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Liu X, Qu Q, Deng P, Zhao Y, Liu C, Fu C, Jia J. Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function. Brain Sci 2022; 12:brainsci12070882. [PMID: 35884689 PMCID: PMC9313444 DOI: 10.3390/brainsci12070882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 12/07/2022] Open
Abstract
Background: A variety of functional disorders can be caused after stroke, among which impairment of respiratory function is a frequent and serious complication of stroke patients. The aim of this study was to examine diaphragmatic function after stroke by diaphragm ultrasonography and then to apply to explore its correlation with extremity motor function and balance function of the hemiplegia patients. Methods: This cross-sectional observational study recruited 48 hemiplegic patients after stroke and 20 matched healthy participants. The data of demographic and ultrasonographic assessment of all healthy subjects were recorded, and 45 patients successfully underwent baseline data assessment in the first 48 h following admission, including post-stroke duration, stroke type, hemiplegia side, pipeline feeding, pulmonary infection, ultrasonographic assessment for diaphragm, Fugl−Meyer Motor Function Assessment Scale (FMA Scale), and Berg Balance Scale assessment. Ultrasonographic assessment parameters included diaphragm mobility under quiet and deep breathing, diaphragm thickness at end-inspiratory and end-expiratory, and calculated thickening fraction of the diaphragm. The aim was to analyze the diaphragm function of hemiplegic patients after stroke and to explore its correlation with extremity motor function and balance function. Results: The incidence of diaphragmatic dysfunction under deep breath was 46.67% in 45 hemiplegia patients after stroke at the convalescent phase. The paralyzed hemidiaphragm had major impairments, and the mobility of the hemiplegic diaphragm was significantly reduced during deep breathing (p < 0.05). Moreover, the thickness fraction of hemiplegic side was extremely diminished when contrasted with the healthy control and non-hemiplegic side (p < 0.05). We respectively compared the diaphragm mobility under deep breath on the hemiplegic and non-hemiplegic side of patients with left and right hemiplegia and found there was no significant difference between the hemiplegic side of right and left hemiplegia (p > 0.05), but the non-hemiplegic side of right hemiplegia was significantly weaker than that of left hemiplegia patients (p < 0.05). The diaphragm mobility of stroke patients under quiet breath was positively correlated with age and FMA Scale score (R2 = 0.296, p < 0.05), and significant positive correlations were found between the diaphragm mobility under deep breath and Berg Balance Scale score (R2 = 0.11, p < 0.05), diaphragm thickness at end-inspiratory and FMA Scale score (R2 = 0.152, p < 0.05), and end-expiratory thickness and FMA Scale score (R2 = 0.204, p < 0.05). Conclusions: The mobility and thickness fraction of the hemiplegic diaphragm after stroke by diaphragm ultrasonography were significantly reduced during deep breathing. Diaphragm mobility on bilateral sides of the right hemiplegia patients were reduced during deep breathing. Moreover, the hemiplegic diaphragmatic function was positively correlated with extremity motor and balance function of the hemiplegia patients.
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Affiliation(s)
- Xiaoman Liu
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai 200031, China; (X.L.); (Q.Q.)
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai 200031, China
| | - Qingming Qu
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai 200031, China; (X.L.); (Q.Q.)
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai 200031, China
| | - Panmo Deng
- Department of Rehabilitation Medicine, Jing’an District Central Hospital of Shanghai, Shanghai 200040, China; (P.D.); (Y.Z.); (C.L.)
| | - Yuehua Zhao
- Department of Rehabilitation Medicine, Jing’an District Central Hospital of Shanghai, Shanghai 200040, China; (P.D.); (Y.Z.); (C.L.)
| | - Chenghong Liu
- Department of Rehabilitation Medicine, Jing’an District Central Hospital of Shanghai, Shanghai 200040, China; (P.D.); (Y.Z.); (C.L.)
| | - Conghui Fu
- Shanghai Jinshan Zhongren Aged Care Hospital, Shanghai 201502, China;
| | - Jie Jia
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai 200031, China; (X.L.); (Q.Q.)
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai 200031, China
- National Center for Neurological Disorders, Shanghai 200031, China
- Correspondence:
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Abstract
While the traditional lung function tests are used to assess lung capacity and pulmonary function, they cannot evaluate respiratory driving function and the integrity of the conduction pathway from the central nervous system to the respiratory motor neuron in the spinal cord and to the diaphragm. The inspiratory trigger is sent from the central nervous system through the phrenic nerve and drives the diaphragm to generate inspiratory movement. Therefore, phrenic nerve stimulation and diaphragmatic electromyography are two fundamental methods to assess respiratory function. There are several useful tools to assess respiratory motor system including electrical or magnetic phrenic nerve stimulation, diaphragmatic needle electromyography, and diaphragmatic ultrasound. By these means, physicians can assess current respiratory status in different neurological diseases that affect respiratory muscles, follow-up of the severity of respiratory impairment, help to predict the chance of successfully weaning from ventilatory support, and confirm clinical diagnoses such as diaphragmatic myoclonus. Although some of these tests require special training, applying these neurophysiological assessments in clinical practice is highly recommended.
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Affiliation(s)
- Yih-Chih Jacinta Kuo
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
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Respiratory Neurophysiology in Intensive Care Unit. J Clin Neurophysiol 2020; 37:208-210. [PMID: 32358247 DOI: 10.1097/wnp.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with intensive care unit-acquired weakness have an increased risk of prolonged mechanical ventilation, which is a risk factor for prolonged stay and mortality. The most common cause of this problem is weakness of the diaphragm, which can derive from phrenic nerve injury associated with critical neuropathy, or with the complex multiorgan failure/systemic respiratory response syndrome causing muscle fiber lesion. Two conventional neurophysiological techniques are useful to investigate the respiratory muscles, phrenic nerve conduction, and needle electromyography of the accessory respiratory muscles and diaphragm. Phrenic nerve stimulation is a standard noninvasive technique; amplitude of the motor response can be reduced because of muscle fiber inexcitability or axonal loss. Electromyography of the diaphragm is an invasive method but is safe if performed as indicated. It can reveal neurogenic or myopathic motor units. Although these neurophysiological methods have limitations in the investigation of intensive care unit patients with severe respiratory involvement, normal phrenic nerve responses should exclude marked axonal loss and indicate a better prognosis.
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Cushman D, Henrie M, Vernon Scholl L, Ludlow M, Teramoto M. Ultrasound Verification Of Safe Needle Examination Of The Rhomboid Major Muscle. Muscle Nerve 2017; 57:61-64. [DOI: 10.1002/mus.25642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 02/22/2017] [Accepted: 03/01/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel Cushman
- Division of Physical Medicine and RehabilitationUniversity of Utah590 Wakara Way, Salt Lake City Utah84108 USA
| | - Michael Henrie
- Division of Physical Medicine and RehabilitationUniversity of Utah590 Wakara Way, Salt Lake City Utah84108 USA
| | | | - Monica Ludlow
- Department of Physical TherapyUniversity of UtahSalt Lake City Utah USA
| | - Masaru Teramoto
- Division of Physical Medicine and RehabilitationUniversity of Utah590 Wakara Way, Salt Lake City Utah84108 USA
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London ZN. Safety and pain in electrodiagnostic studies. Muscle Nerve 2016; 55:149-159. [DOI: 10.1002/mus.25421] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Zachary N. London
- University of Michigan; 1324 Taubman Center, 1500 E. Medical Center Drive Ann Arbor Michigan 48109 USA
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