- 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.