The Impact of Manual Assisted Cough Technique on Peak Cough Flow and Pulmonary Function in Patients with Incomplete Cervical Spine Injury

Abstract Background: Spinal cord injury (SCI) often results in motor and sensory impairments below the site of injury, with various causes contributing to its occurrence. Incidence rates of SCI are higher in males, and the distribution across different age groups varies. In cases of incomplete cervical spine injury, individuals may experience reduced peak cough flow (PCF) and pulmonary function. The Manually Assisted Cough (MAC) technique has been proposed as a potential intervention to address these outcomes. Objective: To assess the effectiveness of the MAC technique in improving PCF and pulmonary functions in patients with incomplete cervical spinal cord injury. Methods: In this quasi-experimental study, 30 participants with Incomplete Cervicale Spinal Cord Injury were selected through convenient sampling at the Paraplegic Center in Peshawar. The MAC technique was administered for four weeks, and PCF was measured as the primary outcome. Data analysis utilized R and SPSS, with paired t-tests and one-way ANOVA employed to assess improvements and differences in device readings before and after the intervention, respectively. Inclusion criteria encompassed PCF below 50%, ASIA scale C and D classification, and an age range of 25 to 40 years for both genders. Exclusion criteria involved upper cervical, thoracic, and lumbar spine injuries, tuberculosis, degenerative diseases, surgical cases, and complete spinal cord injury. Results: The study includes 82.1% males and 17.9% females with C4 (17.9%), C5 (25.0%), C6 (42.9%), and C7 (14.3%) injuries. The paired t tests results show significant improvement in device reading spirometer (p=0.009), peak flowmeter (p=5.554e-07), pulse oximeter (p=0.1596) after intervention with null hypothesis rejected at 95% C.I. Generalized linear regression model demonstrated spirometer readings has significant impact on improvement scores (p=4.74e-15 ***). The study also demonstrated a significant improvement in the patients with specific spinal cord injury. Conclusion: MAC technique is effective in treating pulmonary functions in patients with spinal cord injuries. Since the improvement scores were based on device readings before and after interventions, spirometer reading was observed to be significantly changed after treatment.