3.54 Inspiratory Resistive Exercises
Category: UWHC Clinical Policy
Effective Date: December 1, 2016
Section: Respiratory Care - Special Procedures
To improve the strength and endurance of intact inspiratory muscles of patients with spinal cord injuries (SCI) at
thoracic vertebra 10 or above, who have a vital capacity (VC) less than 60% of predicted or negative inspiratory
force (NIF) less than 60cmH
O (with a leak). Inspiratory muscles are trained by having the patient inspire at a
constant preset pressure load.
A All patients will be assessed by the Respiratory Care Practitioner (RCP).
B. Therapy will be provided in accordance with a provider’s order
C. SCI patients will have a respiratory assessment done per Respiratory Therapy (RT) Protocol.
A. Inspiratory Muscle Trainer
B. NIF Meter with leak, one-way valve, mouthpiece, spirometer, nose clips
A. Review and acknowledge the provider’s order.
B. Review patient’s chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
E. Position the patient supine with their abdominal binder removed or loosened.
F. Measure the patient’s VC/NIF and compare to predicted values.
G. Adjust the threshold device to create a pressure equal to one half of the patient's maximal NIF.
H. Instruct the patient to breathe continuously, through the threshold device for 5 minutes.
1. This should be done at a steady, slow rate.
2. Nose clips may be beneficial.
3. Re-evaluate the set threshold if the patient cannot tolerate therapy for a full 5 minutes.
4. Therapy should be done twice a day for 5 min.
I. Assess the patient throughout the procedure.
1. The patient may be allowed to take short breaks.
2. The procedure may be revised to meet a specific patient’s needs.
J. Measure the patient's VC and NIF every Monday to monitor the patient's progress and adjust the
threshold as needed at that time.
A. Inspiratory Muscle Trainer instruction pamphlets.
B. Inspiratory Resistive Exercises HFFY #4914.
C. RT Protocol for SCI Follow Up Algorithm
Approved by the Director and Medical Director of Respiratory Care.
A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].