Effects of immersion on the breathing parameters of patients with Duchenne muscular dystrophy

Abstract

In many rehabilitation centers, Aquatic Physiotherapy is commonly used as an optional treatment for Duchenne Muscular dystrophy (DMD) patients. However, there is so little scientific evidence about the immersion effects on the breathing parameters of these patients. Objective: Our goal was to evaluate the immersion effects to the depth of the seventh cervical vertebra (C7), related to the breathing parameters in DMD patients. Method: Fifteen boys with DMD participated of the study, averaging 12 years in age. Clinical history and general information were investigated, and the following parameters were evaluated on the ground and inside the pool: Partial Oxygen Saturation (SpO2), heart rate (HR), maximal inspiratory (PI Max.) and expiratory (PE Max.) pressures, minute volume (MV), respiratory rate (RR), tidal volume (TV), Forced Vital Capacity (FVC) and peak expiratory flow (PEF). The SpO2 diminished after the aquatic evaluation when compared to values beforehand (p = 0.01). RR was higher inside the pool than outside (p = 0.02). PI Max. and PE Max. did not change inside the pool. Results: Analyzing the results for volumes, FVC and EPF were reduced inside the pool when compared to evaluation on solid ground (p = 0.004). MV and TV did not change. A positive correlation between ground and pool values of FVC and PEF was seen (FVC: r = 0.692, p = 0.006; EPF: r = 0.913, p = 0.0001). C7 immersion was able to reduce SpO2, FVC, and PEF, while increasing the RR of DMD patients. Conclusion: With the correlation between ground and pool values of FVC and PEF encountered in this study, there is a possibility of predicting pool values for these parameters using only the ground data. These findings could lead to a scientific base for a better Aquatic Physiotherapy prescription for DMD patients, at different pathology stages.