Purpose: Weakness of the respiratory muscles is common in older adults and can affect breathing efficiency, walking, balance, swallowing, and voice. Respiratory muscle training (RMT) including inspiratory (IMT), expiratory (EMT), and combined approaches, have advanced from simple threshold devices to newer calibrated or technology-supported devices systems that offer real-time biofeedback, progressive resistance, and remote monitoring. This narrative review examines recent developments in RMT protocols and their clinical applications in physical therapy (PT) and speech-language pathology (SLP) practice with adults age 65 years and older. Methods: Peer reviewed articles published in PubMed, Google Scholar, and ASHA journals were searched from January 2022 through June 2025 to inform a narrative synthesis. Studies were included if they focused on adults age 65 years or older, used IMT, EMT, or combined RMT within PT or SLP practice, and incorporated technology-supported devices. Results: Across the 20 peer-reviewed studies synthesized, RMT, whether delivered with traditional mechanical threshold devices or newer technology-supported systems, was associated with improvements in inspiratory and expiratory pressures, cough strength, walking distance, balance, swallowing safety, voice measures, dyspnea, and quality of life in geriatric/frail, pulmonary, neurogenic, and voice-disordered populations. Technology-supported devices offering real-time biofeedback, progressive resistance, and remote monitoring did not consistently outperform traditional threshold devices when training parameters were comparable, but were associated with high reported adherence and may particularly benefit older adults with frailty or complex medical needs who require remote supervision. Devices such as POWERbreathe®, PrO 2 Fit™, EMST150, IMT/PEP systems, the Orygen Dual Valve, Resp-in-out, The Breather, and several Internet of Things–based platforms were associated with improvements in inspiratory and expiratory pressures, cough strength, walking distance, balance, swallowing safety, voice measures, dyspnea, and overall quality of life across a range of clinical groups. Technology-assisted programs demonstrated higher adherence. However, very old and severely frail populations remain underrepresented in current research, and long-term follow-up data are limited. Conclusion: Modern RMT devices and protocols enable individualized home-based treatment programs that use feedback to help older adults achieve benefits that extend past lung function improvement to enhance their mobility, airway protection, swallowing abilities, and communication skills. RMT provides a practical method for PT and SLP professionals to work together for better patient results in this specific population.
Purpose: Chronic obstructive pulmonary disease (COPD) limits exercise capacity and quality of life, and participation in pulmonary rehabilitation (PR) is often suboptimal. Virtual reality (VR) may enhance engagement and complement rehabilitation. We synthesized the effects of immersive and nonimmersive VR on functional capacity, dyspnea, lung function, quality of life, mental health, and adherence in people with COPD. Methods: PubMed, MEDLINE, and CINAHL were searched through June 2025 for experimental VR studies in COPD. Twelve studies met inclusion criteria. Risk of bias was assessed with RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). Random-effects meta-analyses were conducted for primary outcomes, with subgroup analyses by VR type. Results: Among randomized trials, four were rated as low risk of bias, 3 moderate, and one high. Among nonrandomized studies, two were rated moderate and two as high risk of bias. Pooled analyses comparing VR interventions with conventional or PR programs did not demonstrate statistically significant differences for the six-minute walk test (standardized mean difference [ SMD ] = 0.98, 95% CI [−1.89, 3.85]), the sit-to-stand test ( SMD = 1.49, 95% CI [−0.85, 3.83]), or dyspnea ( SMD = −0.41, 95% CI [−0.88, 0.07]). Subgroup analyses suggested immersive VR reduced dyspnea more than nonimmersive approaches. Individual studies often reported improvements in lung function and quality of life, but small samples and heterogeneity limited pooling. Conclusions: Virtual reality interventions show improvements comparable with conventional rehabilitation. However, pooled analyses did not demonstrate statistically significant advantages of VR for primary outcomes, which may be constrained by small, heterogeneous studies and short interventions. Subgroup analyses suggested larger dyspnea reductions in immersive VR studies. Larger, adequately powered trials with standardized VR dosage, core outcomes, and longer follow-up are needed to clarify VR's role as an adjunct to PR in COPD.
Background and Purpose: Lung transplantation presents unique rehabilitation challenges, particularly in the acute postoperative phase where formal physical therapy guidelines are limited. Evidence supporting their use in this setting, however, remains limited. The purpose of this case report was to describe the implementation of a standardized battery of outcome measures and the physical therapy management of a medically complex patient in the acute phase after bilateral lung transplantation (LT). Case Description: A 66-year-old man with end-stage COPD underwent bilateral LT with left diaphragm plication. Postoperatively, the patient presented with significant deconditioning, impaired functional endurance, and required assistance of 2 individuals for all mobility. Intervention: Physical therapy was provided once daily, 6 days per week, progressing from early mobilization and upright tolerance to pregait activities, progressive ambulation, lower extremity strengthening, and endurance training. Outcomes: The AM-PAC 6-Clicks score improved from 11 to 23, the 6-Minute Walk Test from 23.77 to 246.58 m, the Short Physical Performance Battery from 3/12 to 10/12, and the Five Times Sit-to-Stand from 90 to 16.62 seconds. The patient was discharged home on hospital day 21 at a supervision level without an assistive device and on room air. Discussion: This case demonstrates that implementing a standardized outcome measure battery during acute inpatient LT rehabilitation is both feasible and clinically valuable. These tools facilitated data-driven decision-making, supported interdisciplinary communication, and informed discharge planning, establishing a foundational protocol for future LT rehabilitation.
Purpose: The Johnson & Johnson MedTech Impella 5.5 ® is a temporary mechanical circulatory support (tMCS) device that supports cardiac output in the setting of cardiogenic shock. Older Impella ® models provide less cardiac output and limit mobility because of femoral insertion sites. It is widely accepted that early mobility is important in the ICU setting, but there is a lack of mobility-specific guidelines for patient selection or procedural interventions with the Impella 5.5 ® . This study describes a framework that was created to aid in patient selection for mobility, discusses procedures for those who are appropriate to mobilize, and provides single-center mobility data in patients with an Impella 5.5 ® temporary ventricular assist device. Methods: Retrospective chart review was performed on all 49 patients who had an Impella 5.5 ® device between April 2023 and September 2024. Variables retrieved from electronic medical records included mobility-related data (highest level of mobility, number of mobility events, device performance level (P-level) and pressors/inotropes at time of mobility), patient data (age, gender), and device data (placement location, duration of device, and concurrent/previous devices). Statistical analysis included percentages to understand data trends and frequency of mobility. Results: Twenty-four out of 49 (49%) of patients with an Impella 5.5 ® were deemed appropriate to mobilize based on the decision-making guideline, for a total of 62 mobility events. A vast majority (98%) of mobility events occurred with physical therapy or occupational therapy, with nursing accounting for the remaining 2%. There were no adverse events noted during mobility. Conclusions: The Johnson & Johnson MedTech Impella 5.5 ® provides up to 5.5 liters per minute of cardiac output, which allows the heart to recover from cardiogenic shock. When paired with interprofessional communication and training, a decision-making algorithm can aid in safe and effective mobilization of medically complex patients with an Impella 5.5 ® mechanical assist device.
