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Sheraz S, Malik AN, Ferraro FV, Siddiqi FA. Does multifactorial inspiratory muscle training improve postural stability and quality of life of patients with diabetes in Pakistan? A randomised controlled trial. BMJ Open 2024; 14:e080718. [PMID: 39284701 PMCID: PMC11409280 DOI: 10.1136/bmjopen-2023-080718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVE To determine the effects of multifactorial inspiratory muscle training (IMT) combined with Otago Exercise Programme (OEP) on balance and quality of life (QoL) in patients with diabetes. METHODS Pretest-post-test randomised controlled trial. SETTING Rehabilitation Department of Pakistan Railway General Hospital. PARTICIPANTS 70 patients with diabetes were randomly assigned to experimental or placebo groups, out of which 59 patients completed the intervention. INTERVENTION Patients in the experimental group performed OEP+IMT (at 50% of baseline maximum inspiratory pressure (MIP)) whereas the placebo group performed OEP+sham IMT (at 15% of MIP). Both groups exercised for 12 consecutive weeks. OUTCOME MEASURES Outcome measures included nine variables: the Berg Balance Scale (BBS), the Biodex Postural Stability System (including postural stability test (Overall Stability Index, Anterior-Posterior Index and Mediolateral Index), fall risk test (FRT), Limits of Stability (LOS) test (time to complete test and direction control), Clinical Test of Sensory Interaction and Balance (CTSIB)) and the Audit of Diabetes Dependent Quality of Life questionnaire. RESULTS Out of 59 patients who completed treatment, 37.1% were men and 62.9% were women with a mean age of 58.37±5.91 years. Results show significant interaction effects on BBS scores with the mean score improving from 41.87±2.61 to 49.16±2.50 in IMT versus sham IMT group with scores improving from 41.58±2.51 to 45.74±2.30. The IMT group significantly improved in dynamic balance tested through BBS (p=0.003), anticipatory balance through LOS test (p=0.003), reactive balance tested through FRT (p=0.04), direction control (p=0.03) and sensory integration through CTSIB test (p=0.04) when compared with the sham IMT group. While no significant changes (p>0.05) between groups were observed in QoL and static balance; significant changes (p<0.05) within group were observed in both groups in QoL and static balance. CONCLUSION Additional research is necessary to understand the association between inspiratory muscle strength and balance, however, we demonstrated that a multifactorial IMT intervention should be used with patients with diabetes to improve balance, postural control and reduce fall risks. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT#04947163.
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Affiliation(s)
- Suman Sheraz
- Faculty of Rehabilitation And Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation And Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | | | - Furqan Ahmed Siddiqi
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad, Pakistan
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Qin L, Liu S, Hu S, Feng L, Wang H, Gong X, Xuan W, Lu T. The Effect of Inspiratory Muscle Training on Health-Related Fitness in College Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1088. [PMID: 39200697 PMCID: PMC11354152 DOI: 10.3390/ijerph21081088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024]
Abstract
In an era characterized by rapid economic growth and evolving lifestyles, college students encounter numerous challenges, encompassing academic pressures and professional competition. The respiratory muscle endurance capability is important for college students during prolonged aerobic exercise. Therefore, it is of great significance to explore an effective intervention to enhance the endurance level of college students. This study explores the transformative potential of inspiratory muscle training (IMT) to improve the physical functions of college students. This research comprised a group of 20 participants who underwent IMT integrated into their daily physical education classes or regular training sessions over an 8-week period, with 18 participants forming the control group. The IMT group adhered to the manufacturer's instructions for utilizing the PowerBreathe device. The findings indicated a significant positive effect on inspiratory muscle strength (p < 0.001), showing improvements in pulmonary function, exercise tolerance, cardiac function, and overall athletic performance. These results revealed the substantial benefits of IMT in enhancing physical fitness and promoting health maintenance among college students.
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Affiliation(s)
| | | | | | | | | | | | - Wei Xuan
- Department of Physical Education, Sports and Health Research Center, Tongji University, Shanghai 200092, China; (L.Q.); (S.L.); (S.H.); (L.F.); (H.W.); (X.G.)
| | - Tianfeng Lu
- Department of Physical Education, Sports and Health Research Center, Tongji University, Shanghai 200092, China; (L.Q.); (S.L.); (S.H.); (L.F.); (H.W.); (X.G.)
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Molina-Hernández N, Rodríguez-Sanz D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Vicente-Campos D, Marugán-Rubio D, Gutiérrez-Torre SE, Calvo-Lobo C. Effectiveness of simultaneous bilateral visual diaphragm biofeedback under low back pain: influence of age and sex. Front Physiol 2024; 15:1407594. [PMID: 39045217 PMCID: PMC11263192 DOI: 10.3389/fphys.2024.1407594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction: The aim of the present study was to determine the effectiveness of simultaneous bilateral visual diaphragm biofeedback (BFB) from ultrasonography in conjunction with inspiratory muscle training (IMT) on diaphragmatic thickness during normal breathing and respiratory and clinical outcomes in patients with non-specific low back pain (NSLBP) and determine the influence of age and sex. Methods: A single-blind randomized clinical trial was carried out (NCT04582812). A total sample of 96 patients with NSLBP was recruited and randomized by sex-based stratification into IMT (n = 48) and BFB + IMT (n = 48) interventions over 8 weeks. Bilateral diaphragmatic thickness at maximum inspiration (Tins) and expiration (Texp), respiratory pressures, lung function, pain intensity, bilateral pressure pain threshold (PPT), disability, and quality of life were measured at baseline and after 8 weeks. Results: The BFB + IMT group showed significant differences (p < 0.05) with increased left hemidiaphragm thickness at Tins and Tins-exp (d = 0.38-053), and right and left PPT (d = 0.71-0.74) versus the IMT group. The interaction with sex was statistically significant (p = 0.007; F(1,81) = 7.756; ηp 2 = 0.087) and higher left hemidiaphragm thickness at Tins was predicted by the BFB + IMT group (R 2 = 0.099; β = 0.050; F(1,82) = 8.997; p = 0.004) and male sex (R 2 = 0.079; β = 0.045; F(1,81) = 7.756;p = 0.007). Furthermore, greater left hemidiaphragm thickness at Tins-exp was predicted by younger age (R 2 = 0.052; β = -0.001; F(1,82) = 4.540; p = 0.036). Discussion: The simultaneous bilateral visual diaphragm biofeedback by ultrasonography in conjunction with IMT was effective in both increasing the left diaphragmatic thickness during inspiration, which was positively influenced and predicted by male sex and younger age, and increasing the bilateral PPT of the paraspinal muscles in patients with NSLBP.
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Affiliation(s)
- Nerea Molina-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | | | - Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
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Zheng Y, Chen Y, Li Y, Zheng S, Yang S. Diaphragm dysfunction is found in patients with chronic painful temporomandibular disorder: A case-control study. Heliyon 2024; 10:e32872. [PMID: 39022095 PMCID: PMC11253231 DOI: 10.1016/j.heliyon.2024.e32872] [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: 05/07/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Aim To determine whether patients with chronic painful temporomandibular disorder (TMD) had abnormal diaphragm function compared to healthy controls and to explore the correlation between diaphragm contractility, psychological status, and pain characteristics. Methods A single-blinded, case-control study was conducted involving 23 chronic painful TMD patients and 22 healthy volunteers. The examination and diagnosis were performed according to the Diagnostic Criteria for Temporomandibular Disorders, and questionnaires were used to evaluate pain, depression, anxiety, and physical symptoms status. B-mode ultrasound was used to measure diaphragm thickness and contractility. The sonographer responsible for measuring the diaphragm was blinded to group membership. Results 1. Depression, anxiety, and physical symptoms scores were significantly higher in the patients than in the controls (p < 0.05). 2. The Interference Score of pain was significantly correlated with depression and physical symptoms (p < 0.01). 3. Bilateral diaphragm contractility was significantly smaller in the patients than in the controls (right: P = 0.003; left: P = 0.001). 3. There was no correlation between diaphragm contractility on the left and right sides in the patients (r = -0.112, P = 0.611), while there was a positive correlation in the control group (r = 0.638, P = 0.001). 4. No correlation was found between the degree of diaphragm contractility, psychological status, and pain scores. Conclusions 1. Patients with chronic painful TMD have worse psychological status, including depression, anxiety, and physical symptoms. 2. Patients with chronic painful TMD have a smaller degree of bilateral diaphragm contractility and more significant left-right incongruity, which indicated that diaphragm dysfunction may be correlated with chronic painful temporomandibular disorder.
