Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients

Minkyu Kim, Kyeongbong Lee, Jieun Cho, Wanhee Lee, Minkyu Kim, Kyeongbong Lee, Jieun Cho, Wanhee Lee

Abstract

BACKGROUND The aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals. MATERIAL AND METHODS Forty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function. RESULTS In stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients. CONCLUSIONS Stroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.

Figures

Figure 1
Figure 1
Ultrasonographic view of the diaphragm over the intercostal space. (A) Rehabilitative ultrasound imaging of diaphragm thickness at end expiration, deep to the intercostal muscle layer and ribs. (B) Rehabilitative ultrasound imaging of diaphragm thickness at total lung capacity, deep to the intercostal muscle layer and ribs

References

    1. Andrews AW, Bohannon RW. Distribution of muscle strength impairments following stroke. Clin Rehabil. 2000;14:79–87.
    1. Nelles G, Spiekermann G, Jueptner M, et al. Reorganization of sensory and motor systems in hemiplegic stroke patients. A positron emission tomography study. Stroke. 1999;30:1510–16.
    1. Macko RF, Smith GV, Dobrovolny CL, et al. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil. 2001;82:879–84.
    1. Macko RF, Benvenuti F, Stanhope S, et al. Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis. J Rehabil Res Dev. 2008;45:323–28.
    1. Lieber RL, Steinman S, Barash IA, Chambers H. Structural and functional changes in spastic skeletal muscle. Muscle Nerve. 2004;29:615–27.
    1. Kraemer WJ, Adams K, Cafarelli E, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2002;34:364–80.
    1. Jandt SR, Caballero RM, Junior LA, Dias AS. Correlation between trunk control, respiratory muscle strength and spirometry in patients with stroke: An observational study. Physiother Res Int. 2011;16:218–24.
    1. Davis RT, 3rd, Bruells CS, Stabley JN, et al. Mechanical ventilation reduces rat diaphragm blood flow and impairs oxygen delivery and uptake. Crit Care Med. 2012;40:2858–66.
    1. Similowski T, Catala M, Rancurel G, Derenne JP. Impairment of central motor conduction to the diaphragm in stroke. Am J Respir Crit Care Med. 1996;154:436–41.
    1. Pinheiro MB, Polese JC, Faria CD, et al. Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds. Eur J Phys Rehabil Med. 2014;50:301–7.
    1. Romer LM, McConnell AK. Inter-test reliability for non-invasive measures of respiratory muscle function in healthy humans. Eur J Appl Physiol. 2004;91:167–76.
    1. Larson JL, Covey MK, Vitalo CA, et al. Maximal inspiratory pressure. Learning effect and test-retest reliability in patients with chronic obstructive pulmonary disease. Chest. 1993;104:448–53.
    1. Lanini B, Bianchi R, Romagnoli I, et al. Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med. 2003;168:109–13.
    1. Nachtmann A, Siebler M, Rose G, et al. Cheyne-Stokes respiration in ischemic stroke. Neurology. 1995;45:820–21.
    1. Reid WD, Samrai B. Respiratory muscle training for patients with chronic obstructive pulmonary disease. Phys Ther. 1995;75:996–1005.
    1. Fry DL, Hyatt RE. Pulmonary mechanics. A unified analysis of the relationship between pressure, volume and gasflow in the lungs of normal and diseased human subjects. Am J Med. 1960;29:672–89.
    1. Lee KB, Kim MK, Jeong JR, Lee WH. Reliability of an electronic inspiratory loading device for assessing pulmonary function in post-stroke patients. Med Sci Monit. 2016;22:191–96.
    1. Xiao Y, Luo M, Wang J, Luo H. Inspiratory muscle training for the recovery of function after stroke. Cochrane Database Syst Rev. 2012;5:CD009360.
    1. Jung KJ, Park JY, Hwang DW, et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients. Ann Rehabil Med. 2014;38:29–37.
    1. Park GY, Kim SR, Kim YW, et al. Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography. Arch Phys Med Rehabil. 2015;96:114–21.
    1. Cohen E, Mier A, Heywood P, et al. Diaphragmatic movement in hemiplegic patients measured by ultrasonography. Thorax. 1994;49:890–95.
    1. Boon AJ, Harper CJ, Ghahfarokhi LS, et al. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve. 2013;47:884–89.
    1. Wait JL, Nahormek PA, Yost WT, Rochester DP. Diaphragmatic thickness-lung volume relationship in vivo. J Appl Physiol (1985) 1989;67:1560–68.
    1. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32:719–27.
    1. Martyn JB, Moreno RH, Pare PD, Pardy RL. Measurement of inspiratory muscle performance with incremental threshold loading. Am Rev Respir Dis. 1987;135:919–23.
    1. Topeli A, Laghi F, Tobin MJ. The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD. Eur Respir J. 2001;18:53–60.
    1. Baria MR, Shahgholi L, Sorenson EJ, et al. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest. 2014;146:680–85.
    1. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med. 1997;155:1570–74.
    1. De Bruin PF, Ueki J, Bush A, Khan Y, et al. Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy. Thorax. 1997;52:472–75.
    1. Enright S, Chatham K, Ionescu AA, et al. The influence of body composition on respiratory muscle, lung function and diaphragm thickness in adults with cystic fibrosis. J Cyst Fibros. 2007;6:384–90.
    1. Hiwatani Y, Sakata M, Miwa H. Ultrasonography of the diaphragm in amyotrophic lateral sclerosis: clinical significance in assessment of respiratory functions. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14:127–31.
    1. Suga K, Tsukuda T, Awaya H, et al. Impaired respiratory mechanics in pulmonary emphysema: evaluation with dynamic breathing MRI. J Magn Reson Imaging. 1999;10:510–20.
    1. Gierada DS, Curtin JJ, Erickson SJ, et al. Diaphragmatic motion: fast gradient-recalled-echo MR imaging in healthy subjects. Radiology. 1995;194:879–84.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться