1
|
Zhang YS, Zhang K, Huang L, Wei JX, Bi ZT, Xiao JH, Huang J, Luo CS, Li YD, Zhang JM. The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: a meta-analysis. Eur Rev Aging Phys Act 2024; 21:4. [PMID: 38383309 PMCID: PMC10882726 DOI: 10.1186/s11556-024-00338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke. METHODS PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI). RESULTS Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51-13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34-12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54-1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94-1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13-1.59), functional capacity (SMD = 0.51, 95%CI: 0.05-0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96-13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80-19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47-1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22-1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41-1.11), functional capacity (SMD = 0.61, 95%CI: 0.08-1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15-15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50-10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21-1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37-1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08-0.72). CONCLUSIONS This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone. TRIAL REGISTRATION Prospero registration number: CRD42021291918.
Collapse
Affiliation(s)
- Yun-Shan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - Kai Zhang
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, 310016, China
| | - Lang Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jing-Xue Wei
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zi-Ting Bi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jing-Hua Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jian Huang
- Cardiopulmonary Rehabilitation Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, China
| | - Chao-Song Luo
- Cardiopulmonary Rehabilitation Center, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, China
| | - Ying-Dong Li
- Department of Rehabilitation Medicine, The Guangxi Zhuang Autonomous Region Workers' Hospital, Nanning, 530000, China
| | - Jia-Mei Zhang
- Department of Rehabilitation Medicine, Guangxi International Zhuang Medicine Hospital, NanningNanning, 530000, China
| |
Collapse
|
2
|
Drakopanagiotakis F, Bonelis K, Steiropoulos P, Tsiptsios D, Sousanidou A, Christidi F, Gkantzios A, Serdari A, Voutidou S, Takou CM, Kokkotis C, Aggelousis N, Vadikolias K. Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training. Neurol Int 2024; 16:139-161. [PMID: 38251057 PMCID: PMC10801624 DOI: 10.3390/neurolint16010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV1, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training.
Collapse
Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Konstantinos Bonelis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (F.D.); (K.B.); (P.S.)
| | - Dimitrios Tsiptsios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Anastasia Sousanidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Foteini Christidi
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aimilios Gkantzios
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Styliani Voutidou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Chrysoula-Maria Takou
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Department of Neurology, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece; (A.S.); (F.C.); (A.G.); (S.V.); (C.-M.T.); (K.V.)
| |
Collapse
|
3
|
Lee Y, Kim Y, Kim D. Effects of Chest Mobilization and Breathing Exercises on Respiratory Function, Trunk Stability, and Endurance in Chronic Stroke Patients after Coronavirus Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2180. [PMID: 38138283 PMCID: PMC10744534 DOI: 10.3390/medicina59122180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: This study investigates the effects of chest mobilization and breathing exercises on respiratory function, trunk stability, and endurance in chronic stroke patients who have contracted coronavirus disease (COVID-19). Materials and Methods: Thirty inpatients of a tertiary hospital in South Korea, who had a history of COVID-19 and were diagnosed with stroke within the last 6 months, were randomly assigned to either chest mobilization exercise with breathing exercise (CMEBE) or conservative physical therapy with breathing exercise (CPTBE) groups. The respiratory function, trunk stability, and endurance were measured at baseline and 6 weeks after the interventions. Results: Both CMEBE and CPTBE groups showed improvements in respiratory function, trunk stability, and endurance after the intervention (p < 0.05). However, the CMEBE group showed significantly greater improvements in forced expiratory volume in 1 s (p < 0.05), trunk stability (p < 0.05), and endurance (p < 0.05) than the CPTBE group. No significant intergroup difference was observed in forced vital capacity and peak expiratory flow. Conclusions: The combination of chest mobilization and breathing exercises improved respiratory muscle mobility and endurance, stabilized the trunk, and enhanced balance and the transfer of weight. The findings suggest that this intervention could be beneficial in improving respiratory function and endurance in stroke patients.
Collapse
Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Gyeongbuk College, 77 Daehang-ro, Yeongju-si 36133, Republic of Korea;
| | - Yoorim Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
| | - Donghoon Kim
- Department of Physical Therapy, Gimcheon University, 214 Daehak-ro, Gimcheon 39528, Republic of Korea
| |
Collapse
|
4
|
Lista-Paz A, Kuisma R, Canosa JLS, Sebio García R, González Doniz L. Pulmonary function in patients with chronic stroke compared with a control group of healthy people matched by age and sex. Physiother Theory Pract 2023; 39:918-926. [PMID: 35098873 DOI: 10.1080/09593985.2022.2031363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Effects of chronic stroke on pulmonary function are largely unknown. AIM To compare lung volumes in people with chronic stroke with a control group of healthy people matched by age and sex, as well as to investigate the relationship between the lung volumes and functional capacity. METHODS A cross-sectional study involving people with chronic stroke. Cases were matched to a control group of healthy people. Lung function and the distance walked during the Six-Minute Walk Test (6MWD) were the main outcomes. Independent t-tests were used to compare pulmonary function between groups and the Pearson correlation coefficient was used to assess any relationship between lung volumes and the 6MWD in the stroke group. RESULTS Sixty-six participants (24 males in each group; 56.5 ± 15.5 years) were included. People with stroke presented significantly lower lung volumes when compared to the control group. The median of forced vital capacity (FVC) was 79% and peak expiratory flow was 64% of the reference value. The 6MWD was found to be weakly correlated with inspiratory reserve volume (r = 0.39, p = .03) and peak inspiratory flow (r = 0.35, p = .05). CONCLUSIONS People with chronic stroke show decreased lung volumes when compared with healthy people and this likely impacts on their functional capacity.
