Girdle/Abdominal Binder
The increase in abdominal pressure from the use of a girdle/binder is considered to position the diaphragm at a longer dome-shaped length and hence, improve inspiratory function. Abdominal binders are most commonly used in people with loss of abdominal wall strength (generally lesions above T6). Some early work (primarily level 4 studies) looking at the effects of abdominal binders on respiratory function in SCI was done prior to 1980 but was not included in this review. Studies on the effects of abdominal binders need to include positioning information as position greatly influences lung volumes in tetraplegia. In addition to being used as a respiratory intervention, abdominal binders are used as an intervention in people with postural hypotension (see the Orthostatic Hypotension module).
Author Year; Country |
Methods | Outcome |
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Cornwell et al. 2014; Australia |
Population: N=13 acute traumatic motor-complete SCI patients from ICU (12M 1F) Mean age (SD): 36.9(21.8), lesion levels C3-T1 |
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Wadsworth et al. 2012; Australia |
Population: N=14 (13M; 1F) people with motor complete, C4-T1 SCI; mean (SD) age: 32(16)yrs. |
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West et al. 2012; UK |
Population: N=13 individuals with SCI and N=8 matched AB controls. SCI group: 12M 1F; mean(SD) age: 32(8). Control group: 6M 2F; mean(SD) age: 32(8) yrs. |
1. In SCI, TB increased VC (14%), expiratory flow throughout VC (15%), IC (21%), and MEP (25%). In contrast, TB reduced residual volume (-34%) and functional residual capacity (-23%). 2. TB increased tidal and twitch transdiaphragmatic pressures (~45%). TB increased cardiac output (28%), systolic mitral annular velocity (22%), and late-diastolic mitral annular velocity (50%). |
Julia et al. 2011; Malaysia |
Population: 18M, 3F; 17 tetraplegia, 4 paraplegia; 13 complete, 8 incomplete |
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Prigent et al. 2010; France |
Population: Regular corset users: 28 males, 8 females, mean age 37, mean YPI 7 |
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Hart et al. 2005; France |
Population: 7 tetraplegia, 3 paraplegia, mean age: 35.8 yrs, age range:18-56 yrs, 3-27 months post-injury, post-traumatic SCI levels: C5-T6, ASIA A, |
Abdominal binding resulted in:
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Estenne et al. 1998; USA |
Population: 8 participants with SCI; Age range: 21-41 years; level of injury C5-C8; length of injury: 6-200 months |
Strapping the abdomen in SCI resulted in:
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McCool et al. 1986; USA |
Population: 13 tetraplegia (C4-C7), 9 able- bodied controls, all male, mean(SD) age: 29.9(11.4) yrs |
Abdominal binding in SCI resulted in:
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Discussion
Well-designed studies demonstrate that abdominal binders in people with tetraplegia significantly increase IC or VC, and decrease FRC in all positions (McCool et al. 1986; Estenne et al. 1998; Hart et al. 2005; Prigent 2010; Julia et al. 2011; West et al. 2012; Wadsworth et al. 2012). One randomized cross-over design of long term use (Wadsworth et al. 2012) showed that abdominal binding significantly improved spirometry and inspiratory muscle strength. One study examining a small sample (n=10) showed that a custom girdle reduces the sensation of respiratory effort as measured by the Borg Rating of Perceived Exertion (Hart et al. 2005). Abdominal binding can improve PEFR (Wadsworth et al. 2012; West et al. 2012; Julia et al. 2011) but its relevance to an improved cough has been questioned enhance cough (Estenne et al. 1998). Worthy of further study, the diaphragmatic pressure-time product increases after abdominal binding may represent enhanced diaphragmatic force production but it is not known if this change translates to an improved efficiency of breathing and decreased work of breathing. Interventions to increase abdominal pressure and decrease the laxity of abdominal chest wall, which in turn affects diaphragm length and position, have been used in other patient groups. Abdominal binding for people with SCI should be introduced cautiously and be rigorously assessed because of the potential for alteration of diaphragm length to result in mechanical inefficiency, increased dyspnea, and inspiratory muscle fatigue. The design of the abdominal binder may influence the impact of the abdominal binder (Julia et al. 2011). One study has shown intermediate or long-term effects of abdominal binding on people with SCI (C4-T1). Positioning and using other interventions that increase abdominal pressure in other chronic respiratory conditions improve diaphragm force production but also can induce diaphragm fatigue and have variable influence on dyspnea reduction. The clinical outcomes of abdominal binding should be carefully evaluated for each individual. Abdominal binding could potentially have positive or deleterious effects on inspiratory muscle efficiency and dyspnea in different people after SCI.
Conclusion
There is level 2 evidence (Wadsworth et al. 2012; Cornwell et al. 2014) that abdominal binding in tetraplegic individuals can improve respiratory function, and longer term use can continue to be effective.