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Affiliation(s)
- Yaqing Zheng
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
- Department of Stomatology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, 361015, China
| | - Yonghui Chen
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Yifeng Li
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Sijing Zheng
- Department of Stomatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
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Fabero-Garrido R, Rodríguez-Marcos I, del Corral T, Plaza-Manzano G, López-de-Uralde-Villanueva I. Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3053. [PMID: 38892764 PMCID: PMC11172635 DOI: 10.3390/jcm13113053] [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: 04/03/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.
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Affiliation(s)
- Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
| | - Iván Rodríguez-Marcos
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
| | - Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Plaza Ramón y Cajal n° 3, Ciudad Universitaria, 28040 Madrid, Spain; (R.F.-G.); (I.R.-M.); (G.P.-M.); (I.L.-d.-U.-V.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Soares de Araujo L, Marostegan AB, Menezes Scariot PP, Bordon Orsi J, Cirino C, Papoti M, Gobatto CA, Manchado-Gobatto FB. Inspiratory muscles pre-activation in young swimmers submitted to a tethered swimming test: effects on mechanical, physiological, and skin temperature parameters. Sci Rep 2024; 14:5975. [PMID: 38472356 DOI: 10.1038/s41598-024-52312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/17/2024] [Indexed: 03/14/2024] Open
Abstract
Inspiratory muscles pre-activation (IMPA) has been studied to improve subsequent performance in swimming. However, the effects of IMPA on various parameters in swimmers are still unknown. Therefore, this study aimed to investigate the effects of IMPA on the mechanical parameters, physiological responses, and their possible correlations with swimming performance. A total of 14 young swimmers (aged 16 ± 0 years) underwent a 30-s all-out tethered swimming test, preceded or not by IMPA, a load of 40% of the maximal inspiratory pressure (MIP), and with a volume of 2 sets of 15 repetitions. The mechanical (strength, impulse, and fatigue index) and physiological parameters (skin temperature and lactatemia) and the assessment of perceived exertion and dyspnea were monitored in both protocols. The IMPA used did not increase the swimming force, and skin temperature, decrease blood lactate concentration, or subjective perception of exertion and dyspnea after the high-intensity tethered swimming exercises. Positive correlations were found between mean force and blood lactate (without IMPA: r = 0.62, P = 0.02; with IMPA: r = 0.65, P = 0.01). The impulse was positively correlated with blood lactate (without IMPA: r = 0.71, P < 0.01; with IMPA: r = 0.56, P = 0.03). Our results suggest that new IMPA protocols, possibly with increased volume, should be developed in order to improve the performance of young swimmers.
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Affiliation(s)
- Lara Soares de Araujo
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Anita Brum Marostegan
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Pedro Paulo Menezes Scariot
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Juan Bordon Orsi
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Carolina Cirino
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Marcelo Papoti
- Study and Research Group in Physiological Sciences and Exercise, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Claudio Alexandre Gobatto
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil
| | - Fúlvia Barros Manchado-Gobatto
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP, 13484-350, Brazil.
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Shaghayeghfard B, Karimi MT, Abbasi L, Razeghi M. Respiratory Function Assessment through Kinematic Analysis of Chest Wall Movements: Effects of Position and Gender. J Biomed Phys Eng 2024; 14:67-78. [PMID: 38357601 PMCID: PMC10862111 DOI: 10.31661/jbpe.v0i0.2105-1335] [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: 05/13/2021] [Accepted: 08/22/2021] [Indexed: 02/16/2024]
Abstract
Background The effect of position and gender on chest movements and respiratory volumes is controversial and investigated in only a few studies. Objective This study aimed to investigate the effects of position and gender on the breathing pattern during four different positions in healthy individuals. Material and Methods In this cross-sectional study, twenty-eight (14 males, 14 females) healthy individuals participated aged 20-45 years. The optoelectronic plethysmography (OEP) method was used for the three-dimensional evaluation of chest wall motions and the compartmental analysis of the breathing pattern in supine, sitting, standing, and active straight leg raised (ASLR) positions. Volume changes in different parts of the chest wall were also measured. Results Position affected total and compartmental respiratory volumes in both genders. Respiratory volumes decreased in the supine position compared to sitting and standing. Total and abdominal respiratory volumes also decreased in females when comparing supine positions with the ASLR. A higher pulmonary rib cage contribution was identified in females, and males exhibited higher abdominal rib cage volume compared with females. Conclusion The breathing pattern was affected by position and gender, and the respiratory volumes increased in more upright positions, perhaps due to a greater gravitational load. The ASLR decreases the respiratory volume, which is probably due to increased postural demand.
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Affiliation(s)
- Bahar Shaghayeghfard
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Taghi Karimi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Terada M, Kosik KB, Gribble PA. Association of Diaphragm Contractility and Postural Control in a Chronic Ankle Instability Population: A Preliminary Study. Sports Health 2024; 16:19-25. [PMID: 36691689 PMCID: PMC10732118 DOI: 10.1177/19417381221147304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Altered reorganization of the sensorimotor system after an initial lateral ankle sprain may lead to a chronic neuromuscular maladaptation in multiple body locations. Specifically, decreased diaphragm contractility has been observed in patients with chronic ankle instability (CAI). The diaphragm has an essential role in postural control. Decreased diaphragm contractility could associate with diminished postural control commonly observed in patients with CAI. However, no study has determined if diaphragm contractility contributes to postural control in a CAI population. HYPOTHESIS Decreased diaphragm contractility would be negatively associated with static postural control in patients with CAI. STUDY DESIGN Cross-sectional study design. LEVEL OF EVIDENCE Level 4. METHODS A total of 15 participants with CAI participated voluntarily. An ultrasonography assessment was performed to quantify the right and left hemidiaphragm thickness at the end of resting inspiration and expiration in supine while breathing quietly. The degree of diaphragm contractility was calculated from the diaphragm thickness. Participants performed 3 eyes-open trials of a 20-second single-leg balance task on the involved limb. Static postural control measures included the center of pressure velocity (COPV) and mean of time-to-boundary (TTB) minima in the anteroposterior (AP) and mediolateral directions. RESULTS Moderate correlations of the right hemidiaphragm contractility were observed with COPV (ρ = -0.54) and TTB mean minima (ρ = 0.56) (P < 0.05) in the AP direction. The left hemidiaphragm contractility was moderately correlated with COPV (ρ = -0.56) and TTB mean minima (ρ = 0.60) (P < 0.05) in the AP direction. CONCLUSION Lower diaphragm contractility may be associated with diminished static postural control in the AP direction in patients with CAI. CLINICAL RELEVANCE This study highlights diaphragm contractility could be a potential connection with diminished static postural control in patients with CAI. Our data raise new avenues for future exploration including potential beneficial effects of implementation of diaphragm breathing exercises and techniques for restoring static postural control in patients with CAI.
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Affiliation(s)
- Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kyle B. Kosik
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Phillip A. Gribble
- The Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
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Helou LB, Dum RP. Volitional inspiration is mediated by two independent output channels in the primary motor cortex. J Comp Neurol 2023; 531:1796-1811. [PMID: 37723869 PMCID: PMC10591979 DOI: 10.1002/cne.25540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
The diaphragm is a multifunctional muscle that mediates both autonomic and volitional inspiration. It is critically involved in vocalization, postural stability, and expulsive core-trunk functions, such as coughing, hiccups, and vomiting. In macaque monkeys, we used retrograde transneuronal transport of rabies virus injected into the left hemidiaphragm to identify cortical neurons that have multisynaptic connections with phrenic motoneurons. Our research demonstrates that representation of the diaphragm in the primary motor cortex (M1) is split into two spatially separate and independent sites. No cortico-cortical connections are known to exist between these two sites. One site is located dorsal to the arm representation within the central sulcus and the second site is lateral to the arm. The dual representation of the diaphragm warrants a revision to the somatotopic map of M1. The dorsal diaphragm representation overlaps with trunk and axial musculature. It is ideally situated to coordinate with these muscles during volitional inspiration and in producing intra-abdominal pressure gradients. The lateral site overlaps the origin of M1 projections to a laryngeal muscle, the cricothyroid. This observation suggests that the coordinated control of laryngeal muscles and the diaphragm during vocalization may be achieved, in part, by co-localization of their representations in M1. The neural organization of the two diaphragm sites underlies a new perspective for interpreting functional imaging studies of respiration and/or vocalization. Furthermore, our results provide novel evidence supporting the concept that overlapping output channels within M1 are a prerequisite for the formation of muscle synergies underlying fine motor control.
