Respiratory abdominal muscle recruitment and chest wall motion in myotonic muscular dystrophy

1 Department of Physical Medicine and Rehabilitation, 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and 3 Center for Nursing Research, University of California Davis Medical Center, Sacramento, California 95817 Abdominal muscles are selectively active in normal subjects during stress and may increase the potential energy for inspiration by reducing the end-expiratory lung volume (EELV). We hypothesized that a similar process would occur in subjects with myotonic muscular dystrophy (MMD), but would be less effective, because of to their weakness and altered chest wall mechanics. Fine-wire electromyography (EMG) of the transversus abdominis (TA), internal oblique (IO), external oblique, and rectus abdominis was recorded in 10 MMD and 10 control subjects. EMG activity, respiratory inductive plethysmography, and gastric pressure were recorded during static pressure measurement and at increasing levels of inspiratory resistance breathing. EELV was reduced and chest wall motion was synchronous only in controls. Although the TA and IO were selectively recruited in both groups, EMG activity of the MMD group was twice that of controls at the same inspiratory pressure. In MMD subjects with mildly reduced forced vital capacity, significant differences can be seen in abdominal muscle recruitment, wall motion, work of breathing, and ventilatory parameters. dynamic electromyogram; transversus abdominis; inspiratory resistance breathing; end-expiratory lung volume