Exercise Training for Respiratory Function Post SCI

An occupational therapist, physiotherapist, and respiratory therapist see Mrs. MB on a daily basis. Each of these therapists work with Mrs. MB on respiratory training exercises. Ms. MB was told that these respiratory training exercises will improve her respiratory function and reduce the likelihood of developing respiratory complications. Ms. MB is interested in learning more about respiratory training exercises, so that she can train her caregivers once discharged to home. 
What are the two forms of respiratory trainers and how does each of these work?
1. The two main types of devices are resistive and threshold trainers (see figure 8).  Both of these devices have a one-way valve that closes during inspiration so that the subject must breathe through a small diameter hole for the resistive trainer or against a spring loaded valve for the threshold trainer. The one-way valve opens during expiration such that no load is imposed during the expiratory phase of respiration. An additional devices is an incentive spirometer, commonly used by respiratory therapists which has the advantage of being able to be used unassisted by individuals with poor hand strength.


Figure 8: Threshold trainer(top) has an adjustable spring-loaded valve that imposes the inspiratory load. The inspiratory load can be increased by winding the spring more tightly. Advantage of this trainer is that the same load is imposed on the inspiratory muscles regardless of breathing pattern. Resistive trainer (bottom) has holes of different diameters. The inspiratory load can be increased by setting the dial to holes of lesser diameter. Disadvantage of this trainer is that the subject can reduce the inspiratory load by breathing more slowly. If this device is used for training, a target must be used. Various targets have been designed that set a breathing rate (flow and/or inspiratory pressure) for the subject. Source: Threshold and P-Flex trainers available from Respironics HealthScan Inc., 41 Canfield Rd., Cedar Grove, NJ7, 0009-1201. 1-800-962-1266.