Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, Rehabilitation
98
Scopus Publications
Scopus Publications
Clinical Predictors of Speaking Valve Use in Neurological Patients: A Retrospective Cohort Study Matías Otto-Yáñez, Gonzalo Monge-Martínez, Rodrigo Torres-Castro, Tamara Muñoz, Erico Segovia, et al. Neurorehabilitation, 2026 Introduction Speaking valves (SVs) restore phonation and may support airway protection in people with a tracheostomy, yet tolerance varies widely in neurological rehabilitation. We aimed to identify clinical factors associated with SV use and duration in a neurological rehabilitation setting. Methods We retrospectively analyzed 117 adults with neurological conditions and tracheostomy admitted to a rehabilitation center. Two internally validated multivariable models were developed: logistic regression for SV use (yes/no) and a quasi-Poisson regression for target daytime SV duration (hours/day), using routinely available bedside clinical variables. Results Of 117 patients, 64 (54.7%) used an SV during hospitalization. In the multivariable logistic model, higher level of consciousness (eMCS vs VS/MCS; OR 6.26, 95% CI 1.53–23.14), a positive blue dye test (OR 0.05, 95% CI 0.01–0.30), and endotracheal suction requirement (vs spontaneous cough; OR 0.07, 95% CI 0.003–0.879) were independently associated with SV use. Model performance was strong (AUC 0.856; accuracy 79.5%). Among SV users, longer daytime duration for SV use was associated with younger age, greater inspiratory and expiratory muscle strength, higher consciousness level, mild dysphagia, spontaneous cough, and neuromuscular or spinal cord injury diagnoses. In contrast, moderate-to-abundant secretions were associated with fewer hours. Conclusion In a single-center neurological rehabilitation cohort, SV adoption and sustained tolerance were associated with bedside indicators of neurological responsiveness, secretion management, swallowing safety, and respiratory muscle strength. Findings should be interpreted as predictive associations and warrant external validation in contemporary multicenter cohorts.
Effects of Body Position on Respiratory Pressure and Muscle Activity in Amyotrophic Lateral Sclerosis and Healthy Subjects Ana Cristina de Medeiros Garcia Maciel, Ana Aline Marcelino da Silva, Jéssica Danielle Medeiros da Fonseca, Rayane Grayce da Silva Vieira, Lailane Saturnino da Silva, et al. Respiratory Care, 2026 Background: Amyotrophic lateral sclerosis (ALS) is a fatal heterogeneous neurodegenerative disease characterized by the degeneration of both upper and lower motor neurons and spinal cord. Measurement of respiratory muscle strength has been shown to be an important assessment in the decision-making process and can be assessed by maximum inspiratory (P Imax ) and expiratory pressures (P Emax ), sniff nasal inspiratory (SNIP) and expiratory (SNEP) pressures. Body position appears to have a significant effect on respiratory muscle strength. The aim of this study was to observe the difference in peak values of SNIP and SNEP of the respiratory muscles measured in 2 different positions (seated and supine with 45° elevation) in subjects with ALS and a group of matched healthy subjects. Methods: This is a case–control study of subjects with ALS and healthy subjects. Spirometry and surface electromyography (EMG) of the sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles were assessed during P Imax and P Emax maneuvers in the seated position, and SNIP and SNEP in the seated and supine positions at 45° elevation (randomized). Results: SNEP values in the 45° elevation were lower than in the sitting position in ALS (70.3 ± 26.7 vs 57.3 ± 22.8 cm H 2 O, P = .041). SNIP and SNEP were lower in ALS in the 45° elevation compared with healthy subjects (69.1 ± 27.2 vs 95.5 ± 23.5 cm H 2 O; 57.3 ± 22.5 vs 92.7 ± 26.4 cm H 2 O, P = .041). In subjects with ALS, baseline electromyographic activity of the sternocleidomastoid muscle at rest was higher than in healthy subjects in both positions ( P = .041). No significant differences in electrical activity were found for other variables and measurements. Conclusions: In ALS, nasal pressure may be affected by reduced diaphragm and abdominal muscle effectiveness in the supine position. The sternocleidomastoid muscle showed increased electrical activity in the supine position with 45° elevation compared with controls, which may indicate muscle weakness.
Breath Stacking: Acute Effects on Cough Peak Flow and Chest Wall Volumes of Healthy Subjects Ana Cristina de Medeiros Garcia Maciel, Vanessa Regiane Resqueti, Jéssica Danielle Medeiros da Fonseca, Illia Nadinne Dantas Florentino Lima, Matías Otto-Yáñez, et al. Journal of Functional Morphology and Kinesiology, 2025 Objectives: The aim of this study was to investigate the acute physiological effects of the BS on CPF and chest wall volumes in healthy individuals, comparing two body positions: supine and 45° trunk inclination. Methods: Observational, analytical, and cross-sectional study conducted with 14 healthy individuals (7 males) who underwent the BS in two different body positions. CPF, tidal chest wall volumes and the contribution of thoracoabdominal compartments were assessed using Optoelectronic Plethysmography. Statistical analyses included two-way ANOVA and Bonferroni post hoc tests, with a significance level of 5%. Results: A significant increase in CPF was observed after the BS in the inclined position (p < 0.05), with no relevant changes in the supine position. Tidal chest wall volumes also increased in both positions, with a more pronounced effect in the 45° inclination (p < 0.05). The volume increase was predominantly thoracic, with a ventilatory redistribution favouring the pulmonary rib cage compartment, especially in the inclined posture. Conclusions: The BS produced immediate beneficial physiological effects in healthy individuals, with greater efficacy in the inclined position, enhancing expiratory flow and thoracic ventilation. These findings support the clinical applicability of BS as a physiotherapeutic strategy even in populations without respiratory dysfunction.
Potential effect of 6 versus 12-weeks of physical training on cardiac autonomic function and exercise capacity in chronic obstructive pulmonary disease European Journal of Physical and Rehabilitation Medicine, 2015
Comparison between a national and a foreign manovacuometer for nasal inspiratory pressure measurement. Revista Brasileira De Fisioterapia Sao Carlos Sao Paulo Brazil, 2010
