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Row-a-boat phenomenon: respiratory compensation in advanced Duchenne muscular dystrophy
1Department of Internal Medicine, Suzuka National Hospital, Suzuka, Japan. f-yasuma@mtb.biglobe.ne.jp
Background:
"Row-a-boat" phenomenon (RBP) is a spontaneous upper-body movement in patients with advanced Duchenne muscular dystrophy (DMD), when sitting upright supported by a belt around the body in a wheelchair. However, the role of RBP has not been clarified.
Objectives:
To support the hypothesis that RBP is an abnormal pattern of respiration to compensate for the atrophied respiratory muscles in advanced DMD.
Patients And Methods:
Age, degree of ventilator dependency, and blood gas and spirometry values of 12 patients with spontaneous RBP were compared to those of 8 patients without RBP. All patients were men, and all exhibited a comparable level of motor function (unable to ambulate). Spirometry was undertaken with an ambulatory pneumotachograph in six patients with RBP in two conditions: sitting with RBP and sitting without RBP. In the latter condition, because a patient's shoulders, neck, and head were manually restricted, RBP was prevented.
Results:
We found that the patients with RBP were older (mean, 25.98 years vs 19.84 years), more dependent on mechanical ventilation (13.96 h/d vs 4.31 h/d), and had lower FVC and percentage of FVC (511.3 mL vs 762.5 mL and 13.37% vs 20.11%, respectively) than those without RBP. We also found that the frequency of RBP was identical with tidal breathing, and FVC was increased by 50.8% by simply allowing RBP.
Conclusion:
We conclude that RBP is a respiratory movement to compensate for the atrophied respiratory muscles in advanced DMD.
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