in all three planes significantly decreased tidal volume, tidal volume at rib cage, inspiration time, expiratory time, and total respiratory time, but significantly increased respiratory rate and UL fatigue as compared to the baseline (P 0.05). During scaption, tidal volume, tidal volume at abdomen, end-inspiratory volume, and end-expiratory volume at abdomen were significantly lower than those of abduction (P 0.05). During flexion, end-inspiratory and end-expiratory volume were significantly lower than those of abduction (P 0.05). There was no significant difference in the sensation of dyspnea and UL fatigue between active shoulder elevation in different planes (P>0.05).
Conclusion(s): When compared to baseline, active shoulder elevation in all three planes altered ventilation, lung volume, the sensation of dyspnea, and UL fatigue. Ventilation and lung volume were more affected during shoulder flexion and scaption as compared to abduction. However, the sensation of dyspnea and UL fatigues were not different between active shoulder elevation in different planes.
Implications: These results provide insight into how active shoulder elevation in different planes impacts ventilation, lung volume, and symptoms of patients with COPD. This information serves as a foundation for tailoring therapeutic exercise or movement to progressively influence lung volume and possibly upper limb exercise tolerance. However, future studies on the impact of these results are warranted.
Keywords: Lung volume, Arm position, COPD
Funding acknowledgements: The present work was supported by Research Grant for New Researcher (MRG-5980084), the Thai Research Fund, Thailand.
Purpose: This study aimed to compare ventilation, lung volume, the sensation of dyspnea, and UL fatigue between shoulder flexion, scaption, abduction, and baseline in patients with COPD.
Methods: Twenty, stable mild to moderate patients with COPD performed three trials of shoulder flexion, scaption, and abduction to their self-selected full range of motion. During resting (baseline) and the experimental tasks, kinematic data of the chest and abdominal walls were captured using a non-invasive optoelectronic plethysmography with 89 markers placed on the chest and abdominal walls. Ventilation and lung volume were then derived from the kinematic data. The sensation of dyspnea and upper limb fatigue were also obtained. Repeated measures ANOVA was used to compare between tasks and Bonferroni post-hoc analysis was used to control for type I error.
Results: The mean±SD age, height, and weight of the subjects were 64.10±6.05 years, 64.54±8.90 kg., 166.35±5.85 cm., respectively. Overall, active shoulder elevation in all three planes significantly decreased tidal volume, tidal volume at rib cage, inspiration time, expiratory time, and total respiratory time, but significantly increased respiratory rate and UL fatigue as compared to the baseline (P 0.05). During scaption, tidal volume, tidal volume at abdomen, end-inspiratory volume, and end-expiratory volume at abdomen were significantly lower than those of abduction (P 0.05). During flexion, end-inspiratory and end-expiratory volume were significantly lower than those of abduction (P 0.05). There was no significant difference in the sensation of dyspnea and UL fatigue between active shoulder elevation in different planes (P>0.05).
Conclusion(s): When compared to baseline, active shoulder elevation in all three planes altered ventilation, lung volume, the sensation of dyspnea, and UL fatigue. Ventilation and lung volume were more affected during shoulder flexion and scaption as compared to abduction. However, the sensation of dyspnea and UL fatigues were not different between active shoulder elevation in different planes.
Implications: These results provide insight into how active shoulder elevation in different planes impacts ventilation, lung volume, and symptoms of patients with COPD. This information serves as a foundation for tailoring therapeutic exercise or movement to progressively influence lung volume and possibly upper limb exercise tolerance. However, future studies on the impact of these results are warranted.
Keywords: Lung volume, Arm position, COPD
Funding acknowledgements: The present work was supported by Research Grant for New Researcher (MRG-5980084), the Thai Research Fund, Thailand.
Topic: Cardiorespiratory; Human movement analysis; Disability & rehabilitation
Ethics approval required: Yes
Institution: Health Sciences Group, Chulalongkorn University
Ethics committee: The Research Ethics Review Committee
Ethics number: no.210/2016
All authors, affiliations and abstracts have been published as submitted.
