Physical Medicine Interventions for Duchenne Muscular Dystrophy, the Including Avoiding Invasive Airway Tubes

13 measured via a peak flow meter from a maximally deep breath with a cough-timed abdominal thrust, and spirometry. The latter measures the VC with the patient sitting or supine, active lung volume recruitment or LVR (air stacking) which is the maximum amount of air that can be held by the glottis stacking three or four delivered volumes of air or, if the patient can not close the glottis (close the throat), by passive LVR to the lung insufflation capacity which is the maximum amount of air that one can put into the lungs via a manual resuscitator (Ambu bag) or air volumes delivered by a ventilator, and glossopharyngeal breathing (GPB) or “frog breathing” maximum breaths. 16 The latter is used by many people with DMD to be able to breathe for periods without ventilator use despite having little or no respiratory muscle strength at all and can be practiced in this stage. Pulmonary function testing doesn’t evaluate CO2, CPF, or spirometry and is useless. Polysomnography (“sleep studies”) are also useless since apneas and hypopneas can be decreased but full NVS settings are always needed to optimally rest muscles overnight and to provide full ventilatory support. Arterial blood gas sampling is also unnecessary and painful. Interventions in Stage 2: Air Stacking and Mechanical Insufflation-Exsufflation. A. Air Stacking This technique involves active lung volume recruitment (LVR) using a manual resuscitation bag, which continuously delivers positive pressure air volumes as the patient retains air until reaching their maximum inflation capacity (lungs filled with air). Its purpose is to mimic a sigh and is performed to maintain or improve thoracopulmonary compliance, having a positive effect on preventing a decline in vital capacity (VC) and improving cough flow. Its combination with an abdominal thrust (manually assisted cough) is used to enhance cough flow. Figure 4 – Active lung volume recruitment using a manual resuscitator to deliver consecutive boluses of air to be held by the glottis. This patient’s lips were too weak to air stack via mouthpiece. *SCAN QR CODE TO LEARN HOW TO MAKE AIR STACKING