Abstract
We have investigated respiratory function of 15 severely handicapped children who had retractive breathing, stridor, chest deformity, scoliosis, clubbing fingers and recurrent respiratory infections. The present study was focused on the changes of arterial oxygen saturation during sleep and awake, and various postures such as the lateral, sitting, supine and prone positions. Even in awake, 6 out of 15 patients showed severe desaturation (SaO2<90%) and other 5 showed mild desaturation (SaO2<92%). After falling asleep, most patients manifested severer desaturation due to hypoventilation or apnea. Marked change in SaO2 was observed when they changed their positions. In general, the best oxygenation was obtained in the prone and lateral positions, and the worst in the supine position. In six children with chronic lung disease, SaO2 was improved when they were laid with the sick lung downward, and five with scoliosis improved when the convexity site was placed down to the bed. The desaturation was partly explained by the upper airway obstruction, lung restriction, mismatching of ventilation and circulation, and dysfunction of respiratory center. We made various designs of positioning block supporting each of the children in his most appropriate position and obtained better oxygenation. Therefore, we would suggest that the braces should be more widely applied to severely handicapped children.
