Lung Boost Trainer Versus Incentive Spirometer in Post COVID-19 Hemiplegic CP Children

* 60 cerebral palsy children were randomly allocated by sealed opaque envelope in to three groups , lung boost trainer group (LBT) , Incentive spirometer group (IST), and Traditional respiratory physical therapy training group in equal numbers . * Inspiratory Muscle Training (IMT) helps to reduce the level of dyspnea and improves the pulmonary function, respiratory muscle strength and functional capacity. * Lung Boost(LBT) is a device used for respiratory muscles training. It is planned for anyone who wishes to improve the strength and endurance of respiratory muscles in an individual, including professional athletes, recreational athletes and healthy individuals. However, this device is not indicated for the people who are too weak or ill to use the device. Furthermore, the device includes screen which play an important role to motivate the child with C.P. and achieve cooperation during program to get best results. it's frequency is 5 sessions per week successive days for 4 weeks , once daily, duration for 15 to 20 minutes. Children were instructed to sit straight, holding the device at mouth level. They placed the mouthpiece deep in their mouths, closed their lips, and inhaled slowly and deeply via the mouthpiece. Therapists adjusted the resistance dial to a level that was demanding but not uncomfortable. Children were encouraged to breathe deeply and slowly, then inhale strongly via the mouthpiece. Inhale for 2-3 seconds, hold briefly, and then exhale for 2-3 seconds for 15 repetitions, followed by 15 seconds. Rest between two sets of exercises. * Incentive spirometer exercises (IST) are commonly used in combination with chest physiotherapy, which allows the patient to perform gradual deep breaths, allowing for the relaxation and opening of collapsed airways, with motivation through visual input. It is an inexpensive and easy tool used with no reported side effects; meeting the visual goal helps the children to do their best and thus fosters patient compliance. Children were taught to sit calmly for a few minutes and focus on their natural breathing. If possible, patients held the flow-type inhaler in one hand and the mouthpiece and tubing in the other; otherwise, the therapist helped with positioning. * The youngster took three to four slow, focused breaths before inserting the incentive spirometer into their mouth. They then inhaled deeply and steadily to lift the ball within the device's chamber, holding the inhalation for at least 2-3 seconds, before exhaling normally away from the mouthpiece. While TRPT, included diaphragmatic breathing, thoracic expansion, segmental breathing, and light chest mobility exercises based on the functional level of the child. Each session took about 20 minutes and was done five times a week over four weeks with supervision of the therapist. All outcomes were measured at the start and end of the therapy. Every kid whose outcome measures were recorded received the intervention based on their original allocation. Our study's findings were divided into two categories: primary outcomes (PFT), including several important variables as: forced vital capacity (FVC%), forced expiratory volume in one second (FEV1%), FEV1/FVC ratio, and secondary outcomes, which included a , the Six-Minute Walk Test Distance (6MWT), and the Short Form-36 to measure quality of life. Pulmonary function tests (PFTs) are tests that show how well your lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange. This information can help your healthcare provider diagnose and decide the treatment of certain lung disorders. It includes several important variables such as: 1. Forced vital capacity (FVC%) is the amount of air breathed out forcefully and quickly after breathing in as much as you can. 2. Forced expiratory volume (FEV1%) is the amount of air breathed out during the first, second, and third seconds of the FVC test. All patients were instructed to inhale and exhale deeply their full capacity of lung while repeating at minimum 3 times with rest between trials. 3. FEV1/ FVC ratio: Then the highest value was taken, and after the PFT data had been normalized for age, gender, and height (percent), the estimated FEV1 and FVC values were computed. * Six-minute walk test (6MWT) is a standard test to assess exercise capacity objectively and determine prognosis in many respiratory (such as COPD, idiopathic pulmonary fibrosis, and pulmonary hypertension) and non-respiratory conditions (such as heart failure) . The minimal clinically important difference for change in the 6MWT distance of adults is approximately 30 meters. The 6MWT is not designed to be used for home oxygen titration and assessment, and a separate study is recommended to assess the need and dose of supplemental oxygen. Performance of the test requires the presence of a flat, straight corridor 30 m (100 feet) in length, the ability to monitor heart rate and pulse oximetry throughout the test, and if the patient uses supplemental oxygen, to record the flow rate and type of Oxygen device. Short form 36 (SF-36) is a valid and frequently used scale to evaluate HRQoL, specific for no groups of age, disorder, and treatment, includes general health concepts, and composed of 36 questions with 8 subscales as physical function, role limitation physical, role limitation emotional, bodily pain, social function, mental health, vitality, and general health. Scores of items are encoded for each subscale and formed as a scale ranging from 0 (poorest health status) to 100 (best health status). SF-36 has two summary measures as physical component scale (PCS) and mental component scale (MCS). PCS is comprised of subscales of physical function, role physical, bodily pain, and general health, and MCS is comprised of subscales of vitality, social function, role emotional, and mental health.