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Affiliation(s)
- Leah B. Helou
- University of Pittsburgh, Department of Communication Science and Disorders, Pittsburgh, PA 15260
| | - Richard P. Dum
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260
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Lespert Y, Rivals I, Ing RK, Clavel L, Similowski T, Sandoz B, Attali V. Coupling Between Posture and Respiration Among the Postural Chain: Toward a Screening Tool for Respiratory-Related Balance Disorders. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4338-4346. [PMID: 37906488 DOI: 10.1109/tnsre.2023.3328860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Alteration of posturo-respiratory coupling (PRC) may precede postural imbalance in patients with chronic respiratory disease. PRC assessment would be appropriate for early detection of respiratory-related postural dysfunction. PRC may be evaluated by respiratory emergence (REm), the proportion of postural oscillations attributed to breathing activity; assessed by motion analysis) as measured from the displacement of the center of pressure (CoP) (measured with a force platform). To propose a simplified method of PRC assessment (using motion capture only), we hypothesized that the REm can appropriately be measured derived from single body segment the postural oscillations of a single body segment rather than whole body postural oscillations. An optoelectronic system recorded the breathing pattern and the postural oscillations of six body segments in 50 healthy participants (22 women), 34 years [26; 48]. The CoP displacements were assessed using a force platform. One-minute recordings were made in standing position in four conditions by varying vision (eyes opened/closed) and jaw position (rest position/dental contact). The Sway Path and Mean Velocity of the CoP and of the representative point of each body segment were recorded. The REm was measured along the major and the minor axis of the 95% confidence ellipse of the CoP position (REm_MajorAxisCoP; REm_MinorAxisCoP) and of that of each body segment. SwayPathCoP and MVCoP varied widely across the four conditions (par< 0.000001). These changes were related to the visual condition ( [Formula: see text]) while the jaw position had no effect. The REm_MajorAxisCoP and the REm_MinorAxisCoP changed across conditions ( [Formula: see text]); this was related to vision while jaw induced changes only for the REm_MinorAxisCoP. The SwayPath, the Mean Velocity and the REm of all body segments were significantly correlated to the CoP, but the highest correlations were observed for the thorax, the pelvis and the shoulder. PRC may be assessed from the postural oscillations of thorax, pelvis and shoulder. This should simplify the evaluation of respiratory-related postural interactions in the clinical environment, by using a single device to simultaneously assess postural oscillations on body segments, and breathing pattern. In addition, this study provides reference data for PRC and its sensory-related modulations on body segments along the postural chain.
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Khurram OU, Mantilla CB, Sieck GC. Neuromotor control of spontaneous quiet breathing in awake rats evaluated by assessments of diaphragm EMG stationarity. J Neurophysiol 2023; 130:1344-1357. [PMID: 37877195 DOI: 10.1152/jn.00267.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
The neuromotor control of the diaphragm muscle (DIAm) is dynamic. The activity of the DIAm can be recorded via electromyography (EMG), which represents the temporal summation of motor unit action potentials. Our goal in the present study was to investigate DIAm neuromotor control during quiet spontaneous breathing (eupnea) in awake rats by evaluating DIAm EMG at specific temporal locations defined by motor unit recruitment and derecruitment. We evaluated the nonstationarity of DIAm EMG activity to identify DIAm motor unit recruitment and derecruitment durations. Combined with assessments of root mean square (RMS) and sum of squares (SS) EMG, the durations of these phases provide physiological information about the temporal aspects of motor control. During eupnea in awake rats (n = 10), the duration of motor unit recruitment comprised 61 ± 19 ms of the onset-to-peak duration (214 ± 62 ms) of the DIAm RMS EMG. The peak-to-offset duration of DIAm EMG activity was 453 ± 96 ms, with a terminating period of derecruitment of 161 ± 44 ms. The burst duration was 673 ± 128 ms. Both the RMS EMG amplitude and the SS EMG were higher at the completion of motor unit recruitment than at the start of motor unit derecruitment, suggesting that offset discharge rates were lower than onset discharge rates. Our analyses provide novel insights into the time domain aspects of DIAm neuromotor control and allow indirect estimates of the contribution of recruitment and frequency to RMS EMG amplitude during eupnea in awake rats.NEW & NOTEWORTHY We characterized three phases of neuromotor control-motor unit recruitment, sustained activity, and derecruitment-based on statistical assessments of stationarity of the diaphragm muscle (DIAm) EMG activity in awake rats. Our findings may allow indirect estimates of the contribution of motor unit recruitment and frequency coding toward generating force and provide novel insights about the temporal aspects of DIAm neuromotor control and descending respiratory drive in unanesthetized animals.
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Affiliation(s)
- Obaid U Khurram
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos B Mantilla
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Gary C Sieck
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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12
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Hyodo Y, Jiroumaru T, Mori K, Hattori T, Oka Y, Kuroda M, Ochi J, Shichiri N, Fujikawa T. Comparison of the effect of respiratory muscle strength on dynamic and static balance assessment between sarcopenia and non-sarcopenia groups. J Phys Ther Sci 2023; 35:703-707. [PMID: 37790998 PMCID: PMC10542420 DOI: 10.1589/jpts.35.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 10/05/2023] Open
Abstract
[Purpose] We compared differences in the association between respiratory muscle strength and static and dynamic balance in sarcopenia and non-sarcopenia groups, for fall risk assessment. [Participants and Methods] The study included 37 participants aged ≥65 years, who were certified to receive long-term care. Inspiratory and expiratory muscle strength, hand grip strength, Timed Up and Go Test scores, and one-leg standing task scores were recorded. Pearson's correlation coefficients and multiple regression analysis were used for data analysis. [Results] Only the expiratory muscle and hand grip strength were correlated in the sarcopenia group. Expiratory and inspiratory muscle strength was correlated with both one-leg standing task scores and hand grip strength, and inspiratory muscle strength was correlated with the Timed Up and Go Test scores in the non-sarcopenia group. Multiple regression analysis revealed that expiratory muscle strength was an explanatory variable for the one-leg standing task and inspiratory muscle strength for the Timed Up and Go Test in the non-sarcopenia group. [Conclusion] Combined evaluation of expiratory muscle strength and the Timed Up and Go Test scores may be useful to assess the fall risk.
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Affiliation(s)
- Yutaro Hyodo
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | | | - Kenji Mori
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | - Tomoka Hattori
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | - Yasumasa Oka
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
- Department of Applied Biology, Kyoto Institute of
Technology, Japan
| | - Minoru Kuroda
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
- Department of Clinical Nursing, Division of Psychiatric and
Mental Health Nursing, Shiga University, Japan
| | - Junko Ochi
- Department of Physical Therapy, Bukkyo University,
Japan
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13
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Sannasi R, Dakshinamurthy A, Dommerholt J, Desai V, Kumar A, Sugavanam T. Diaphragm and core stabilization exercises in low back pain: A narrative review. J Bodyw Mov Ther 2023; 36:221-227. [PMID: 37949564 DOI: 10.1016/j.jbmt.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Core stabilization is a vital concept in clinical rehabilitation (including low back pain rehabilitation) and competitive athletic training. The core comprises of a complex network of hip, trunk and neck muscles including the diaphragm. AIMS The paper aims to discuss the role of the diaphragm in core stability, summarize current evidence and put forth ideal core training strategies involving the diaphragm. METHOD Narrative review RESULTS: The diaphragm has a dual role of respiration and postural control. Evidence suggests that current core stability exercises for low back pain are superior than minimal or no treatment, however, no more beneficial than general exercises and/or manual therapy. There appears to be a higher focus on the transversus abdominis and multifidi muscles and minimal attention to the diaphragm. We propose that any form of core stabilization exercises for low back pain rehabilitation should consider the diaphragm. Core stabilization program could commence with facilitation of normal breathing patterns and progressive systematic restoration of the postural control role of the diaphragm muscle. CONCLUSION The role of the diaphragm is often overlooked in both research and practice. Attention to the diaphragm may improve the effectiveness of core stability exercise in low back pain rehabilitation.
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Affiliation(s)
- Rajasekar Sannasi
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Anandhi Dakshinamurthy
- SRM College of Physiotherapy, Faculty of Medical and Health Sciences, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, 603203, Kanchipuram, Chennai, Tamil Nadu, India.