Collapse
Affiliation(s)
- Ana Lista-Paz
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
| | - Raija Kuisma
- Karelia University of Applied Sciences. Tikkarinne, Joensuu, Finland
| | - Jesús L Saleta Canosa
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Department of Preventive Medicine, Complejo Hospitalario Universitario de A Coruña. As Xubias, A Coruña, Spain
| | - Raquel Sebio García
- Department of Rehabilitation. Hospital Clinic de Barcelona. Barcelona, Spain Casanova bis Barcelona, Spain
- Research Group in Attention to Chronicity and Innovation in Health (GRACIS). School of Health Sciences TecnoCampus - University Pompeu Fabra. Avinguda Ernest Lluch, Mataró, Spain
| | - Luz González Doniz
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
| |
Collapse
|
5
|
Park HY, Hwang UJ, Kwon OY. Correlation between trunk rotation and lateral flexion range of motion, peak cough flow, and chest expansion in stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1970. [PMID: 35962597 DOI: 10.1002/pri.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Stroke patients have problems with voluntary movement and trunk control. Moreover, the respiratory function in stroke patients is affected by neurological impairment, which increases the incidence of respiratory complications. OBJECTIVES To determine the correlation between trunk rotation range of motion (TRROM) and trunk lateral flexion range of motion (TLFROM), peak cough flow (PCF), and chest expansion in stroke patients. METHODS This was an observational study involving 21 patients with a clinical diagnosis of stroke from October 2021 to January 2022. TRROM and TLFROM were assessed using smartphone applications (Compass and Clinometer), respectively, PCF was assessed using a peak flow meter, and chest expansion was assessed using a tape measure. Pearson's correlation was used to analyze the relationships between the variables. RESULTS Statistically significant correlations were found between TRROM and TLFROM (r = 0.91, p < 0.01) and between upper chest expansion and PCF (r = 0.59, p < 0.01). There were significant correlations between lower chest expansion and TRROM (r = 0.50, p < 0.05) and between lower chest expansion and TLFROM (r = 0.51, p < 0.05). CONCLUSION This study demonstrates the relationship between upper chest expansion and PCF. Upper chest expansion exercises should be considered to improve the PCF in stroke patients. In addition, a very strong positive correlation between TRROM and TLFROM was demonstrated. TRROM and TLFROM exercises should be considered to improve the lower chest expansion in stroke patients.
Collapse
Affiliation(s)
- Hee-Yong Park
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
| |
Collapse
|
6
|
Chen Y, Zhou S, Liao L, He J, Tang D, Wu W, Wang K. Diaphragmatic ultrasound can help evaluate pulmonary dysfunction in patients with stroke. Front Neurol 2023; 14:1061003. [PMID: 37144002 PMCID: PMC10151578 DOI: 10.3389/fneur.2023.1061003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
Objective Pulmonary dysfunction after stroke is increasingly gaining attention from clinical and rehabilitation specialists. However, owing to cognitive and motor dysfunction in patients with stroke, determining the pulmonary function of these patients remains challenging. The present study aimed to devise a simple method for an early evaluation of pulmonary dysfunction in patients with stroke. Methods Overall, 41 patients with stroke in the recovery period (stroke group) and 22 matched healthy controls (control group) were included in the study. We first collected data regarding baseline characteristics for all participants. Furthermore, the participants with stroke were examined using additional scales, such as the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment scale (FMA), and modified Barthel Index (MBI). Subsequently, we examined the participants with simple pulmonary function detection and diaphragm ultrasound (B-mode). Ultrasound indices calculated were as follows: the thickness of the diaphragm under the position of functional residual capacity (TdiFRC), the thickness of the diaphragm under the position of forced vital capacity (TdiFVC), thickness fraction, and diaphragmatic mobility. Finally, we compared and analyzed all data to identify group differences, the correlation between pulmonary function and diaphragmatic ultrasound indices, and the correlation between pulmonary function and assessment scale scores in patients with stroke, respectively. Results Compared with the control group, patients in the stroke group exhibited lower values for indices of pulmonary and diaphragmatic function (p < 0.001), except for TdiFRC (p > 0.05). The majority of the patients with stroke had restrictive ventilatory dysfunction, as indicated by a significantly higher incidence ratio (36 in 41 patients) than that in the control group (0 in 22 patients) (p < 0.001). Moreover, significant correlations were found between pulmonary function and diaphragmatic ultrasound indices (p < 0.05), with the strongest correlation between TdiFVC and pulmonary indices. In the stroke group, pulmonary function indices were negatively correlated with the NIHSS scores (p < 0.001) and positively correlated with the FMA scores (p < 0.001). No (p > 0.05) or weak (p < 0.05) correlation was found between pulmonary function indices and the MBI scores. Conclusion We found that patients with stroke had pulmonary dysfunction even in the recovery period. Diaphragmatic ultrasound can be used as a simple and effective tool for detecting pulmonary dysfunction in patients with stroke, with TdiFVC being the most effective index.
Collapse
|
7
|
Fuzari HKB, de Andrade AD, Barcelar JDM, Sarmento A, Bernardino SN, de Souza FHM, de Oliveira DA. Ventilation asymmetry, diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury. J Hand Ther 2022; 35:308-316. [PMID: 35491300 DOI: 10.1016/j.jht.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/12/2022] [Accepted: 03/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed. PARTICIPANTS The cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied. MAIN OUTCOME Compartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device. RESULTS TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p < .001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p < .05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles. CONCLUSION Compared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.
