The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke

Ju-Hyeon Jung, Nan-Soo Kim, Ju-Hyeon Jung, Nan-Soo Kim

Abstract

[Purpose] This study aimed to investigate the correlation between the diaphragm thickness and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed using ultrasonography, and the diaphragm thickening ratio was standardized using a formula. To analyze pulmonary function, we measured the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Results] A statistically significant correlation was found between the diaphragm thickness, thickness ratio, and diaphragm excursion; and the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a relationship between respiratory function and diaphragm thickness and diaphragm excursion, especially in the paretic side of the diaphragm. Therefore, the role of the respiratory muscles of the paretic side is important in rehabilitation programs to improve the respiratory function of stroke patients.

Keywords: Diaphragm thickness; Respiratory function; Stroke.

References

    1. Menezes KK, Nascimento LR, Ada L, et al. : Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. J Physiother, 2016, 62: 138–144.
    1. Pollock RD, Rafferty GF, Moxham J, et al. : Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke, 2013, 8: 124–130.
    1. Xiao Y, Luo M, Wang J, et al. : Inspiratory muscle training for the recovery of function after stroke. Cochrane Database Syst Rev, 2012, 5: CD009360.
    1. Martín-Valero R, De La Casa Almeida M, Casuso-Holgado MJ, et al. : Systematic review of inspiratory muscle training after cerebrovascular accident. Respir Care, 2015, 60: 1652–1659.
    1. Britto RR, Rezende NR, Marinho KC, et al. : Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil, 2011, 92: 184–190.
    1. Howard RS, Rudd AG, Wolfe CD, et al. : Pathophysiological and clinical aspects of breathing after stroke. Postgrad Med J, 2001, 77: 700–702.
    1. Lanini B, Bianchi R, Romagnoli I, et al. : Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med, 2003, 168: 109–113.
    1. de Almeida IC, Clementino AC, Rocha EH, et al. : Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement. Respir Physiol Neurobiol, 2011, 178: 196–201.
    1. Kim NS, Jung JH: The effects of breathing retraining on asymmetry of diaphragm thickness in stroke patients. J Korean Soc Phys Med, 2013, 8: 263–269.
    1. Cohen E, Mier A, Heywood P, et al. : Diaphragmatic movement in hemiplegic patients measured by ultrasonography. Thorax, 1994, 49: 890–895.
    1. American Thoracic Society/European Respiratory Society: ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med, 2002, 166: 518–624.
    1. Ueki J, De Bruin PF, Pride NB: In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax, 1995, 50: 1157–1161.
    1. McCool FD, Conomos P, Benditt JO, et al. : Maximal inspiratory pressures and dimensions of the diaphragm. Am J Respir Crit Care Med, 1997, 155: 1329–1334.
    1. Sutbeyaz ST, Koseoglu F, Inan L, et al. : Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil, 2010, 24: 240–250.
    1. Jung JH, Kim NS: The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. J Phys Ther Sci, 2015, 27: 3267–3269.
    1. Jung JH, Shim JM, Kwon HY, et al. : Effects of abdominal stimulation during inspiratory muscle training on respiratory function of chronic stroke patients. J Phys Ther Sci, 2014, 26: 73–76.
    1. Enright SJ, Unnithan VB, Heward C, et al. : Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Phys Ther, 2006, 86: 345–354.
    1. Kaneko H, Yamamura K, Mori S, et al. : Ultrasonographic evaluation of the function of respiratory muscles during breathing exercises. J Phys Ther Sci, 2009, 21: 135–139.
    1. Cohen E, Mier A, Heywood P, et al. : Excursion-volume relation of the right hemidiaphragm measured by ultrasonography and respiratory airflow measurements. Thorax, 1994, 49: 885–889.
    1. Cohn D, Benditt JO, Eveloff S, et al. : Diaphragm thickening during inspiration. J Appl Physiol 1985, 1997, 83: 291–296.
    1. Miller MR, Hankinson J, Brusasco V, et al. ATS/ERS Task Force: Standardisation of spirometry. Eur Respir J, 2005, 26: 319–338.

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