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA; Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Vidhi Desai
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Ajay Kumar
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Thavapriya Sugavanam
- Health Services Research Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom.
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14
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Yang G, He S, Meng D, Wei M, Cao J, Guo H, Ren H, Wang Z. Body landmarks and genetic algorithm-based approach for non-contact detection of head forward posture among Chinese adolescents: revitalizing machine learning in medicine. BMC Med Inform Decis Mak 2023; 23:179. [PMID: 37697312 PMCID: PMC10496156 DOI: 10.1186/s12911-023-02285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
Addressing the current complexities, costs, and adherence issues in the detection of forward head posture (FHP), our study conducted an exhaustive epidemiologic investigation, incorporating a comprehensive posture screening process for each participant in China. This research introduces an avant-garde, machine learning-based non-contact method for the accurate discernment of FHP. Our approach elevates detection accuracy by leveraging body landmarks identified from human images, followed by the application of a genetic algorithm for precise feature identification and posture estimation. Observational data corroborates the superior efficacy of the Extra Tree Classifier technique in FHP detection, attaining an accuracy of 82.4%, a specificity of 85.5%, and a positive predictive value of 90.2%. Our model affords a rapid, effective solution for FHP identification, spotlighting the transformative potential of the convergence of feature point recognition and genetic algorithms in non-contact posture detection. The expansive potential and paramount importance of these applications in this niche field are therefore underscored.
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Affiliation(s)
- Guang Yang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Shichun He
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Deyu Meng
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Meiqi Wei
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China
| | - Jianwei Cao
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
| | - Hongzhi Guo
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
- Graduate School of Human Sciences, Waseda University, Tokorozawa, 169-8050, Saitama Prefecture, Japan
| | - He Ren
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA
| | - Ziheng Wang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Renmin Street, Changchun, 130024, Jilin, China.
- AI Group, Intelligent Lancet LLC, 2108 N Street, Sacramento, 95816, CA, USA.
- Advanced Research Center for Human Sciences, Waseda University, Tokorozawa, 169-8050, Saitama Prefecture, Japan.
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15
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Nezhad FF, Daryabor A, Abedi M, Smith JH. Effect of Dynamic Neuromuscular Stabilization and Vojta Therapy on Respiratory Complications in Neuromuscular Diseases: A Literature Review. J Chiropr Med 2023; 22:212-221. [PMID: 37644999 PMCID: PMC10461149 DOI: 10.1016/j.jcm.2023.04.002] [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: 01/22/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 08/31/2023] Open
Abstract
Objective The purpose of this study was to review the literature on the effect of dynamic neuromuscular stabilization (DNS)/Vojta on respiratory complications of neuromuscular diseases. Methods The search strategy was conducted, based on the population, intervention, comparison, and outcome method, in the PubMed, Embase, ISI Web of Knowledge, ProQuest, and Scopus databases from inception to August 2021. The quality assessment of included papers was performed through the Physiotherapy Evidence Database scale. A narrative analysis was performed since a meta-analysis could not be conducted. Results A total of 7 papers were chosen for the final assessment. All studies, except 1, evaluated individuals with neurological disease. Three studies evaluated Vojta therapy effects, and 4 studies evaluated DNS effects on respiratory parameters. Although the studies had limitations in their methodology according to the Physiotherapy Evidence Database scale, 4 were identified as level 1 evidence. None of the studies reported any adverse effects of Vojta therapy or DNS on respiratory parameters. However, not enough clinical trials were found to examine the effect of DNS on respiratory disease. Conclusion Although the studies were weak in internal and external validity, this review suggests that Vojta therapy and DNS may influence respiratory parameters, such as blood gases, diaphragm movements, and functional respiratory parameters, in patients with neuromuscular diseases.
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Affiliation(s)
- Fatemeh Falahati Nezhad
- Student Research Committee, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Abedi
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Joseph H. Smith
- Department of Health, Nutrition and Exercise Sciences, North Dakota State University, Fargo, North Dakota
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16
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Azevedo IG, da Câmara SMA, Maciel ACC, Vieira ER, Espinoza CFL, Pichún SMM, Viana EDSR, Sousa SLDO. Relationship between inspiratory muscle strength and balance in women: A cross-sectional study. PLoS One 2023; 18:e0280465. [PMID: 36791078 PMCID: PMC9931101 DOI: 10.1371/journal.pone.0280465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/31/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND There is scarce evidence on changes at the functional level associated with the respiratory area in women. This study aims to analyse the relationship between inspiratory muscle strength and balance in women. MATERIAL AND METHODS In this cross-sectional observational study, the sample consisted of groups according to the results obtained in the balance test. Inspiratory muscle weakness was defined as maximum inspiratory pressure (MIP) ≤ 80% of the predictive value. MIP was carried out using through a mouthpiece, with an electronic manometer. Logistic regression model was used to examine if MIP predicts balance. RESULTS 159 women participated in the study. Approximately 20% of them achieved balance ≤ 2 seconds and 18% presented MIP≤80%. MIP was associated with the time achieved in the one-leg support test. Subjects with MIP ≤ 80% of the predictive value show 3 times more risk of having a lower performance in the balance test (OR = 3.26). CONCLUSIONS Inspiratory muscle weakness is associated with deficient balance in this sample. It shows the need for multidimensional assessment and rehabilitation strategies for patients identified as having MIP weakness and/or balance disorders.
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Affiliation(s)
- Ingrid Guerra Azevedo
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Saionara M. A. da Câmara
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Alvaro C. C. Maciel
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
| | - Edgar R. Vieira
- Department of Physical Therapy, Florida International University, Miami, Florida, United States of America
| | - Camila F. L. Espinoza
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
| | - Sebastián M. M. Pichún
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco UCT, La Araucanía, Temuco, Chile
| | - Elizabel de S. R. Viana
- Departamento de Fisioterapia, Federal University of Rio Grande do Norte UFRN, Natal, Rio Grande do Norte (RN), Brazil
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17
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Diaphragmatic Activation Correlated with Lumbar Multifidus Muscles and Thoracolumbar Fascia by B-Mode and M-Mode Ultrasonography in Subjects with and without Non-Specific Low Back Pain: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020315. [PMID: 36837516 PMCID: PMC9967570 DOI: 10.3390/medicina59020315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects.
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18
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Shimozawa Y, Kurihara T, Kusagawa Y, Hori M, Numasawa S, Sugiyama T, Tanaka T, Suga T, Terada RS, Isaka T, Terada M. Point Prevalence of the Biomechanical Dimension of Dysfunctional Breathing Patterns Among Competitive Athletes. J Strength Cond Res 2023; 37:270-276. [PMID: 35612946 DOI: 10.1519/jsc.0000000000004253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Shimozawa, Y, Kurihara, T, Kusagawa, Y, Hori, M, Numasawa, S, Sugiyama, T, Tanaka, T, Suga, T, Terada, RS, Isaka, T, and Terada, M. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res 37(2): 270-276, 2023-There is growing evidence of associations between altered biomechanical breathing patterns and numerous musculoskeletal and psychological conditions. The prevalence of dysfunctional and diaphragmatic breathing patterns is unknown among athletic populations. The purpose of this study was to examine the prevalence of dysfunctional and diaphragmatic breathing patterns among athletic populations with a clinical measure to assess the biomechanical dimension of breathing patterns. Using a cross-sectional design, 1,933 athletes across multiple sports and ages were screened from 2017 to 2020. Breathing patterns were assessed using the Hi-Lo test in the standing position. Scores of the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The Hi-Lo test scores were used to categorize observational breathing mechanics as dysfunctional and diaphragmatic breathing patterns. The prevalence of athletes with dysfunctional breathing patterns was 90.6% (1,751 of 1,933). Athletes with diaphragmatic breathing patterns accounted for 9.4% of all athletes in our sample (182 of 1,933). There were no differences in the proportion of breathing patterns between male and female athletes ( p = 0.424). Breathing patterns observations were associated with sport-setting categories ( p = 0.002). The highest percentages of dysfunctional breathers were in middle school student athletes (93.7%), followed by elementary school student athletes (91.2%), high school student athletes (90.6%), professional/semiprofessional athletes (87.5%), and collegiate athletes (84.8%). The current study observed that dysfunctional breathing patterns (90.6%) in the biomechanical dimension were more prevalent than diaphragmatic breathing pattern (9.4%) among competitive athletes. These results suggest that clinicians may need to consider screening breathing patterns and implementing intervention programs aimed to improve the efficiency of biomechanical dimensions of breathing patterns in athletic populations. This study may help raise awareness of impacts of dysfunctional breathing patterns on athletes' health and performance.
