Are pulmonary physical therapy interventions beneficial in the management of amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

Answer

A literature review by Macpherson and Bassile indicated that pulmonary physical therapy interventions—specifically, inspiratory muscle training (IMT), lung volume recruitment training (LVRT), and manually assisted coughing (MAC)—can have a beneficial effect on respiratory outcome measures and length of survival in ALS. The investigators reported that respiratory muscle strength could be prolonged through IMT, with the mean length of survival being extended by a year. Immediate cough efficacy benefited from LVRT, while peak cough expiratory flow showed just a small amount of improvement in association with MAC. [12]

However, a literature review by Silva et al suggested that in patients with ALS, respiratory muscle training has no significant impact on physical functioning or quality of life. The investigators found that after an 8-week period, in patients with ALS who underwent expiratory muscle training (EMT), the percent predicted forced vital capacity (FVC%) demonstrated no clear difference from that of patients treated with sham EMT. Although after 4 months’ therapy, patients who underwent IMT showed improvement in FVC%, the evidence was of low certainty, and outcomes derived from the Amyotrophic Lateral Sclerosis Functional Rating Scale did not clearly differ between IMT and sham-IMT patients. [13]


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