Neuromotor / Neuromuscular Disorders

Neuromotor and neuromuscular disorders arise from a broad variety of congenital and acquired etiologies; clinical manifestations are equally diverse. In patients with severe disability or advanced disease, respiratory muscle weakness significantly increases risk for pulmonary complications associated with retained airway secretions; respiratory illness is the leading cause of hospitalization and premature death.

  1. Castagnino M, Vojtove J, Fink R. Safety of high-frequency chest wall oscillation in patients with respiratory muscle weakness. Chest 1996; 110: S65.
    In this controlled short-term evaluation of safety, efficacy and acceptance of high frequency chest wall oscillation (HFCWO) therapy, 8 patients with respiratory muscle weakness (vital capacities of 30 ml/kg or less; Age >10 years, able to perform PFTs) received HFCWO at frequencies of 5, 15, and 20 Hz for five minutes each. Measures of patient comfort, pulmonary function, and other physiological parameters were collected and evaluated as mean percent change from baseline. No clinically relevant changes occurred in physiological values, all patients found HFCWO both comfortable and acceptable; no adverse events were noted.
  2. Chiappetta A, Beckerman R. High-frequency chest-wall oscillation in spinal muscular atrophy (SMA). RT J Respir Care Pract 1995; 8:112-114.
    This six-week study evaluated the substitution of high frequency chest wall oscillation (HFCWO) to replace chest physiotherapy (CPT) in a ten-year old girl with spinal muscular atrophy. The child had been hospitalized 3x in past year for pneumonia, mucus retention, and pulmonary deterioration. She had received percussion and postural drainage therapy (P&PD) 2x daily from her mother for 4 years. HFCWO was administered 2x daily for 30 minutes for 5 minutes at each of 6 frequencies; each 5 minute session was followed by one or two cough maneuvers. After six weeks of HFCWO, the patient showed stronger cough function and improvements in FVC, FEV1, MEF and NIF of 25%, 16%, 20%, and 28% respectively.
  3. Giarraffa P, Berger KI, Chaikin AA, Axelrod FB, Davey C, Becker B. Assessing efficacy of high-frequency chest wall oscillation in patients with familial dysautonomia. Chest 2005; 128:3377-3381.
    This study evaluated daily high-frequency chest wall oscillation (HFCWO) therapy in15 patients
(11-33 years of age) with familial dysautonomia (FD) and clinically evident lung disease. A twelve
month retrospective/prospective medical chart data comparison showed improvements in all
measured outcomes including: pneumonias (p = 0.056); hospitalizations (p = 0.0156); antibiotic
courses (p = 0.0005); antibiotic days (p = 0.0002); doctor visits (p = 0.0005) and; absenteeism
(p = 0.0002).
  4. Gomez A, Acker R, Buehler C, Newman V. Successful use of high frequency chest wall oscillation in pediatric post operative spinal fusion. Presentation at the 48th International Respiratory Congress of the American Association for Respiratory Care, AARC 2002 Abstract; OF-O2-156.
    A retrospective hospital course chart review is reported for four adolescent spinal fusion patients (idiopathic scoliosis) in a pediatric intensive care unit (PICU) who received high frequency chest wall oscillation (HFCWO) 3-5 days post-operatively after failing other airway clearance interventions. Indications were atelectasis with or without pleural effusion and with or without evidence of mucus plugging. All patients had either inadequate cough secondary to post operative pain, an artificial airway for ventilatory support and/or neuromuscular disease. HFCWO was administered for 20-30 minutes every 2-4 hours. Radiographs after 4 days of HFCWO for all patients showed either complete resolution or minimal residual atelectasis.
  5. Gomez A, Elisan I, Hardy K. Utilization of high frequency chest wall oscillation (Vest therapy) during therapeutic pediatric flexible fiberoptic bronchoscopy. Poster presentation at the 46th International Respiratory Congress of the American Association for Respiratory Care, October 7, 2000, Cincinnati, Ohio, USA.
    This report of the use of high frequency chestwall oscillation (HFCWO) in three pediatric patients in conjunction with fiberoptic broncoscopy showed marked enhancement of secretion clearance in two of the three during the procedure. No safety concerns were noted.
  6. Gomez A, Elisan I, Hardy K. High frequency chest wall oscillation: video documentation of effect on a patient with Duchenne muscular dystrophy and severe scoliosis. Poster presentation at the 46th International Respiratory Congress of the American Association for Respiratory Care, October 7, 2000, Cincinnati, Ohio, USA.
    A 16 year-old Duchenne muscular dystrophy patient with severe kyphoscoliosis and deteriorating respiratory health had persistent atelectasis and mucus plugging unresponsive to both manual chest physiotherapy (CPT) and therapeutic bronchoscopy. A subsequent bronchoscopy performed while the patient received high frequency chest wall oscillation (HFCWO) therapy successfully cleared large volumes of secretions. A follow-up videotaped broncoscopy with HFCWO showed healing bronchial mucosa, minimal secretions and significant mobilization for mucus from peripheral lung regions.
  7. Overgaard PM, Radford PJ. High frequency chest wall oscillation improves outcomes in children with cerebral palsy. Chest, October 2005.
    A retrospective quality assurance review of 13 children with cerebral palsy (CP) using HFCWO for airway clearance therapy for at least 6 months (7 for 6+ months; 6 for 1+ years) showed significant aggregate reductions in hospitalizations and emergency room (ER) visits. Chart review for the year prior to HFCWO use compared prospectively with 6 or more months of HFCWO therapy documented 8 hospitalizations and 5 ER visits vs. 5 hospitalizations and 1 ER visit. Parents reported fewer respiratory illnesses, less antibiotic use, and reduced absenteeism. Treatment adherence (measured by hourly use meter) and parental satisfaction were high.
  8. Plioplys AV, Lewis S, Kasnicka I. Pulmonary vest therapy in pediatric long-term care. J Am Med Dir Assoc 2002; 3:318-321.
    In this retrospective/prospective study to evaluate the use of high frequency chest compression (HFCC)/high frequency chest wall oscillation (HFCWO) in institutionalized quadriplegic cerebral palsy (CP) patients with lung disease, 7 subjects (age range 7-28, median age 19) received HFCC/HFCWO for 12 months. All subjects had histories of frequent pulmonary infections, were fed by G-tube and were treated retrospectively with CPT; 5 had tracheostomies, 3 had active seizure disorder. Prospective data was collected and compared with 12 month retrospective data from nursing records maintained daily according to facility protocol. Improvements were shown in all outcome measures after 12 months of HFCC/HFCWO: 1) fewer pneumonias (p = 0.025); 2) fewer hospitalizations (p = 0.16) and; 3) increased effective suctioning interventions (p = 0.008). Unexpectedly, seizures fell from 267 events retrospectively to only 43 during the HFCC/HFCWO year (p = 0.125). HFCC/HFCWO was well tolerated; no complications or side effects were noted.

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