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Affiliation(s)
- Yuka Shimozawa
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Toshiyuki Kurihara
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | - Yuki Kusagawa
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Miyuki Hori
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Shun Numasawa
- Medical Science Committee of Osaka Basketball Association, Osaka, Japan ; and
| | - Takashi Sugiyama
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Takahiro Tanaka
- Graduate School of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Tadashi Suga
- Research Organization of Science and Technology, Ritsumeikan University, Shiga, Japan
| | | | - Tadao Isaka
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Shiga, Japan
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19
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de Oliveira-Sousa SL, León-Garzón MC, Gacto-Sánchez M, Ibáñez-Vera AJ, Espejo-Antúnez L, León-Morillas F. Does Inspiratory Muscle Training Affect Static Balance in Soccer Players? A Pilot Randomized Controlled Clinical Trial. Healthcare (Basel) 2023; 11:healthcare11020262. [PMID: 36673630 PMCID: PMC9859380 DOI: 10.3390/healthcare11020262] [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: 12/07/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Inspiratory muscle training (IMT) is effective in improving postural stability and balance in different clinical populations. However, there is no evidence of these effects in soccer players. A single-blind, two-arm (1:1), randomized, placebo-controlled pilot study on 14 soccer players was performed with the main aim of assessing the effect of IMT on static balance, and secondarily, of examining changes in the respiratory muscle function. The experimental group (EG) received an IMT program with progressive intensity, from 20% to 80%, of the maximal inspiratory pressure (MIP). The sham group (SG) performed the same program with a fixed load of 20% of the MIP. Static balance and respiratory muscle function variables were assessed. A two-factor analysis of variance for repeated measures was used to assess differences after training. Statistical significance was set at p < 0.05. Significant increases were observed in the EG on length of sway under eyes open (from 2904.8 ± 640.0 to 3522.4 ± 509.0 mm, p = 0.012) and eyes closed (from 3166.2 ± 641.3 to 4173.3 ± 390.8 mm, p = 0.004). A significant increase in the maximal voluntary ventilation was observed for both groups (EG p = 0.005; SG p = 0.000). No significant differences existed between the groups. IMT did not improve the static balance in a sample of soccer players. Conducting a high-scale study is feasible and could refine the results and conclusions stemming from the current pilot study.
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Affiliation(s)
| | - Martha Cecilia León-Garzón
- Department of Physiotherapy, Jerónimos Campus, 135. Catholic University of Murcia UCAM, Guadalupe, 30107 Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physiotherapy, University of Murcia, 30003 Murcia, Spain
- Correspondence:
| | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Felipe León-Morillas
- Department of Physiotherapy, Jerónimos Campus, 135. Catholic University of Murcia UCAM, Guadalupe, 30107 Murcia, Spain
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20
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Thakre PP, Rana S, Benevides ES, Fuller DD. Targeting drug or gene delivery to the phrenic motoneuron pool. J Neurophysiol 2023; 129:144-158. [PMID: 36416447 PMCID: PMC9829468 DOI: 10.1152/jn.00432.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Phrenic motoneurons (PhrMNs) innervate diaphragm myofibers. Located in the ventral gray matter (lamina IX), PhrMNs form a column extending from approximately the third to sixth cervical spinal segment. Phrenic motor output and diaphragm activation are impaired in many neuromuscular diseases, and targeted delivery of drugs and/or genetic material to PhrMNs may have therapeutic application. Studies of phrenic motor control and/or neuroplasticity mechanisms also typically require targeting of PhrMNs with drugs, viral vectors, or tracers. The location of the phrenic motoneuron pool, however, poses a challenge. Selective PhrMN targeting is possible with molecules that move retrogradely upon uptake into phrenic axons subsequent to diaphragm or phrenic nerve delivery. However, nonspecific approaches that use intrathecal or intravenous delivery have considerably advanced the understanding of PhrMN control. New opportunities for targeted PhrMN gene expression may be possible with intersectional genetic methods. This article provides an overview of methods for targeting the phrenic motoneuron pool for studies of PhrMNs in health and disease.
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Affiliation(s)
- Prajwal P Thakre
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - Sabhya Rana
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - Ethan S Benevides
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, Gainesville, Florida
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21
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Illidi CR, Romer LM. Stabilising function of the human diaphragm in response to involuntary augmented breaths induced with or without lower-limb movements. Exp Physiol 2022; 107:1477-1492. [PMID: 36177711 PMCID: PMC10092310 DOI: 10.1113/ep090605] [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: 06/01/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is the stabilising function of the diaphragm altered differentially in response to involuntary augmented breaths induced with or without lower-limb movements? What is the main finding and its importance? At equivalent levels of ventilation, the diaphragm generated higher passive pressure but moved significantly less during incremental cycle ergometry compared with progressive hypercapnia. Diaphragm excursion velocity and power output did not differ between the two tasks. These findings imply that the power output of the diaphragm during stabilising tasks involving the lower limbs may be preserved via coordinated changes in contractile shortening. ABSTRACT Activity of key respiratory muscles, such as the diaphragm, must balance the demands of ventilation with the maintenance of stable posture. Our aim was to test whether the stabilising function of the diaphragm would be altered differentially in response to involuntary augmented breaths induced with or without lower-limb movements. Ten healthy volunteers (age 21 (2) years; mean (SD)) performed progressive CO2 -rebreathe (5% CO2 , 95% O2 ) followed 20 min later by incremental cycle exercise (15-30 W/min), both in a semi-recumbent position. Ventilatory indices, intrathoracic pressures and ultrasonographic measures of diaphragm shortening were assessed before, during and after each task. From rest to iso-time, inspiratory tidal volume and minute ventilation increased two- to threefold. At equivalent levels of tidal volume and minute ventilation, mean inspiratory transdiaphragmatic pressure ( P ¯ di ${\bar P_{{\rm{di}}}}$ ) was consistently higher during exercise compared with CO2 -rebreathe due to larger increases in gastric pressure and the passive component of P ¯ di ${\bar P_{{\rm{di}}}}$ (i.e., mechanical output due to static contractions), and yet diaphragm excursion was consistently lower. This lower excursion during exercise was accompanied by a reduction in excursion time with no difference in the active component of P ¯ di ${\bar P_{{\rm{di}}}}$ . Consequently, the rates of increase in excursion velocity (excursion/time) and power output (active P ¯ di ${\bar P_{{\rm{di}}}}$ × velocity) did not differ between the two tasks. In conclusion, the power output of the human diaphragm during dynamic lower-limb exercise appears to be preserved via coordinated changes in contractile shortening. The findings may have significance in settings where the ventilatory and stabilising functions of the diaphragm must be balanced (e.g., rehabilitation).
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Affiliation(s)
- Camilla R Illidi
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Lee M Romer
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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Faghy MA, Shei R, Armstrong NCD, White M, Lomax M. Physiological impact of load carriage exercise: Current understanding and future research directions. Physiol Rep 2022; 10:e15502. [PMID: 36324291 PMCID: PMC9630762 DOI: 10.14814/phy2.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Load carriage (LC) refers to the use of personal protective equipment (PPE) and/or load-bearing apparatus that is mostly worn over the thoracic cavity. A commonplace task across various physically demanding occupational groups, the mass being carried during LC duties can approach the wearer's body mass. When compared to unloaded exercise, LC imposes additional physiological stress that negatively impacts the respiratory system by restricting chest wall movement and altering ventilatory mechanics as well as circulatory responses. Consequently, LC activities accelerate the development of fatigue in the respiratory muscles and reduce exercise performance in occupational tasks. Therefore, understanding the implications of LC and the effects specific factors have on physiological capacities during LC activity are important to the implementation of effective mitigation strategies to ameliorate the detrimental effects of thoracic LC. Accordingly, this review highlights the current physiological understanding of LC activities and outlines the knowledge and efficacy of current interventions and research that have attempted to improve LC performance, whilst also highlighting pertinent knowledge gaps that must be explored via future research activities.
