Enhancing Cough Capacity: The Unseen Benefits of Active-Passive Lower Limb Training in Patients with Tracheostomy ‑ A...

Challenges associated with decannulation following tracheostomy frequently arise from diminished cough efficacy. Active-passive lower limb training is a rehabilitative strategy that is commonly employed but insufficiently studied in this context. This study aimed to assess the effectiveness of active-passive lower limb training in potentially enhancing diaphragm engagement, thereby improving cough capacity in tracheostomized patients with central nervous system injuries.

A total of 36 patients were enrolled in this study and stratified into three groups (n = 12) for a 14-day intervention assessment. Utilizing a randomized crossover design combine with a control group. In intervention groups, participants were allocated to one of two intervention sequences: (1) the CA sequence, which involved an initial phase of active-passive lower limb training followed by an additional physiotherapy (PT) course; or (2) the AC sequence, which applied these interventions in the reverse order. A standard care control group (Con) was monitored for an equivalent duration. Assessments were conducted on days 1, 7, and 14. Primary and secondary outcomes included peak cough flow (PCF), Glasgow Coma Scale score, and ultrasound-derived measurements of cough-related respiratory muscle thickness.

All groups showed significantly improved PCF post-intervention (p = 0.011, 0.007, 0.007). Active-passive lower limb training led to a greater PCF increase compared to additional PT or standard care (p = 0.011). Both interventions increased parasternal intercostal muscle thickness (p < 0.05).

Active-passive lower limb training significantly improved cough capacity in tracheostomized patients with CNS injuries, being as effective as additional PT and potentially reducing staffing needs. This intervention is a promising approach to enhance cough effectiveness in tracheostomy patients.