Collapse
Affiliation(s)
- Helen Kerlen Bastos Fuzari
- Neuropsychiatry and Behavioral Sciences Program (POSNEURO), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil.
| | | | | | - Antônio Sarmento
- Physiotherapy Department, Universidade Federal de Pernambuco (UFRN), Natal, RN, Brasil
| | | | | | | |
Collapse
|
8
|
Kang ES, Yook JS, Ha MS. Breathing Exercises for Improving Cognitive Function in Patients with Stroke. J Clin Med 2022; 11:jcm11102888. [PMID: 35629013 PMCID: PMC9144753 DOI: 10.3390/jcm11102888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with stroke may experience a certain degree of cognitive decline during the period of recovery, and a considerable number of such patients have been reported to show permanent cognitive damage. Therefore, the period of recovery and rehabilitation following stroke is critical for rapid cognitive functional improvements. As dysfunctional breathing has been reported as one of the factors affecting the quality of life post stroke, a number of studies have focused on the need for improving the breathing function in these patients. Numerous breathing exercises have been reported to enhance the respiratory, pulmonary, cognitive, and psychological functions. However, scientific evidence on the underlying mechanisms by which these exercises improve cognitive function is scattered at best. Therefore, it has been difficult to establish a protocol of breathing exercises for patients with stroke. In this review, we summarize the psychological, vascular, sleep-related, and biochemical factors influencing cognition in patients and highlight the need for breathing exercises based on existing studies. Breathing exercises are expected to contribute to improvements in cognitive function in stroke based on a diverse array of supporting evidence. With relevant follow-up studies, a protocol of breathing exercises can be developed for improving the cognitive function in patients with stroke.
Collapse
Affiliation(s)
- Eui-Soo Kang
- Department of Sports Science Convergence-Graduate School, Dongguk University-Seoul, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Korea;
| | - Jang Soo Yook
- Center for Functional Connectomics, Brain Research Institute, Korea Institute of Science and Technology (KIST), Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Korea;
| | - Min-Seong Ha
- Department of Sports Culture, College of the Arts, Dongguk University-Seoul, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Korea
- Correspondence: ; Tel.: +82-2-2290-1926
| |
Collapse
|
9
|
Kasemsap N, Jeerasuwannakul W, Tiamkao S, Vorasoot N, Kongbunkiat K, Chotmongkol V, Sawanyawisuth K, Panitchote A. Propensity Score Analysis of the Association between Chronic Obstructive Lung Disease and Stroke Outcome: Thailand’s National Database. Cerebrovasc Dis 2022; 51:577-584. [DOI: 10.1159/000521767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The impact of coexisting chronic obstructive lung disease (COPD) in patients with stroke remains unclear. This study aims to investigate the effect of COPD on survival and hospital outcomes among stroke patients. <b><i>Methods:</i></b> The outcomes of patients with stroke between fiscal years 2005 and 2017 from Thailand’s Universal Coverage Scheme database were compared between COPD and non-COPD patients using propensity score matching and flexible parametric survival model. <b><i>Results:</i></b> A total of 805,561 patients were admitted with stroke during the study period, 12,650 (1.92%) of whom had been diagnosed with COPD. Participants with COPD were significantly older, were more likely to be male, and had higher prevalences of pre-existing atrial fibrillation, ischemic heart disease, and heart failure and a higher incidence of ischemic stroke (<i>p</i> < 0.001). The propensity score-matched groups were well balanced in terms of all observed covariates. Participants with COPD had higher incidences of pneumonia (odds ratio [OR] 1.98, 95% confidence interval [CI]: 1.83–2.15), urinary tract infection (OR 1.27, 95% CI: 1.14–1.42), sepsis (OR 1.50, 95% CI: 1.32–1.70), cardiac arrest (OR 1.50, 95% CI: 1.19–1.88), respiratory failure (OR 1.82, 95% CI: 1.69–1.96), acute kidney injury (OR 1.29, 95% CI: 1.14–1.46), and in-hospital death (OR 1.21, 95% CI: 1.13–1.30) than those without. The impact of COPD on mortality was highest at day 93 (hazard ratio [HR] 1.73, 95% CI: 1.60–1.87) and nonsignificant at day 965 of follow-up (HR 1.08, 95% CI: 1.00–1.16). <b><i>Conclusions:</i></b> COPD was associated with respiratory, cardiac, renal, and infectious complications and significantly impacted survival for up to 2.6 years.
Collapse
|
10
|
Arumairaj AJ, Agarwal S, Borkar R, Park H, Habtes I. Hemidiaphragmatic Paralysis Post Stroke Leading to Hypercapneic Respiratory Failure. Cureus 2021; 13:e13141. [PMID: 33728155 PMCID: PMC7935294 DOI: 10.7759/cureus.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unilateral diaphragmatic paralysis is a rare complication after stroke. We report a case of right-sided hemidiaphragmatic paralysis after stroke in a 51-year-old man who presented with shortness of breath and orthopnea. Chest X-ray (CXR) revealed an elevated right-sided hemidiaphragm. The weakened diaphragmatic contraction from paralyzed right hemidiaphragm resulted in persistent atelectasis of the right lung base and inadequate alveolar ventilation leading to the development of right basal pneumonia with hypercapneic respiratory failure. However, the patient had a remarkable improvement with the appropriate institution of non-invasive ventilation and medical management with intravenous antibiotics.
Collapse
Affiliation(s)
| | - Sanket Agarwal
- Internal Medicine, Metropolitan Hospital Center, New York, USA
| | - Rachana Borkar
- Internal Medicine, Metropolitan Hospital Center, New York, USA
| | - Hansang Park
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Imnett Habtes
- Pulmonary and Critical Care Medicine, Metropolitan Hospital Center, New York, USA
| |
Collapse
|
11
|
Chuchalin AG, Gusev EI, Martynov MY, Kim TG, Shogenova LV. [Pulmonary insufficiency in acute stroke: risk factors and mechanisms of development]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-16. [PMID: 32790970 DOI: 10.17116/jnevro20201200717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Various degrees of pulmonary insufficiency (PI) (PaO2 ≤60 mm Hg, SaO2 ≤90%) are diagnosed in most of patients with severe acute stroke (AS). Frequency and severity of PI positively correlates with the severity of AS. PI worsens patient's condition, prolongs the hospitalization period, and increases the probability of fatal outcome. Early clinical signs of PI may be undiagnosed due to the severity of stroke and thus not treated. The initiating pathogenic mechanism of PI is stress-related activation of sympathetic nervous system (SNS) and systemic immunosuppression. In severe stroke with mass effect, the rapid and significant increase in intracranial pressure may additionally activate the SNS. Risk factors of PI include older age, previous pulmonary disease, prolonged supine position, respiratory muscle dysfunction, apnea, and concomitant somatic diseases. Decompensation of somatic diseases leads to multiple stage reactions with facilitation of functional and morphologic changes in the pulmonary system, hypoxemia and hypoxia, promotes infectious complications and multiple organ failure and worsens neurological outcome. Diagnosis and treatment of PI in AS decreases mortality and improves rehabilitation prognosis.