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Affiliation(s)
- Mark A. Faghy
- Biomedical Research Theme, School of Human SciencesUniversity of DerbyDerbyUK
| | - Ren‐Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nicola C. D. Armstrong
- Defence Science and Technology LaboratorySalisburyUK
- Extreme Environments Laboratory, School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Mark White
- Rocky Mountain University of Health ProfessionsProvoUtahUSA
| | - Mitch Lomax
- Extreme Environments Laboratory, School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
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Palermo AE, Nash MS, Kirk-Sanchez NJ, Cahalin LP. Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study. Spinal Cord Ser Cases 2022; 8:85. [PMID: 36309488 PMCID: PMC9617741 DOI: 10.1038/s41394-022-00551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Study design The pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4. Objective To assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI). Setting Assessments: research institution or zoom. IMT: participant’s home. Methods Participants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance. Results Data from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant’s training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1. Conclusion Our data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety. ClinicalTrials.gov Registration number: NCT04210063.
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Affiliation(s)
- Anne E Palermo
- Neuroscience Research Australia, Sydney, NSW, Australia. .,University of New South Wales, Sydney, NSW, Australia.
| | - Mark S Nash
- University of Miami Miller School of Medicine, Department of Physical Therapy and The Miami Project to Cure Paralysis, Miami, FL, USA
| | - Neva J Kirk-Sanchez
- University of Miami Miller School of Medicine, Department of Physical Therapy, Miami, FL, USA
| | - Lawrence P Cahalin
- University of Miami Miller School of Medicine, Department of Physical Therapy, Miami, FL, USA
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The Role of Core Stability and Core Muscles in Ankylosing Spondylitis: A Review of Functional and Clinical Importance. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1123915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: Physiotherapy and exercise training are one of the cornerstones in the treatment of patients with ankylosing spondylitis (AS). However, although the effects of exercise programs and their superiority over each other have still not been determined, research on this subject is continuing in the literature day by day. Due to the pathophysiology of AS, the spine is one of the most affected areas of the musculoskeletal system. Therefore, stabilization of the lumbopelvic region and the spine, which is the reference point for the core muscles, is important for the treatment and management of this disease.
In this review, the involvement of core muscles and core stability in patients with AS and the literature on core training programs will be discussed.
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Postural-respiratory function of the diaphragm assessed by M-mode ultrasonography. PLoS One 2022; 17:e0275389. [PMID: 36215306 PMCID: PMC9550028 DOI: 10.1371/journal.pone.0275389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations. METHODS 31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM. RESULTS Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001). CONCLUSION In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.
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Liang WM, Bai ZM, Aihemaiti M, Yuan L, Hong ZM, Xiao J, Ren FF, Rukšėnas O. Women's Respiratory Movements during Spontaneous Breathing and Physical Fitness: A Cross-Sectional, Correlational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12007. [PMID: 36231308 PMCID: PMC9566329 DOI: 10.3390/ijerph191912007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Abdominal/diaphragmatic breathing exercises are popular worldwide and have been proven to be beneficial for physical performance. Is abdominal motion (AM) during spontaneous breathing correlated with physical fitness? The present study aimed to answer this question. METHODS 434 women (aged 20-59) were enrolled and participated in respiration tests using two respiration belts (one was tied at the height of the xiphoid and another at the navel) to detect AM and thoracic motion (TM). They also performed physical fitness tests to measure body size, muscular strength, muscular power, muscular endurance, balance, flexibility, reaction time, and cardiorespiratory endurance. RESULTS All the correlation coefficients between respiratory movements (AM, TM, AM + TM, AM/(AM + TM)) and physical fitness outcomes were less than 0.4/-0.4. Only AM and muscular power (countermovement jump height) had a weak correlation, with a correlation coefficient close to 0.4 in the 20-29-year age group (rs = 0.398, p = 0.011, n = 40). CONCLUSIONS Women's respiratory movements during spontaneous breathing were not correlated with physical fitness. Future studies may focus on the relationship between AM and countermovement jump height in young women with a larger sample size and using ultrasound to directly test the excursion of the diaphragm.
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Affiliation(s)
- Wen-Ming Liang
- Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania
- Department of Physiotherapy and Rehabilitation, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Zhen-Min Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Maiwulamu Aihemaiti
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Lei Yuan
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Zhi-Min Hong
- School of Science, Inner Mongolia University of Technology, Hohhot 010051, China
| | - Jing Xiao
- Department of Physiotherapy and Rehabilitation, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Fei-Fei Ren
- Department of Physical Education, Beijing Language and Culture University, Beijing 100083, China
| | - Osvaldas Rukšėnas
- Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania
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Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial. J Clin Med 2022; 11:jcm11154318. [PMID: 35893409 PMCID: PMC9332609 DOI: 10.3390/jcm11154318] [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: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland−Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP.
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Palermo AE, Kirk-Sanchez NJ, Garcia KL, Nash MS, Cahalin LP. Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study. Arch Phys Med Rehabil 2022; 103:1303-1310. [PMID: 34922931 DOI: 10.1016/j.apmr.2021.11.006] [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: 08/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. DESIGN The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. SETTING Research facility. PARTICIPANTS Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). INTERVENTION Not applicable. MAIN OUTCOME MEASURES IMP, LOI, UEMS, FIST-SCI. RESULTS UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). CONCLUSIONS The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.
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Affiliation(s)
- Anne E Palermo
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
| | - Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelsey L Garcia
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Department of Rehabilitation, Jackson Health Systems, Miami, Florida
| | - Mark S Nash
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
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Diaphragmatic Mobility and Chest Expansion in Patients with Scapulocostal Syndrome: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10050950. [PMID: 35628087 PMCID: PMC9141335 DOI: 10.3390/healthcare10050950] [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: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Scapulocostal syndrome (SCS) is a subset of myofascial pain syndrome affecting the posterior shoulder and upper back area. Some of the affected muscles are attached to the rib cage, which may affect diaphragmatic mobility and chest expansion. The purpose of this study was to investigate the characteristics of diaphragmatic mobility and chest expansion in patients with SCS. Twenty-nine patients with SCS and twenty-nine healthy participants of a similar age, gender, weight, and height were included in the study. All participants were evaluated for diaphragmatic mobility (DM) by real-time ultrasound (RTUS) and for chest expansion (CE) using a cloth tape measure. An independent t-test was used to compare the outcome variables between groups. The DM value in the SCS group was 46.24 ± 7.26 mm, whereas in the healthy group it was 54.18 ± 9.74 mm. The DM value was lower in the SCS group compared to in healthy participants (p < 0.05). Chest expansion at the axilla, the fourth intercostal space (4th ICS), and the xiphoid level in the SCS group was 7.26 ± 1.13, 6.83 ± 0.94, and 6.86 ± 1.25, respectively, while chest expansion at the axilla, 4th ICS, and xiphoid level in the healthy group was 7.92 ± 1.39, 7.54 ± 1.43, and 8.13 ± 1.32, respectively. Chest expansion at the 4th ICS and the xiphoid level in the SCS group was significantly lower than in the healthy group (p < 0.05). Patients with SCS presented a decrease in diaphragmatic mobility and chest expansion. Therefore, SCS treatment programs ought to add breathing exercises to improve lung expansion.
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Ziaeifar M, Noorizadeh Dehkordi S, Haghighatkhah HR, Sarrafzadeh J, Arabloo AM, Zendehdel Jadehkenari A. Intrarater Reliability of Diaphragm Excursion and Resting Thickness Using Ultrasound Imaging in Subjects With Nonspecific Chronic Low Back Pain. J Chiropr Med 2022; 21:15-22. [DOI: 10.1016/j.jcm.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
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Aramaki Y, Homma Y, Mamizu T, Kakizaki F. Analysis of the asymmetry of thoracic shape at rest: relationship with lateral thoracic deviation. J Phys Ther Sci 2022; 34:454-458. [PMID: 35698555 PMCID: PMC9170482 DOI: 10.1589/jpts.34.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/06/2022] [Indexed: 12/03/2022] Open
Abstract
[Purpose] We analyzed the relationship between the degree of asymmetry in the shape of
the thorax and postural changes in the frontal plane, and examined the mechanism that
creates an asymmetry in the thoracic shape. [Participants and Methods] The participants
included 19 healthy young males. We calculated the thoracic volume and lateral deviation
from the amount of displacement of reflective markers attached to the thoracic area using
the Vicon MX 3D-analysis system. [Results] Left-right differences were shown in each area
of the thorax, and positive and negative correlations were found with the amount of
lateral deviation of the thorax, which captured postural changes in the frontal plane.
[Conclusion] The results of this study suggest that postural changes in the frontal plane
are factors involved in the mechanism of left-right asymmetry formation in the thoracic
shape.
