• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.833-837
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• 2018

Objective To investigate and demonstrate persistent increase of peak cough flow after mechanical in-exsufflator application, in patients with neuromuscular diseases and pneumonia. Methods A mechanical in-exsufflator was applied with patients in an upright or semi-upright sitting position (pressure setting, +40 and $-40cmH_2O$; in-exsufflation times, 2-3 and 1-2 seconds, respectively). Patients underwent five cycles, with 20-30 second intervals to prevent hyperventilation. Peak cough flow without and with assistive maneuvers, was evaluated before, and 15 and 45 minutes after mechanical in-exsufflator application. Results Peak cough flow was 92.6 L/min at baseline, and 100.4 and 100.7 L/min at 15 and 45 minutes after mechanical in-exsufflator application, respectively. Assisted peak cough flow at baseline, 15 minutes, and 45 minutes after mechanical in-exsufflator application was 170.7, 179.3, and 184.1 L/min, respectively. While peak cough flow and assisted peak cough flow increased significantly at 15 minutes after mechanical in-exsufflator application compared with baseline (p=0.030 and p=0.016), no statistical difference was observed between 15 and 45 minutes. Conclusion Increased peak cough flow after mechanical in-exsufflator application persists for at least 45 minutes.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.2
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• pp.85-93
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• 2019

Purpose : The purpose of this study was to investigate the effects of abdominal functional electrical stimulation on peak cough flow and forced vital capacity in patients with cervical spinal cord injury. Methods : The study examined 20 patients with cervical spinal cord injury. The subjects were randomly divided into two groups. All subjects performed conservative physical therapy for 30 minutes. The experimental group also underwent abdominal functional electrical stimulation for at least 20 minutes per day. Abdominal functional electrical stimulation was applied to the rectus abdominis muscle twice each day, three times a week, for four weeks. In all subjects, the peak cough flow was measured using a peak flow meter and forced vital capacity was assessed using a spirometer. Results : The experimental group showed a significant increase in peak cough flow and forced vital capacity in pre-post measurements (p<.05), while the control group showed a significant increase only in peak cough flow. Conclusion : These findings suggest that conservative physical therapy in combination with the abdominal functional electrical stimulation can improve peak cough flow and forced vital capacity in patients with cervical spinal cord injury.

• Physical Therapy Korea
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• v.22 no.1
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• pp.19-29
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• 2015

Impaired respiratory function is common in patients with stroke. The purpose of this study were to investigate the effectiveness of exercises and to assess forced vital capacity and peak cough flow after completion of neck stabilizing and respiratory reeducation exercises (combining diaphragmatic breathing and pursed-lip breathing exercises). The 45 participants were randomly assigned to an experimental group 1 ($n_1=15$), experimental group 2 ($n_2=15$), and a control group ($n_3=15$). All subjects performed conservative physical therapy for 30 minutes. Experimental group 1 undertook the neck stabilizing exercise and the respiratory reeducation exercise. Experimental group 2 undertook the respiratory reeducation exercise. Additional exercise did not exceed 30 minutes, five times a week for six weeks. The subjects were assessed for deep neck flexor thickness and breathing function (forced vital capacity, forced expiratory volume at one second, forced expiratory volume at one second/forced vital capacity, peak expiratory flow, and manual assisted peak cough flow) at pre-post value. The results of this study were as follows. Experimental group 1 showed a significant increase only in deep neck flexor thickness change rate (p<.05). All groups showed significant increases in forced vital capacity, forced expiratory volume at one second, and peak expiratory flow in pre-post measurement (p<.05). Experimental groups 1 and 2 showed an increase in manual assisted peak cough flow in pre-post measurement (p<.05). There was no significant difference between experimental group 1 and experimental group 2, but experimental group 1 improved more than experimental group 2 in respiratory function as a whole. In conclusion, these findings suggest that the neck stabilizing exercise in combination with the respiratory reeducation exercise can improve forced vital capacity and peak cough flow in patients with stroke.

• Physical Therapy Korea
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• v.16 no.3
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• pp.1-8
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• 2009

It is important to find the effective position for cough and sputum clearance in respiratory physical therapy. The purpose of this study was to compare the changes in peak expiratory flow (PEF), forced expiratory volume in 1 second ($FEV_1$), and peak cough flow (PCF) related to functional level and measurement position in patients with Duchenne muscular dystrophy. Twenty one subjects were classified into three functional levels, and measurements was undertaken in three different measurement positions (upright sitting, $45^{\circ}$ reclining and supine). Vitalograph PEF/FEV DIARY was used to measure PEF and $FEV_1$, and Ferraris Pocket Peak was used to measure PCF. Mixed two-way analysis of variance and Bonferroni post-hoc test were used for statistical analysis. The results of the study were as follows: 1) Significant main effects for measurement position were found. 2) PEF was the highest in upright sitting, followed by $45^{\circ}$ reclining, and supine in order. 3) $FEV_1$ in upright sitting and $45^{\circ}$ reclining were significantly greater compared with that in supine. 4) PCF in upright sitting and $45^{\circ}$ reclining were significantly greater compared with that in supine. 5) No significant main effects for functional level were found in PEF, $FEV_1$, and PCF. 6) No significant functional level by measurement position interactions were found in PEF, $FEV_1$, and PCF. Therefore, it is concluded that upright sitting and $45^{\circ}$ degree reclining positions are recommended for effective cough and sputum clearance.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.4
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• pp.407-414
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• 2011