Collapse
Affiliation(s)
- A G Chuchalin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - T G Kim
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Shogenova
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
12
|
Zheng Y, Zhang Y, Li H, Qiao L, Fu W, Yu L, Li G, Yang J, Ni W, Yong Z, Wang Y, Fan H. Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:423-430. [PMID: 32795561 DOI: 10.1016/j.apmr.2020.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To compare the effects of Liuzijue Qigong and conventional respiratory training on trunk control ability and respiratory muscle functions in patients at an early recovery stage from stroke. DESIGN A single-blind, randomized controlled trial. SETTING A hospital. PARTICIPANTS Patients (N=60) within 2 months poststroke. INTERVENTIONS The experimental group (n=30) received conventional rehabilitation training combined with Liuzijue exercise, and the control group (n=30) received conventional rehabilitation training combined with conventional respiration training. The training in the 2 groups was conducted 5 times per week for 3 weeks. MAIN OUTCOME MEASURES Trunk Impairment Scale (TIS), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum expiratory mid-flow (MMEF), diaphragmatic movement, the change of intra-abdominal pressure (IAP), Berg Balance Scale (BBS), and Modified Barthel Index (MBI). All outcome measures were assessed twice (at baseline and 3 weeks). RESULTS Both groups significantly improved in TIS, MIP, FVC, PEF, and the change of IAP, BBS, and MBI when pre- and postassessments (P<.05) were compared. Compared with the control group, there was a significant difference in the experimental group in the static sitting balance subscale (P=.014), dynamic balance subscale (P=.001), coordination subscale (P<.001), TIS total scores (P<.001; effect size [ES]=0.9), MIP (P=.012; 95% confidence interval [CI], 2.23-17.69; ES=0.67), MEP (P=.015; 95% CI, 1.85-16.57; ES=0.65), change of IAP (P=.001), and MBI (P=.016; 95% CI, 1.51-14.16; ES=0.64). No significant differences were found between the 2 groups in FEV1 (P=.24), FVC (P=.43), PEF (P=.202), MMEF (P=.277), the diaphragmatic movement of quiet breathing (P=.146), deep breathing (P=.102), and BBS (P=.124). CONCLUSIONS Liuzijue exercise showed more changes than conventional respiratory training in improving trunk control ability, respiratory muscle functions, and activities of daily living ability in patients at an early recovery stage from stroke.
Collapse
Affiliation(s)
- Yanan Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China; School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China.
| | - Hongli Li
- Shanghai Shenyuan Rehabilitation Hospital, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianzhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Zhijie Yong
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hang Fan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| |
Collapse
|
13
|
Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155356. [PMID: 32722338 PMCID: PMC7432552 DOI: 10.3390/ijerph17155356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023]
Abstract
Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. Study selection and data extraction: randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. Results: nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. Conclusions: RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.
Collapse
|
14
|
Cho SH, Choi KB. Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients. Healthcare (Basel) 2020; 8:E222. [PMID: 32707960 PMCID: PMC7551892 DOI: 10.3390/healthcare8030222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Evaluation of stroke patients is prioritized over therapeutic interventions to restore cardiorespiratory capacity. This study aimed to develop a clinically applicable guideline to evaluate cardiorespiratory physiotherapy in stroke patients based on a literature review and a modified Delphi survey. The literature search included 13,498 articles in PubMed, EMBASE, CINAHL, and Cochrane Library electronic databases. We surveyed previous articles between January 2010 and June 2019. After the option elimination process, a total of 27 documents were selected and analyzed (draft: 18, modified Delphi survey: 9). The results of this research are roughly divided into two categories. First, 31 draft items were extracted, and a modified Delphi survey questionnaire was created from a literature review. Second, an expert was asked to make two modified Delphi surveys and to modify, delete, and supplement the entries in the statistical analysis at each level to finalize the steps to 20 items. The guidelines developed in this study reflect the selective use of cardiorespiratory physiotherapy evaluation methods in the clinical setting, based on the health status of individual patients. Moreover, the guidelines may help physiotherapists make informed decisions based on expert knowledge, thereby playing a crucial role in the patient-centered treatment planning process.
