SEED PROJECT - Breathe to Rebuild: Enhancing Inspiratory Muscle Training in Spinal Cord Injury Recovery

About the Project

Researcher name: Danielle Ferguson

Project team: Danielle Ferguson, Dr Kelly Clanchy, Dr Delena Amsters, Professor Tim Geraghty, Soo Oh, Brooke Duggan, Emilie Gollan

This project aims to increase the use of Inspiratory Muscle Training (IMT) in spinal cord injury (SCI) rehabilitation and help close the gap between research and clinical care.

Respiratory complications are a significant and costly complication of SCI and remain a leading cause of mortality in both acute and chronic tetraplegia.  IMT is a simple breathing exercise using a handheld device that strengthens the respiratory muscles by breathing in against resistance. It is safe, easy to use, and has been shown to improve lung function and quality of life for people with spinal cord injury. Clinical practice guidelines for physiotherapy recommend IMT for SCI rehabilitation, based on strong evidence from multiple studies. Regular use for 8 weeks, can significantly improve breathing strength and reduce the risk of respiratory complications, such as pneumonia.

There is minimal research examining the use of IMT in SCI from a MDT perspective, particularly with a focus on swallowing and voice outcomes. It is proposed that IMT use will be beneficial for swallowing and voice outcomes based on the relationship between voice deficits and impaired respiratory drive. IMT has been found to improve swallow function, by reducing the aspiration risk within neurological populations such as stroke and Parkinson’s disease, but limited evidence exists in SCI.

Aim and objective:

The two aims of this project are to:

• Aim 1: to support the implementation of IMT in physiotherapy practice, as there is already evidence to support its benefits in this context.
• Aim 2:  to conduct a needs identification study within speech pathology and occupational therapy space, which will inform the design of a future trial investigating how IMT can be used from an MDT approach to achieve multiple benefits.

We will deliver a number of workshops inviting physiotherapists, occupational therapists, speech pathologists and individuals with lived experience to participate to guide the two aims of this project.

Expected outcomes and impact:

The expected outcomes of this project include:

• Develop education and training material for clinicians and patients.
• Establish the prioritised implementation strategies for use within SIU physiotherapy.Co-developed protocol for a preliminary efficacy trial for IMT use within the wider MDT to examine voice related outcomes.

Project status and timeframe:

• An environmental scan will review existing resources and guidelines from various clinical sites across Australia and New Zealand.
• The project will be divided into three phases: Learn, Design, and Refine, with workshops held during each phase.

Learn: Examine current evidence and explore potential applications of IMT in SCI rehabilitation.

Design: Collaboratively identify barriers and facilitators to implementation and begin designing a feasibility trial.

Refine: Prioritise implementation strategies to enhance the sustainability of IMT use and lay the groundwork for a feasibility trial within the broader multidisciplinary team.