Lung Boost Trainer Versus Incentive Spirometer in Post COVID-19 Hemiplegic CP Children

Plain-language summary

Cerebral palsy (CP) is the most common physical disability in children. Children with CP have a higher incidence of respiratory dysfunction than healthy children. They usually have recurrent chest infections, bronchiectasis, atelectasis, sleep apnea, and chronic obstructive lung disease. They have high risk of morbidity and mortality due to excessive drooling and frequent aspiration that result in chest infections. Children with spastic CP have decreased chest wall mobility, weak respiratory muscles, and deviation of optimal chest wall structure, resulting in lower pulmonary function than healthy children. A new coronavirus (SARS-CoV-2) outbreak occurred in December 2019, which caused various clinical symptoms leading to a syndrome called "Corona virus disease of 2019 " ("COVID-19"). COVID-19 can lead to the occurrence of symptoms such as fever, cough, increased airway secretions, dyspnea, weakness and decreased exercise tolerance due to long-term bed rest in isolation. The method to safely rehabilitate COVID-19 patients is an issue that has led to concerns among physiotherapists at present. Inspiratory Muscle Training (IMT) helps to reduce the level of dyspnea and improves the pulmonary function, respiratory muscle strength and functional capacity. Lung Boost is a device used for respiratory muscles training. Lung Boost is planned for anyone who wishes to improve the strength and endurance of respiratory muscles in an individual, including professional athletes, recreational athletes and healthy individuals. However, this device is not indicated for the people who are too weak or ill to use the device. Furthermore, the device includes screen which play an important role to motivate the child with C.P. and achieve cooperation during program to get best results. Incentive spirometer exercises are commonly used in combination with chest physiotherapy, which allows the patient to perform gradual deep breaths, allowing for the relaxation and opening of collapsed airways, with motivation through visual input. It is an inexpensive and easy tool used with no reported side effects; meeting the visual goal helps the children to do their best and thus fosters patient compliance. Treatment procedure: LBT Group : received lung boost trainer in addition to traditional respiratory muscle training IST Group: received incentive exercises in addition to traditional respiratory muscle training. TRPT Group: received traditional respiratory physical therapy protocol only. (control group) HYPOTHESES: 1- There is no Significant difference between Lung boost trainer and incentive spirometer on lung compliance on post-COVID hemiplegic cerebral palsy patients. as regards to: 1. forced expiratory volume at first second (FEV1%), 2. the forced vital capacity (FVC %), 3. FEV1/ FVC ratio 4. 6minute walk test (6MWT) 5. Quality of life questionnaire (SF 36) Study duration has taken 6 months to be completed for all groups. Intervention duration for each child lasts for four weeks with five sessions a week. RESEARCH QUESTION: Is there difference between Lung boost trainer and incentive spirometer on lung compliance in post COVID hemiplegic cerebral palsy patients? Patients will be included: 1. 60 patients from both genders. 2. spastic CP patients between the ages 4 and 9 years. 3. Reasonable cognitive functions and a reasonable IQ so as to be able to follow instructions. 4. after two weeks of COVID19 recovery Participants excluded if : 1. Had other psychiatric and/or neurological disorders than cerebral palsy as Seizures. 2. Had any spinal deformities that affect chest mobility or pulmonary functions 3. Had medical conditions that could affect respiratory function such as cardiac disease or Chronic respiratory disease or on medications that affect respiratory function

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