Collapse
Affiliation(s)
- Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, 23 Cheomdanjungang-ro, Gwangsan-gu, Gwangju 62271, Korea;
| | - Ki-Bok Choi
- Team of Rehabilitation Treatment, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| |
Collapse
|
15
|
Shetty N, Samuel SR, Alaparthi GK, Amaravadi SK, Joshua AM, Pai S. Comparison of Diaphragmatic Breathing Exercises, Volume, and Flow-Oriented Incentive Spirometry on Respiratory Function in Stroke Subjects: A Non-randomized Study. Ann Neurosci 2020; 27:232-241. [PMID: 34556964 PMCID: PMC8454997 DOI: 10.1177/0972753121990193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Abstract. BACKGROUND Reduced respiratory muscle strength leads to reduced pulmonary function, chest wall movements in the affected side, and increased chest infections, which thereby reduces oxygenation and ventilation. Respiratory muscle training can be used in acute stroke subjects to increase their pulmonary function. PURPOSE To compare the short-term effects of diaphragmatic breathing exercise, flow, and volume-oriented incentive spirometry on respiratory function following stroke. METHODS A non-randomized hospital-based study was conducted at Kasturba Medical College Hospitals, Mangalore, India. Forty-two sub-acute subjects of either gender, with the first episode of stroke within six months, were assigned to three groups by the consultant, i.e., diaphragmatic breathing group (DBE), Flow oriented-incentive spirometry group (FIS), and volume oriented-incentive spirometry group (VIS; N = 14) each. All subjects received intervention thrice daily, along with conventional stroke rehabilitation protocols throughout the study period. Pre- and post-intervention values were taken on alternate days until day 5 for all the three groups. RESULTS The pulmonary function and maximal respiratory pressures were found to be significantly increased by the end of intervention in all three groups, but FIS and DBE groups had better results than VIS (FVC = FIS group, 13.71%; VIS group, 14.89%; DBE group, 21.27%, FEV1 = FIS group, 25.97%; VIS group, 22.52%; DBE group, 19.38%, PEFR = FIS group, 38.76%; VIS group,9.75%; DBE group, 33.16%, MIP = FIS group, 28.23%; VIS group, 19.36%; DBE group, 52.14%, MEP = FIS group, 43.00%; VIS group, 22.80%; DBE group, 28.68%). CONCLUSION Even though all interventions had positive outcomes in all variables, flow incentive spirometry had better results across all outcomes (pulmonary function and maximal respiratory pressures) when compared to the other two interventions making it a valuable tool for stroke rehabilitation.
Collapse
Affiliation(s)
- Natasha Shetty
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sampath Kumar Amaravadi
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| |
Collapse
|
16
|
Yoon SY, Moon HI, Kim JS, Yi TI, Park YG. Comparison Between M-Mode Ultrasonography and Fluoroscopy for Diaphragm Excursion Measurement in Patients With Acquired Brain Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:535-542. [PMID: 31512782 DOI: 10.1002/jum.15130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patients with acquired brain injury show decreased pulmonary function and diaphragm excursion (DE), which can affect functional outcomes. This study aimed to compare ultrasonography (US) and fluoroscopy for DE assessment and to determine how the relationship between pulmonary function test results and DE differs according to the paralytic condition. METHODS From September 2017 to April 2018, we prospectively enrolled patients with acquired brain injury. The patients underwent a pulmonary function test, including the functional vital capacity, forced expiratory volume at 1 second, forced expiratory volume at 1 second-to-functional vital capacity ratio, peak cough flow, and respiratory muscle strength such as the maximal inspiratory pressure and maximal expiratory pressure. Diaphragm excursion was measured with M-mode US and fluoroscopy on admission. A partial correlation analysis was used to assess the correlation between US and fluoroscopy for DE assessment. RESULTS During the study period, 50 patients with acquired brain injury were enrolled. After adjusting for age, sex, height, and weight, the correlation coefficients between US and fluoroscopy were 0.744 for the right side (P < .001) and 0.631 for the left side (P < .001). In a subgroup analysis for patients with hemiplegia, the correlation coefficients were 0.507 for the paretic side (P = .007) and 0.677 for the nonparetic side (P < .001). Diaphragm excursion in the nonparetic side was significantly correlated with the maximal inspiratory pressure, maximal expiratory pressure, and peak cough flow (P < .05). CONCLUSIONS M-mode US can be an alternative method for DE measurement in patients with impaired locomotion function after acquired brain injury. Preserved function of the nonparetic side might affect pulmonary function after brain injury, which suggests the importance of prestroke respiratory function.
Collapse
Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Joo-Sup Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Valenza MC, Prados-Román E, Granados-Santiago M, Torres-Sanchez I, Lopez-Lopez L, Cabrera-Martos I. Respiratory repercussions of neurological diseases and how best to manage them. Expert Rev Respir Med 2019; 14:89-102. [PMID: 31679407 DOI: 10.1080/17476348.2020.1689124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The high incidence of respiratory impairments in patients with neurological diseases is recognized, but the design, dosage, and effectiveness of interventions to manage them are seen as an ongoing challenge.Areas covered: This article summarizes the evidence regarding the respiratory impairments in major neurological diseases, and how to best manage them.Expert opinion: On the balance of available evidence, respiratory impairments are part of the clinical profile of neurological diseases including Multiple Sclerosis, Stroke, and Parkinson's Disease, acquiring more importance as the pathologies progress. It is recognized that knowledge gaps remain in some areas of relevance related to respiratory function and further research is required. When considering the therapeutic options, the respiratory training emerges as the approach with most evidence. However, important questions remain unsolved: what kind, how much, and how to best include respiratory interventions is uncertain. At present, respiratory programs also fail to include clinically relevant factors such as ambulation and trunk stability.
Collapse
Affiliation(s)
- Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Irene Torres-Sanchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura Lopez-Lopez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| |
Collapse
|
18
|
Alqahtani AS, Alajam R, Eickmeyer SM, Vardey R, Liu W. Feasibility and trend of pulmonary function in a pilot trial of aerobic walking exercise in non-ambulatory stroke survivors. Top Stroke Rehabil 2019; 27:190-198. [PMID: 31622173 DOI: 10.1080/10749357.2019.1673590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Lung function is compromised in stroke survivors, which may cause fatigue and exercise intolerance. Furthermore, past studies of aerobic exercise have involved only stroke survivors who could walk independently. Stroke survivors who were unable to walk were not included in the previous research-investigating changes in lung function from walking exercise interventions. In this pilot study, the feasibility and the effect of aerobic walking exercise on lung function was examined in non-ambulatory stroke survivors using a treadmill, bodyweight support system, and a gait training device.Methods: This study was a single group trial. Eight non-ambulatory stroke survivors (five males, mean age 63.3 ± 13.7 years, seven with ischemic stroke) completed a low intensity walking exercise program (30 min/session; three sessions/week for 8 weeks) and lung function test. Before and after the intervention, vital capacity (VC) and forced vital capacity (FVC) using a spirometer were measured according to the guideline from American Thoracic Society/European Respiratory Society.Results: The rates of compliance and attrition were 100% and 10%; respectively, and no adverse events were reported. There were significant differences between pre- and post-intervention assessments in FVC (p = .09), percentage of predicted VC (p = .08), and percentage of predicted FVC (p = .08).Conclusions: In non-ambulatory stroke survivors, aerobic walking exercise is feasible and safe. Also, the results are promising and suggest that aerobic walking exercise may improve lung function; more data are needed.
