4 This is thought to allow an increase in lung volume, particularly VC, and a more forceful expiration when required, which may provide increased breath support for speech. 17 In a patient with SCI, binding of the abdomen is hypothesized to improve respiratory mechanics by mimicking the non-functioning abdominal muscles, compressing the abdominal contents to increase intra-abdominal pressure, and thus elevating the diaphragm into a more optimal position for breathing. In the uninjured person, as the diaphragm moves caudally during inspiration, it presses on the abdominal contents, which act as a fulcrum and transmit вЂappositionalвЂ™ forces laterally to expand the lower rib cage. 6 Because of the diaphragm's connection with the viscera, this results in a decrease in diaphragmatic curvature as the diaphragm is drawn inferiorly. 16 In the upright position, the abdominal contents are unsupported and migrate in an anterior and downward direction because of both gravity and increased abdominal compliance on account of denervation of the abdominal muscles. 14, 15 The mechanism of action of ABs is thought to be related to improving respiratory mechanics. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Several studies have reported that vital capacity (VC) in tetraplegic SCI is decreased to 50вЂ“80% of predicted values.

2ДЄbdominal binders (ABs) have been used to aid respiratory function in people who have suffered SCI. These impairments lead to decreased pulmonary capacity, greater retention of secretions and increased atelectasis.

1 Compromised respiratory function is caused by denervation of intercostal muscles, which limits inspiratory and expiratory ability, and loss of abdominal muscle function, which prevents an effective cough. Further studies utilizing more methodologically rigorous designs are required.Д¬omplications arising from compromised respiratory function are the major cause of morbidity and mortality in people after cervical spinal cord injury (SCI). Available evidence is not yet sufficient to either support or discourage the use of an abdominal binder in this patient population. Overall, the quality of the studies was poor. This review found some evidence that the use of an abdominal binder improves VC, but decreases FRC when assuming the sitting or tilted position in people who have suffered SCI. Meta-analysis indicated that the use of abdominal binders improved vital capacity (VC) by (weighted mean difference (95% confidence interval (CI)) 0.32 (0.09, 0.55) litres, decreased functional residual capacity (FRC) by 0.41 (0.14, 0.67) litres, but did not significantly influence total lung capacity (TLC). A PEDro mean score of 4.3 out of 8 (range: 3вЂ“6) was found. Comparison of studies involving elastic and non-elastic binders was performed. Results:Д®leven studies met the review inclusion criteria and employed either crossover or within subject designs. Further descriptive analysis was performed. The size of effect of an abdominal binder on outcomes was also calculated where sufficient data were reported. Methodological quality of studies identified was assessed using the PEDro scale. Setting:ДЄ search of multiple databases (Medline, Cinahl, Cochrane, Embase, PEDro) was undertaken accompanied by the reference list evaluation of each relevant publication identified. To review the evidence for the use of an abdominal binder on breathing, speech and cardiovascular function in people who have suffered a spinal cord injury (SCI).

Abdominal binder