School of Physiotherapy, Australian Catholic University, North Sydney, New South Wales, Australia.
Department of Physiotherapy, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Respir Care. 2018 Dec;63(12):1520-1527. doi: 10.4187/respcare.06213. Epub 2018 Sep 25.
Cough augmentation techniques are taught by health-care providers to improve secretion clearance and to help prevent respiratory infections in children with neuromuscular disease. There is some evidence of the effectiveness of a manually assisted cough when applied by health-care providers. However, it is unknown whether parents and caregivers may also be effective in applying manually assisted cough. The aim of this study was to evaluate whether parents and caregivers are effective at applying a manually assisted cough to a child with neuromuscular disease after being taught by a health-care provider.
For this prospective cohort study, children and their parents or caregivers were recruited from neuromuscular clinics in the Sydney Children's Hospitals Network. Cough peak flow was the outcome measure for the strength of the child's cough. Children were eligible to participate if their unassisted cough peak flow at baseline was <270 L/min. Parents and caregivers were taught a manually assisted cough by a physiotherapist before being measured. The cough peak flow was measured in the following order: (1) during an unassisted cough as baseline, (2) during a manually assisted cough performed by a physiotherapist, (3) during a manually assisted cough performed by a parent or caregiver, and (4) during an unassisted cough after intervention.
Twenty-eight children (24 boys, 4 girls; mean ± SD age, 12 ± 3 y) completed the study. No clinically or statistically significant changes were found in the cough peak flow after the application of a manually assisted cough by parents or caregivers (95% CI -11 to 11 L/min) or by physiotherapists (95% CI -6 to 14 L/min).
Parents and caregivers and health-care providers were ineffective at increasing cough peak flow in children with neuromuscular weakness when applying a manually assisted cough. A single training session was insufficient for a parent or caregiver to be able to apply a manually assisted cough effectively on his or her child with neuromuscular weakness. Further research is warranted to guide recommendations on how best to equip parents and caregivers with the skills to help manage children with neuromuscular disease.
咳嗽增强技术由医疗保健提供者教授，以改善分泌物清除并帮助患有神经肌肉疾病的儿童预防呼吸道感染。有一些证据表明，医疗保健提供者实施手动辅助咳嗽是有效的。然而，尚不清楚父母和护理人员是否也能有效地实施手动辅助咳嗽。本研究旨在评估在医疗保健提供者教授后，父母和护理人员是否能有效地对神经肌肉疾病患儿实施手动辅助咳嗽。
这项前瞻性队列研究招募了来自悉尼儿童医院网络的神经肌肉诊所的儿童及其父母或护理人员。咳嗽峰流速是评估儿童咳嗽强度的结果测量指标。如果患儿在基线时的未辅助咳嗽峰流速<270 L/min，则有资格参加。在测量前，父母和护理人员由物理治疗师教授手动辅助咳嗽技术。咳嗽峰流速的测量顺序如下：（1）未辅助咳嗽时作为基线，（2）物理治疗师实施手动辅助咳嗽时，（3）父母或护理人员实施手动辅助咳嗽时，以及（4）干预后未辅助咳嗽时。
28 名儿童（24 名男孩，4 名女孩；平均±标准差年龄，12±3 岁）完成了研究。父母或护理人员实施手动辅助咳嗽（95%CI-11 至 11 L/min）或物理治疗师实施手动辅助咳嗽（95%CI-6 至 14 L/min）后，咳嗽峰流速无临床或统计学显著变化。
在对神经肌肉无力的儿童实施手动辅助咳嗽时，父母和护理人员以及医疗保健提供者均无法有效增加咳嗽峰流速。单次培训课程不足以使父母或护理人员能够有效地对其患有神经肌肉疾病的孩子实施手动辅助咳嗽。需要进一步研究来指导如何最好地为父母和护理人员提供技能，以帮助管理患有神经肌肉疾病的儿童。