Collapse
Affiliation(s)
- Abdulfattah S Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ramzi Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA.,Department of Physical Therapy, Jazan University, Gazan, Saudi Arabia
| | - Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Rakesh Vardey
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MO, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MO, USA
| |
Collapse
|
19
|
Ptaszkowska L, Ptaszkowski K, Halski T, Taradaj J, Dymarek R, Paprocka-Borowicz M. Immediate effects of the respiratory stimulation on ventilation parameters in ischemic stroke survivors: A randomized interventional study (CONSORT). Medicine (Baltimore) 2019; 98:e17128. [PMID: 31567951 PMCID: PMC6756618 DOI: 10.1097/md.0000000000017128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-stroke brain damage, which affects the central control of respiration, leads to various respiratory disorders. They can be caused by the weakening of the respiratory muscles and chest movements, which can indirectly contribute to an impairment of the ventilation function. The aim of the study is an objective assessment of the effect of a single-session intervention of respiratory stimulation through Proprioceptive Neuromuscular Facilitation (PNF) on chosen respiratory parameters and the following comparison of these changes with a group in which positioning was used (intra- and intergroup comparison). METHODS This was a randomized interventional study evaluating the respiratory parameters depending on the applied respiratory stimulation in patients after ischemic stroke. The patients qualified to participate in the study were randomly assigned to 1 of 2 groups: PNF-treated group - in which respiratory stimulation through PNF was used, PNF untreated group - in which positioning was used. The research procedure consisted of several stages. First, an interview was conducted with each participant and basic data was collected. Then, spirometry was conducted, after which each patient underwent a single-session intervention according to their assigned group. Finally, the patients were given another spirometry examination. The main outcomes will be to compare the results of a spirometry test (FVC, FEV1, FEV1/ FVC%, PEF) before and after single-session intervention and between groups. RESULTS Based on the inclusion and exclusion criteria for the study, 60 patients took part in the measurement. The values of FEV1/FVC% were higher in PNF-treated group than in PNF-untreated group, if the post-intervention measures (P = .04) are considered. The difference between the pre- and post-intervention results of the FEV1/FVC% values in PNF-untreated group was substantially lower than in PNF-treated group (P = .001). CONCLUSION A single application of respiratory stimulation through PNF positively affect air flow in the respiratory tract. Application of PNF stimulation contributed to an increase in the FEV1/FVC% parameter. However, no positive changes were noted in the other parameters, which would provide proof of the beneficial effect of facilitation on the respiratory system function.
Collapse
Affiliation(s)
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw
| | - Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Katowice, Poland
- College of Rehabilitation Sciences, University of Manitoba,Winnipeg, Canada
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
20
|
Diaphragm ultrasonography and pulmonary function tests in patients with spinal cord injury. Spinal Cord 2019; 57:679-683. [PMID: 30967603 DOI: 10.1038/s41393-019-0275-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To investigate the role of ultrasonographic measurement of the diaphragm thickness on pulmonary function tests in patients with spinal cord injury (SCI). SETTING Rehabilitation center in Ankara, Turkey. METHODS A total of 42 patients (34 M, 8 F) with SCI and 20 able-bodied volunteers (8 M, 12 F) were enrolled. Patients with SCI were divided into three groups according to their neurological (injury) levels. All participants underwent ultrasonographic measurements for diaphragm thickness on both sides and spirometric tests for pulmonary functions. The thickness ratio of the diaphragm was also calculated. RESULTS There were seven patients (5 M, 2 F) in C2-C4 injury group, 14 patients (12 M, 2 F) in C5-T5 group, 21 patients (14 M, 7 F) in T6-L2 group, and 20 able-bodied volunteers (8 M, 12 F). The diaphragms of C2-C4 group were thicker than those of the controls at end-inspirium on the right side (2.7 ± 0.7 mm vs. 2.0 ± 0.5 mm; p = 0.035). The thickness ratios of C2-C4 group were lower than those of controls on the right (0.8 ± 0.4 vs. 1.5 ± 0.5; p = 0.005) and left (0.8 ± 0.5 vs. 1.6 ± 0.7; p = 0.003) sides. For all the pulmonary function tests (except for FEV1/FVC); patients with SCI had worse results than controls; and among the SCI groups, the higher the injury level, the worse the results. CONCLUSION Although patients with high-level SCI had worse pulmonary function tests and decreased the contractile capacity of the diaphragm, they had thicker diaphragm muscles than controls. This may have been due to the compensatory effect of the diaphragm (performing its maximum contraction capacity and increasing frequency of inspiration).
Collapse
|
21
|
Park SH, Lee MM. Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial. Med Sci Monit 2019; 25:1740-1748. [PMID: 30842392 PMCID: PMC6417147 DOI: 10.12659/msm.913036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability. Material/Methods Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison. Results The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group. Conclusions Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.
