Effects of diaphragmatic breathing and manual diaphragm relaxation on respiratory muscle strength, chest expansion, pulmonary function, and sitting ability in children with diplegic cerebral palsy: A randomized controlled trial.

TL;DR

Adding diaphragmatic breathing exercises and manual diaphragm relaxation to standard physiotherapy improved respiratory muscle strength in children with diplegic cerebral palsy (CP), though effects on broader lung function measures were unclear.

What the Study Found

Cerebral palsy affects motor control across the body, and children with diplegic CP (weakness primarily in the legs) often have reduced respiratory muscle function alongside mobility limitations. This randomized controlled trial tested whether targeted breathing interventions could improve respiratory outcomes beyond what standard physiotherapy alone achieves.

Researchers enrolled 15 children with diplegic CP aged 5-15 years. The control group received conventional physiotherapy twice weekly for eight weeks. The intervention group received the same standard care plus additional manual diaphragm relaxation techniques and diaphragmatic breathing exercises. The researchers measured respiratory muscle strength using pressure tests (maximum inspiratory and expiratory pressure), pulmonary function via standard breathing tests, chest wall expansion, and sitting ability using the Gross Motor Functional Measurement scale.

After eight weeks, the intervention group showed statistically significant improvements in respiratory muscle strength compared to controls. Chest expansion also improved in the intervention group. On the GMFM-B sitting measure, the intervention group showed within-group improvements, though the between-group difference didn't reach statistical significance. However, standard pulmonary function test parameters (measures of air flow and volume) did not differ significantly between groups.

This pattern suggests the manual relaxation and breathing work produced measurable mechanical changes in the respiratory muscles themselves, but didn't translate to broader changes in overall lung function capacity as measured by standard clinical tests. The relatively small sample size (15 total, split between two groups) and short intervention window (eight weeks) are important limitations when interpreting strength of effect.

What This Means for You

If you're managing CP in a child or working with a pediatric physical therapist, this finding adds modest support to including breathing-focused interventions in standard care. The respiratory muscle strength improvements are notable because respiratory function affects exercise tolerance, fatigue, and postural stability. The lack of change in standard pulmonary function tests suggests these breathing exercises work differently than treatments aimed at overall lung capacity.

The study doesn't establish that these techniques replace standard physiotherapy. Rather, they appear to be a reasonable complement when incorporated into existing rehabilitation. Any implementation should be done under supervision of a qualified pediatric physical therapist, since proper technique matters for safety and effectiveness.

The evidence tier here reflects a small randomized trial with positive findings on one outcome (respiratory muscle strength) but unclear results on others (pulmonary function, functional sitting ability). Larger, longer studies would help clarify whether these benefits sustain over time and affect meaningful clinical outcomes like exercise tolerance or quality of life.

Study Details

Sources

PubMed: 41664476