On interpretation of the Spirometer Test on dry land and in a pool…
Ron has talked about using a spirometer for an objective tool in a pool. We have one but no norms and no clarification on expectations.
Hyperinflation decreases the resting length of the diaphragm and the length of the zone of apposition which in return causes a decrease in the pressure generated by the diaphragm, further limiting the capacity of the diaphragm to produce rib cage expansion.
After working in the pool where ZOA is maximized because of the waters pressure on the abdomen and because of the dynamic activity to reduce Left AIC patterns, the increase in rib expansion, thoracic elastic re-coil and decrease of length-tension of intercostals all allows for greater spirometric values. But, initially these values may be low because of the initial impedance of rib cage expansion.
I would check supine dry land spirometer values before a PRI aquatic program is initiated, after 1st pool session and then after their 2nd or 3rd session or weekly which ever comes first. On some patients the readings will go up immediately and others it probably will go down. The patients that have lower values initially should be put back in the pool sooner than not until values start to increase, in my opinion.
Spirometer readings (exhalation not inhalation) can be used instead of a balloon…if they can’t blow up a balloon correctly (without pinching the neck, or putting the tongue in the opening). Balloon blowing, however, is a different process from spirometric testing…because of the positive pressure on the intra-abdominal muscles and the neck for proper airway mechanics required by the balloon.
Norms, per patient, age and sex and have been developed by the manufacturers. But objective improvement can be recorded weekly, reflecting each patients elastic recoil, abdominal activity and degree of hyperinflation. On some of these patients who are way over the norm, a decrease in values would be very positive.
I would encourage to establish a spirometer goal for each patient…but especially those who are asthmatic who need more lung volume exchange and those who are off the charts and need to possibly decrease these values.
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