Collapse
Affiliation(s)
- Sam-Ho Park
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon, South Korea
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon, South Korea
| |
Collapse
|
22
|
Slupska L, Halski T, Żytkiewicz M, Ptaszkowski K, Dymarek R, Taradaj J, Paprocka-Borowicz M. Proprioceptive Neuromuscular Facilitation for Accessory Respiratory Muscles Training in Patients After Ischemic Stroke. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1160:81-91. [PMID: 30680643 DOI: 10.1007/5584_2018_325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study focused on how pulmonary function is affected by proprioceptive neuromuscular facilitation (PNF) of accessory respiratory muscles in the chronic post-stroke phase. The study involved patients who had had ischemic stroke 6 months or more before the PNF treatment investigated. The objective was to define the effect of PNF on bioelectrical resting and maximum activity of the accessory muscles. Patients were randomly assigned to PNF treatment and just positioning treatment as a reference for comparison; 30 patients each. Electromyography of accessory muscles was investigated before and after physiotherapeutic treatments. We found that there was a greater reduction in EMG activity in all muscles investigated after PNF compared to positioning treatment alone. A reduction of muscle activity due to PNF concerned both affected and unaffected body side, but it was greater on the affected side. We conclude that a reduction of the accessory respiratory muscle activity due to PNF treatment could be of benefit in chronic stoke patients in that it would help normalize breathing pattern and thereby prevent the development of hypoxia.
Collapse
Affiliation(s)
- Lucyna Slupska
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | - Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | | | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Taradaj
- Department of Physiotherapy Basics, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Malgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
23
|
Kwon HY, Kim BJ. Correlation between the dimensions of diaphragm movement, respiratory functions and pressures in accordance with the gross motor function classification system levels in children with cerebral palsy. J Exerc Rehabil 2018; 14:998-1004. [PMID: 30656161 PMCID: PMC6323324 DOI: 10.12965/jer.1836422.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022] Open
Abstract
This study was executed as correlation study to investigate the correlation between the dimensions of diaphragm movement, and respiratory functions and pressures in accordance with the Gross Motor Function Classification System (GMFCS) levels on children with cerebral palsy as the participants. Forty-three children in the age range of 5–13 years diagnosed with cerebral palsy as the research participants were divided into three groups (levels I, II, and III) through systematic stratified random sampling in accordance with their GMFCS levels. Pearson correlation analysis was executed to examine the correlation between dimensions of diaphragm movement, and respiratory functions and pressures in accordance with the GMFCS levels of the participants. There was no significant correlation between the dimensions of diaphragm movement, and respiratory functions and pressures in all of the three groups in accordance with the GMFCS levels of the participants. Therefore, it is deemed that although measurement of the dimensions of diaphragm movement of children with cerebral palsy by using diagnostic ultrasonic M-mode imaging device can be considered as auxiliary tool in predicting the breathing capabilities, it cannot be used as independent measurement equipment.
Collapse
Affiliation(s)
- Hae-Yeon Kwon
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-eui University, Busan, Korea
| | - Byeong-Jo Kim
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-eui University, Busan, Korea
| |
Collapse
|
24
|
Menezes KKP, Nascimento LR, Alvarenga MTM, Avelino PR, Teixeira-Salmela LF. Prevalence of dyspnea after stroke: a telephone-based survey. Braz J Phys Ther 2018; 23:311-316. [PMID: 30245043 DOI: 10.1016/j.bjpt.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Dyspnea is a relevant outcome to be taken into consideration during stroke rehabilitation. Prevalence, severity, and effects of this condition on individuals with stroke remain uncertain. This study investigated the prevalence and severity of dyspnea after a stroke, as well the associations between dyspnea, activity limitations, and participation restrictions. METHODS A telephone-based survey was conducted with 285 individuals with stroke. The survey included information regarding the onset and severity of the dyspnea, activity limitations, and participation restrictions. Prevalence of dyspnea was reported as percentage of individuals who had the symptom. Chi-square tests were used to investigate the associations between dyspnea, activity limitations, and participation restrictions. Relative risks and respective 95% confidence intervals were calculated. RESULTS Out of the 285 participants, 124 (44%) reported having dyspnea after stroke. Severe symptoms were reported by 51% of the participants with dyspnea. In addition, dyspnea limited activity and restricted social participation in 85% and 49% of the participants, respectively. Dyspnea was significantly correlated with activity limitations (r=0.87; 95% CI 0.82-0.92; p<0.01) and participation restrictions (r=0.53; 95% CI 0.46-0.62; p<0.01). The analyses indicated that individuals with dyspnea were more likely to report that it limited their activities (RR: 6.5; 95% CI 4.3-9.9) and restricted social participation (RR: 1.7; 95% CI 1.5-2.0). CONCLUSIONS Dyspnea is an important symptom after stroke and showed to be associated with activity limitations and restrictions in community participation. Earlier detection of dyspnea in people with stroke, followed by appropriate management, is strongly recommended and has the potential to improve activity and social participation.
Collapse
Affiliation(s)
- Kênia K P Menezes
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | - Lucas R Nascimento
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Maria Tereza M Alvarenga
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Patrick R Avelino
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
25
|
Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Cazzola M, Siafakas N. Chronic Obstructive Pulmonary Disease and Stroke. COPD 2018; 15:405-413. [PMID: 29746193 DOI: 10.1080/15412555.2018.1464551] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.
Collapse
Affiliation(s)
- Alexandru Corlateanu
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Serghei Covantev
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | | | - Victor Botnaru
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Mario Cazzola
- c Department of Systems Medicine , Università degli Studi di Roma "Tor Vergata," Rome , Italy
| | - Nikolaos Siafakas
- d University General Hospital , Department of Thoracic Medicine, Stavrakia , Heraklion , Greece
| |
Collapse
|
26
|
Jung JH, Kim NS. The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke. J Phys Ther Sci 2017; 29:2176-2179. [PMID: 29643599 PMCID: PMC5890225 DOI: 10.1589/jpts.29.2176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
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.
