Original Research

The role of physiotherapy in the respiratory management of children with neuromuscular diseases: A South African perspective

Anri Human, Lieselotte Corten, Brenda M. Morrow
South African Journal of Physiotherapy | Vol 77, No 1 | a1527 | DOI: https://doi.org/10.4102/sajp.v77i1.1527 | © 2021 Anri Human, Lieselotte Corten, Brenda M. Morrow | This work is licensed under CC Attribution 4.0
Submitted: 28 August 2020 | Published: 07 May 2021

About the author(s)

Anri Human, Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa; and, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Lieselotte Corten, Department of Physiotherapy, School of Health Sciences, University of Brighton, Eastbourne, United Kingdom
Brenda M. Morrow, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach.

Objectives: To explore South African physiotherapists’ knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD.

Methods: An online survey was conducted amongst members of the South African Society of Physiotherapy’s Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N= 481).

Results: Most respondents worked in private healthcare, with 1–10 years’ experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management.

Conclusion: Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists.

Clinical implications: There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care.


Keywords

respiratory management; neuromuscular diseases; chest physiotherapy; airway clearance techniques; children

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