Purpose : The aim of this study was to clarify the lung capacity, maximal insufflation capacity, and peak cough flow when a mechanical insufflation-exsufflation(MIE) method was used to increase Duchenne muscular dystrophy patients' lung function. Methods : The subjects of the study were 21 patients with Duchenne muscular dystrophy. They were randomly selected from patients within the boundaries of the selection criteria, and divided into two groups; The subject group(n=11) used the mechanical insufflation-exsufflation method with traditional therapeutic exercise. The control group(n=10) used only traditional therapeutic exercise. Results :The results indicated that maximal insufflation capacity, unassisted peak cough flow and assisted peak cough flow significantly increased in the subject group(p<.05). By contrast, in the control group, the results didn't indicate the significant differences from the variable. There were significant differences in maximal insufflation capacity and assisted peak cough flow between the subject group and the control group before and after the application of the mechanical insufflation-exsufflation method. Conclusion : A mechanical insufflation-exsufflation method has positive effects on the improvements of cough functions and that of pulmonary functions such as lung volume, lung elasticity in patients with Duchenne muscular dystrophy.

• Journal of the Korean Society of Physical Medicine
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• v.9 no.4
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• pp.399-406
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• 2014

PURPOSE: The purpose of this study was to examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and cough capacity in stroke patients. METHODS: This study used a nonequivalent control group pre-post test design. We recruited thirty-four stroke patients(16male, 18female), who were assigned to intervention (n=17), or control (n=17) groups. Both groups participated in a conventional stroke rehabilitation program, with the intervention groups also receiving respiratory muscle training 20 minutes a day, three times a week, for 4 weeks. Respiratory function (forced vital capacity) and respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure) were assessed by spirometry. Cough capacity (peak expiratory flow) was assessed using a peak flow meter. The collected data were analyzed by independent and paired t-tests. RESULTS: The intervention group showed a significant increase in the forced vital capacity (FVC), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and peak expiratory flow (PEF) at the end of the program, while the control group showed no significant changes. CONCLUSION: This study showed that respiratory muscle training increased respiratory function, respiratory muscle strength, and cough capacity in stroke patients and prevented a decrease in cough capacity. These findings suggest that respiratory muscle training effect on respiratory function, respiratory muscle strength and cough capacity for rehabilitation in patients with stroke.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.654-661
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• 1999

Background : The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. Methods : PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test($FEV_1$, $FEV_1%$ pred, FVC, and FVC% pred) were measured at first visiting. Results : Values of PIFn, $FEV_1$, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was $41.4{\pm}15.9$ years. Normal subjects were 32(22 males and 10 females) and the mean age was $39.8{\pm}18.6$ years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects($2.25{\pm}0.68\;L/sec$ vs. $2.75{\pm}1.00\;L/sec$ ; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects (mean$\pm$SD ; $2.18{\pm}0.66$ vs. $2.75{\pm}1.00\;L/sec$, p=0.006). Conclusion : There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.

• Annals of Rehabilitation Medicine
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• v.42 no.6
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• pp.798-803
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• 2018

Objective To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke. Methods This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups. Results The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups. Conclusion Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.23-31
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• 2021

Purpose : To compare the immediate effects of air stacking maneuver using resuscitator bags and balloons. Methods : Twenty healthy young adults participated in this study. Forced vital capacity (FVC) and peak cough flow (PCF) tests were performed at pre-intervention, and then, the maximum insufflation capacity (MIC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), and peak cough flow (PCF) were measured using the air stacking maneuver via resuscitator bags and balloons. Interventions were randomly performed, and a 40-min break was provided between interventions. The evaluation process in this study was conducted in accordance with the guidelines of the American Thoracic Society (ATS) 2019. To compare the three outcomes measured at pre-and post-interventions, repeated measures analysis of variance was performed. Results : A significant difference was found in the MIC, FEV1, PEF, and PCF after the air stacking maneuver using resuscitator bags and balloons, whereas no significant difference was observed between resuscitator bags and balloons. Conclusion : No significant difference was found in the immediate effect of the air stacking maneuver using resuscitator bags and balloons in this study. Air stacking maneuver using balloons can increase the success rate of the techniques by providing visual feedback on the amount of air insufflation when performed with balloon blowing exercise. Balloons are cheaper and easier to buy compared to manual resuscitator bags; therefore, education on the air stacking maneuver using balloons will have a positive effect on pulmonary rehabilitation.

• The Journal of Korean Physical Therapy
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• v.24 no.5
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• pp.340-347
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• 2012

Purpose: This study was conducted in order to investigate the effect on respiratory function, trunk control, and functional activities of daily living (ADL) through respiratory muscle strength training in patients with chronic stroke. Methods: Eighteen subjects who were six months post stroke participated in this study. The subjects were randomly allocated to two groups: experimental (n=10) and control (n=8). Both groups received physical therapy for five sessions, 30 minutes per week, during a period of six weeks. Subjects in the experimental group participated in an additional respiratory muscle strength training program, in which the threshold PEP device was used for 30 minutes per day, three days per week, during a period of six weeks. Results from pretest-posttest control were evaluated by pulmonary function forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC, peak expiratory flow (PEF), capacity of cough, trunk control, and functional ADL. Results: Significant improvement in the FEV1, PEF of pulmonary function (p<0.05), cough function (p<0.05), and trunk control (p<0.05) was observed among the groups. Conclusion: Respiratory muscle strength training improves pulmonary function, capacity of cough, and trunk control. These results suggest that respiratory muscle strength training is feasible and suitable for individuals with chronic stroke.