Collapse
Affiliation(s)
- Ju-Hyeon Jung
- Department of Physical Therapy, Gimhae College, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan: 9 Bugok 3-dong, Geumjung-gu, Busan 609-757, Republic of Korea
| |
Collapse
|
27
|
Richard P. [Exploring the diaphragm: Ultrasound is essential]. Rev Mal Respir 2017; 34:645-660. [PMID: 28502520 DOI: 10.1016/j.rmr.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
The diaphragm is the muscle most implicated in breathing. Its morphological exploration usually depends on pulmonary radiography, fluoroscopy, CT-scanning and MRI. Its function is evaluated by the classical respiratory functional tests, the measurement of maximum inspiratory and expiratory pressures, the transdiaphragmatic pressure and even an electromyogram. Ultrasound is a technique still insufficiently used in respiratory medicine. It offers, however, many advantages: it is easy to implement, there is no irradiation, it is usable at the bedside, particularly when the patient is immobile or in intensive care. The results of the examination are immediately available. It allows morphological and dynamic study of each hemidiaphragm as well as providing invaluable information on the thoracic and subdiaphragmatic environment. Its field of exploration is extremely wide: raised hemidiaphragm, dyspnea following a stroke or a surgical procedure (thoracic or abdominal), road accident trauma, diagnosis and follow-up of a paresis or paralysis, evaluation of diaphragmatic mobility during the course of COPD (Chronic Obstructive Pulmonary Disease) and many other pathologies. Ultrasound is insufficiently used in pleural disease and even less so in the evaluation of the morphology and function of the diaphragm.
Collapse
Affiliation(s)
- P Richard
- Service de pneumologie, centre hospitaliser de la région de Saint-Omer, route de Blendecques, BP 60357, 62570 Helfaut, France.
| |
Collapse
|
28
|
Andresdottir GT, Hjaltason H, Ragnarsdottir M. Irregular amplitude and frequency of respiratory movements in hemispheric stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2016.1261367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Haukur Hjaltason
- Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland
| | - Maria Ragnarsdottir
- Department of Physiotherapy, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
29
|
Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, Conceição CS. Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2016; 97:1994-2001. [PMID: 27216224 DOI: 10.1016/j.apmr.2016.04.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke. DATA SOURCES We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials. STUDY SELECTION Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently. DATA EXTRACTION Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported. CONCLUSIONS Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.
Collapse
Affiliation(s)
- Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil; The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil.
| | - Micheli Bernardone Saquetto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil
| | | | - Vitor Oliveira Carvalho
- The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Nildo Ribeiro
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | |
Collapse
|
30
|
de Sant'Anna M, Eboli LC, Silva JG, Dos Santos AG, Lourenço M, Moreno AM, de Freitas GR, Orsini M. Resting metabolic rate analysis in chronic hemiparesis patients. Neurol Int 2014; 6:5442. [PMID: 25568736 PMCID: PMC4274406 DOI: 10.4081/ni.2014.5442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/13/2014] [Accepted: 09/02/2014] [Indexed: 01/28/2023] Open
Abstract
The objective of the present study was to compare resting metabolic rate (RMR) of chronic hemiparetic patients to sedentary health individuals. The sample was composed of 16 individuals, that were divided into two groups. The first group had eight hemiparetic patients and the second group was formed by eight sedentary individuals. To access and analyze the gases information a VO2000 analyzer was used. The following variables were measured: VO2, VCO2, VE, QR, grams of fat (GrFAT), grams of carbohydrate. RMR was calculated based on Weir’s equation. There was a significant shift on ventilation variables: VE (P<0.0003), VO2 (P<0.0004) and VCO2 (P<0.0001) on hemiparetic individuals group when compared to control group. When the energetic substrate used behavior is observed, it shows that fat consumption (represented by GrFAT) is higher on the hemiparetic group when compared to controls (P<0.0001) significant differences were observed for RMR between groups (P<0.0001). RMR showed a correlation to VO2 on the hemiparetic group (r=0.9277, P=0.0022). To sum up, it was observed through the results that individuals with hemiparesis as a sequel of stroke showed a RMR larger than normal individuals.
Collapse
Affiliation(s)
| | | | - Julio Guilherme Silva
- Rehabilitation Science Program, Analysis of Human Movement Laboratory, Augusto Motta University Center (UNISUAM) , Rio de Janeiro, Brazil ; Physical Therapy Department, Federal University of Rio de Janeiro (UFRJ) , Brazil
| | | | - Michele Lourenço
- Rio de Janeiro Federal Institute of Education, Science and Technology , Brazil
| | | | | | - Marco Orsini
- Rehabilitation Science Program, Analysis of Human Movement Laboratory, Augusto Motta University Center (UNISUAM) , Rio de Janeiro, Brazil ; Neurology Department, Federal Fluminense University - UFF , Niterói, Rio de Janeiro, Brazil
| |
Collapse
|
31
|
Park GY, Kim SR, Kim YW, Jo KW, Lee EJ, Kim YM, Im S. Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography. Arch Phys Med Rehabil 2014; 96:114-21. [PMID: 25234476 DOI: 10.1016/j.apmr.2014.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/04/2014] [Accepted: 08/23/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects. DESIGN Prospective cross-sectional study. SETTING University rehabilitation hospital. PARTICIPANTS Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured. RESULTS The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (P<.001); 23.8±7.1, 32.7±10.6, and 44.7±10.3 (P<.001); and 16.8±4.8, 28.5±4.9, and 36.0±8.2 (P<.001), respectively. The differences were statistically significant. Differences were observed in the maximum inspiratory (P<.001) and expiratory (P<.001) pressures and peak cough flow (P=.027) among the 3 groups. Forward selection stepwise regression analysis, which was performed to determine variables that help predict diaphragm excursion during voluntary coughing, showed that the presence of dysphagia explained up to 60% (P<.001) of the hemiplegic diaphragm movement during voluntary coughing in patients with stroke. CONCLUSIONS M-mode ultrasonography showed that stroke patients with dysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing.
Collapse
Affiliation(s)
- Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Seong-Rim Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Young Woo Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Kwang Wook Jo
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Eu Jeen Lee
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Young Moon Kim
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
| |
Collapse
|