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Affiliation(s)
- Yoshihiro Aramaki
- Department of Rehabilitation, Sendai Seiyo Gakuin College: 4-3-55 Nagamachi, Taihakuku, Sendai 982-0011, Japan
| | - Yuuki Homma
- Department of Physical Therapy, Facullty of Health Science Technology, Bunkyo Gakuin University, Japan
| | - Tetsuya Mamizu
- Department of Rehabilitation, Niizashiki Chuo General Hospital, Japan
| | - Fujiyasu Kakizaki
- Department of Physical Therapy, Facullty of Health Science Technology, Bunkyo Gakuin University, Japan
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The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. J Bodyw Mov Ther 2022; 29:146-153. [DOI: 10.1016/j.jbmt.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 09/13/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
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Fuller DD, Rana S, Smuder AJ, Dale EA. The phrenic neuromuscular system. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:393-408. [PMID: 35965035 PMCID: PMC11135908 DOI: 10.1016/b978-0-323-91534-2.00012-6] [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] [Indexed: 11/25/2022]
Abstract
The phrenic neuromuscular system consists of the phrenic motor nucleus in the mid-cervical spinal cord, the phrenic nerve, and the diaphragm muscle. This motor system helps sustain breathing throughout life, while also contributing to posture, coughing, swallowing, and speaking. The phrenic nerve contains primarily efferent phrenic axons and afferent axons from diaphragm sensory receptors but is also a conduit for autonomic fibers. On a breath-by-breath basis, rhythmic (inspiratory) depolarization of phrenic motoneurons occurs due to excitatory bulbospinal synaptic pathways. Further, a complex propriospinal network innervates phrenic motoneurons and may serve to coordinate postural, locomotor, and respiratory movements. The phrenic neuromuscular system is impacted in a wide range of neuromuscular diseases and injuries. Contemporary research is focused on understanding how neuromuscular plasticity occurs in the phrenic neuromuscular system and using this information to optimize treatments and rehabilitation strategies to improve breathing and related behaviors.
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Affiliation(s)
- David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States; McKnight Brain Institute, University of Florida, Gainesville, FL, United States; Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States.
| | - Sabhya Rana
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States; McKnight Brain Institute, University of Florida, Gainesville, FL, United States; Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States
| | - Ashley J Smuder
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Erica A Dale
- McKnight Brain Institute, University of Florida, Gainesville, FL, United States; Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States; Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
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Molnár T, Domján A, Szűcs M, Surányi A, Bódis J. Utilizing Synergism between the Transverse Abdominal and Pelvic Floor Muscles at Different Postures in Nulliparous Women: A Randomized Case-Control Study. Urol Int 2021; 106:274-281. [PMID: 34814156 DOI: 10.1159/000519590] [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: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to determine the effects of the pelvic floor muscle (PFM) training (PFM-T) in combination with transverse abdominal (TRA) muscle activation (cPFM-T) in female urinary incontinence. METHODS We enrolled nulliparous women in supine (SUG) (n = 22), sitting (SIG) (n = 19), and control (COG) (n = 14) groups. We conducted an 8-week cPFM-T programme. We examined the effect of training on the parameters with the Kruskal-Wallis test, the pairwise comparisons with the Mann-Whitney U test, and the Wilcoxon rank test with the Bonferroni correction. RESULTS Before training, 15 participants reported occasional urinary leakage. After cPFM-T, 7 participants reported that urinary leakage had disappeared. Maximal isometric contraction of the PFMs until fatigue improved significantly in the SUG (p < 0.001) and SIG (p = 0.015) groups but not significantly in the COG group (p = 0.499). Holding time increased in the SUG (p = 0.972) and the SIG (p = 0.717) groups and decreased in the COG group (p = 0.132). The dynamic endurance of the PFM improved significantly in the SUG group (p < 0.001) but not in the SIG (p = 0.798) and the COG (p = 0.153) groups. The number of maximal fast contractions within 1 min increased in both the SUG (p < 0.001) and SIG (p = 0.813) groups and decreased in the COG group (p = 0.257). Relaxation improved significantly in the SIG group (p = 0.011). TRA mucle thickness increased in both training groups. CONCLUSION Slow-twitch fibres of the PFM can be trained effectively with PFM-T in both the body positions.
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Affiliation(s)
- Tímea Molnár
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Andrea Domján
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Andrea Surányi
- Department of Obstetrics and Gynaecology, University of Szeged, Szeged, Hungary
| | - József Bódis
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Vicente-Campos D, Sanchez-Jorge S, Terrón-Manrique P, Guisard M, Collin M, Castaño B, Rodríguez-Sanz D, Becerro-de-Bengoa-Vallejo R, Chicharro JL, Calvo-Lobo C. The Main Role of Diaphragm Muscle as a Mechanism of Hypopressive Abdominal Gymnastics to Improve Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2021; 10:4983. [PMID: 34768502 PMCID: PMC8584898 DOI: 10.3390/jcm10214983] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic low back pain (LBP) has been stated as one of the main health concerns in the XXI century due to its high incidence. OBJECTIVE The objective of this study was to determine the effects of an 8-week program of hypopressive abdominal gymnastics (HAG) on inspiratory muscle strength, diaphragm thickness, disability and pain in patients suffering from non-specific chronic LBP. METHODS A total of 40 patients with chronic LBP were randomly divided into two groups. The experimental group carried out an 8-week supervised program of HAG (two sessions/week), whereas the control group did not receive any treatment. Outcomes were measured before and after the intervention, comprising diaphragm thickness during relaxed respiratory activity, maximal inspiratory pressure (PImax), pain intensity (NRS), pressure pain threshold and responses to four questionnaires: Physical Activity Questionnaire (PAQ), Roland-Morris Disability Questionnaire (RMQ), Central Sensitization Inventory (CSI) and Tampa Scale of Kinesiophobia-11 Items (TSK-11). RESULTS Statistically significant differences (p < 0.05) were observed for greater thickness of the left and right hemi-diaphragms at inspiration, as well as higher PImax and decreased NRS, CSI and RMQ scores in the intervention group. After treatment, the increases in the thickness of the left and right hemi-diaphragms at inspiration and PImax, as well as the decrease in the NRS and RMQ scores, were only predicted by the proposed intervention (R2 = 0.118-0.552). CONCLUSIONS An 8-week HAG intervention seemed to show beneficial effects and predicted an increase in diaphragm thickness and strength during inspiration, as well as a reduction in pain intensity, central sensitization and disability, in patients suffering from chronic non-specific LBP with respect to non-intervention.
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Affiliation(s)
- Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - Sandra Sanchez-Jorge
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - Pablo Terrón-Manrique
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - Marion Guisard
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - Marion Collin
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - Borja Castaño
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain; (D.V.-C.); (S.S.-J.); (P.T.-M.); (M.G.); (M.C.); (B.C.)
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.R.-S.); (R.B.-d.-B.-V.); (C.C.-L.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.R.-S.); (R.B.-d.-B.-V.); (C.C.-L.)
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.R.-S.); (R.B.-d.-B.-V.); (C.C.-L.)
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Ghavipanje V, Rahimi NM, Akhlaghi F. Six Weeks Effects of Dynamic Neuromuscular Stabilization (DNS) Training in Obese Postpartum Women With Low Back Pain: A Randomized Controlled Trial. Biol Res Nurs 2021; 24:106-114. [PMID: 34555964 DOI: 10.1177/10998004211044828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The worldwide prevalence of obesity and low back pain (LBP) has recently dramatically increased and is mainly indicated among postpartum women, leading to a range of adverse health consequences. OBJECTIVE This study aimed to investigate the effects of 6 weeks of Dynamic Neuromuscular Stabilization training (DNS) in obese postpartum women with LBP. METHOD This was a pretest-posttest study design. The study was conducted with 40 obese postpartum women with LBP randomized to receive DNS (n = 20) or General Exercise (GE, n = 20) 6 times a week for 6 weeks. The data were gathered before and after the 6-week intervention. RESULTS Forty participants completed the study (mean ± SD, age 29.30 ± 3.77 years; weight 88.10 ± 6.09 kg; height 165.40 ± 6.31 cm; and BMI, 32.19 ± 1.07 kg/m2). The overall group-by-time interaction was significant for Numeric Pain-Rating Scale, Modified Oswestry Disability Questionnaire, Fear-Avoidance Beliefs Questionnaire, Inspiration and Expiration Breath Hold Time, and Respiratory Rate outcomes. The global rating of change was significantly different between groups (p < .05). The rate of improvement was higher in the DNS group compared to the GE group in all 6 tests. CONCLUSION The present study confirms that DNS is applicable in obese postpartum women with LBP and effectively improved NPRS, MODQ, FABQ, BHT, and RR. It is clinically suggested that DNS is imperative based on ideal ontogenetic patterns to attain optimal results for obese postpartum women with LBP.
