High-Frequency Chest Wall Oscillation for Airway Clearance in Neuromuscular Dysfunction

Respiratory complications are a common consequence of neuromuscular dysfunction in inherited and acquired neuromuscular diseases (NMD) affecting motor neurons. 2 These diseases include muscular dystrophies, myotonias, spinal muscular atrophies, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Guillain Barré syndrome, and poliomyelitis. Though not an NMD, cerebral palsy (CP) is a functional neurologic disorder in which respiratory complications arise as a consequence of neuromuscular dysfunction. Neuromuscular dysfunction in CP and NMD affects swallowing and respiratory muscles. Most people with these disorders develop restrictive lung disease. Spinal deformity is also common, which results in reduced chest wall compliance. These people often require daily airway clearance therapy to prevent recurrent respiratory infections that can precipitate atelectasis and respiratory failure. Ineffective cough coupled with aspiration of food particles, saliva and other liquid as a result of dysphagia not only disrupt normal airway clearance but also impair respiratory function and precipitate lung damage, which in turn results in increased secretion production and impaired secretion clearance. Ultimately, respiratory insufficiency is a leading cause of morbidity and mortality in people with severe neuromuscular dysfunction. 2, 6, 7