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Affiliation(s)
- Vajihe Ghavipanje
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
| | | | - Farideh Akhlaghi
- Obstetrics & Gynecology, Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial. PLoS One 2021; 16:e0257595. [PMID: 34555068 PMCID: PMC8460029 DOI: 10.1371/journal.pone.0257595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD). METHODS We studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PImax) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PImax increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week. RESULTS After the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PImax (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPImax and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027). CONCLUSION Compared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients. TRIAL REGISTRATION The trial registry name: Clinical Trials; Registration number: NCT04084405; URL: https://clinicaltrials.gov/ct2/show/NCT04084405.
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Affiliation(s)
- Bilel Tounsi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amal Acheche
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thierry Lelard
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
| | - Zouhair Tabka
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Yassine Trabelsi
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Said Ahmaidi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
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Marugán-Rubio D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Vicente-Campos D, Dávila-Sánchez GJ, Calvo-Lobo C. Concurrent Validity and Reliability of Manual Versus Specific Device Transcostal Measurements for Breathing Diaphragm Thickness by Ultrasonography in Lumbopelvic Pain Athletes. SENSORS 2021; 21:s21134329. [PMID: 34202716 PMCID: PMC8272009 DOI: 10.3390/s21134329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations (r) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852-0.996, SEM = 0.0002-0.054, and MDC = 0.002-0.072), and most measurements did not show significant systematic errors (p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714-0.997, SEM = 0.003-0.023, and MDC = 0.008-0.064 cm), several significant systematic measurement errors (p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate (r = 0.486-0.718; p < 0.05). Bland-Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.
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Affiliation(s)
- Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | - Jose L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | | | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
- Correspondence:
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
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Jiroumaru T, Wachi M, Noguchi S, Ikeya M, Hattori T, Fujitani R, Suzuki M, Tanida S, Shichiri N, Fujikawa T. Is the diaphragm thickness related to gait speed in patients with hemiplegia caused by cerebrovascular accident? J Phys Ther Sci 2021; 33:450-454. [PMID: 34177107 PMCID: PMC8219597 DOI: 10.1589/jpts.33.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We aimed to determine the relationship between gait speed and diaphragm thickness in community-residing patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] We recruited 11 elderly participants (six male and five female, mean age 71.1 ± 13.6 years) from an outpatient rehabilitation unit. The inclusion criteria were as follows: patients with hemiplegia caused by cerebrovascular accidents, those able to walk without assistance, and those able to understand our instructions. We measured the diaphragm thickness on both the paretic and non-paretic sides in each participant during maximum exhalation and inhalation during three laboured breaths by ultrasonography with a 7.5-MHz linear scanner. The liner scanner was placed on the eighth or ninth rib between the anterior and middle axillary lines. And their gait speed was measured during a 10 m walk. [Results] There was a strong positive correlation between gait speed and the ratio of diaphragm thickness between the paretic and the non-paretic sides during maximal inspiration. The other measured parameters did not show significant correlation with gait speed. [Conclusion] The symmetrical thickness of the diaphragm is a key factor in increasing gait speed in patients with hemiplegia. These findings may contribute to the development of trunk muscle strength-training programs that improve trunk function and gait speed in patients with hemiplegia.
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Affiliation(s)
- Takumi Jiroumaru
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
| | - Michio Wachi
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
| | - Shinichi Noguchi
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
| | - Masae Ikeya
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
| | | | - Ryo Fujitani
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
| | - Mika Suzuki
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi, Shiga 527-0145, Japan
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Cramberg M, Greer S, Young BA. The functional morphology of the postpulmonary septum of the American alligator (Alligator mississippiensis). Anat Rec (Hoboken) 2021; 305:3055-3074. [PMID: 34128345 DOI: 10.1002/ar.24692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/22/2021] [Accepted: 04/03/2021] [Indexed: 11/08/2022]
Abstract
The American alligator (Alligator mississippiensis) has a postpulmonary septum (PPS) that partitions the intracoelomic cavity. The PPS adheres to the capsule of the liver caudally and to the visceral pleura of the lung cranially; the ventrolateral portions of the PPS are invested with smooth muscle, the remainder is tendinous. Differential pressure transducers were used to record the intrathoracic (ITP) and intraperitoneal (IPP) pressures, and determine the transdiaphragmatic pressure (TDP). Each ventilatory pulse resulted in a pulse in ITP and a significantly lower pulse in IPP; meaning that a TDP was established, and that the pleural and peritoneal cavities were functionally isolated. The anesthetized alligators were tilted 30° head-up or head-down in order to displace the liver. Head-up rotations caused a significant increase in IPP, and a significant decrease in ITP (which became negative); head-down rotations produced the opposite effect. During these rotations, the PPS maintained opposite pressures (positive or negative) in the pleural and peritoneal cavities, and established TDPs greater than have been reported for some mammals. Two types of "breaths" were recorded during these experiments. The first was interpreted as a contraction of the diaphragmaticus muscle, which displaces the liver caudally; these breaths had the same effect as the head-up rotations. The second type of breath was interpreted as constriction of the thoracic and abdominal body walls; this type of breath produced pronounced, long-duration, roughly parallel, increases in ITP and IPP. The smooth muscle within the PPS is suggestive of higher-order adjustment or tuning of the PPS's tensile state.
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Affiliation(s)
- Michael Cramberg
- Department of Anatomy, Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
| | - Skye Greer
- Department of Anatomy, Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
| | - Bruce A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
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Ziaeifar M, Sarrafzadeh J, Noorizadeh Dehkordi S, Arab AM, Haghighatkhah H, Zendehdel Jadehkenari A. Diaphragm thickness, thickness change, and excursion in subjects with and without nonspecific low back pain using B-mode and M-mode ultrasonography. Physiother Theory Pract 2021; 38:2441-2451. [PMID: 34061721 DOI: 10.1080/09593985.2021.1926022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Previous studies have demonstrated that respiratory dysfunction has a potential association with low back pain (LBP). Despite the role of the diaphragm for respiration and spinal stability, knowledge of the function of both sides of the diaphragm in subjects with LBP is still limited.Objective: This study aimed to compare the structural integrity and function of the right and left hemidiaphragm by ultrasonography (USG) in subjects with and without nonspecific chronic low back pain (NS-CLBP).Methods: A total of 37 subjects with NS-CLBP and 34 healthy subjects participated in this case-control study. The thickness, thickness change, and excursion of the right and left hemidiaphragm were compared within and between the groups during quiet breathing (QB) and deep breathing (DB) through B-mode and M-mode ultrasound imaging.Results: The LBP group had a significantly smaller degree of right hemidiaphragm thickness change (P = .001) compared with the healthy control group, with a strong effect size. Nevertheless, there was no significant change for diaphragm thickness and excursion between the two groups. The result showed that, in the healthy group, the right hemidiaphragm had a significantly smaller thickness at expiration and larger thickness change compared with the left hemidiaphragm, with a moderate effect size. Based on the multivariate prediction analysis, the right hemidiaphragm thickness change might significantly predict LBP.Conclusion: We found that participants with LBP had a smaller degree of right hemidiaphragm thickness change. Also, the right hemidiaphragm thickness change might significantly predict LBP.
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Affiliation(s)
- Maryam Ziaeifar
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Javad Sarrafzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Amir Massoud Arab
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Haghighatkhah
- Radiology Department of Diagnosis Imaging Shohadae Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Alieh Zendehdel Jadehkenari
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
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Guo J, Guo W, Ren G. Embodiment of intra-abdominal pressure in a flexible multibody model of the trunk and the spinal unloading effects during static lifting tasks. Biomech Model Mechanobiol 2021; 20:1599-1626. [PMID: 34050846 DOI: 10.1007/s10237-021-01465-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
The role of intra-abdominal pressure (IAP) in spinal load reduction has remained controversial, partly because previous musculoskeletal models did not introduce the pressure generating mechanism. In this study, an integrated computational methodology is proposed to combine the IAP change with core muscle activations. An ideal gas relationship was introduced to calculate pressure distribution within the abdominal cavity. Additionally, based on flexible multibody dynamics, a muscle membrane element was developed by incorporating the muscular fiber deformation, inter-fiber stiffness, and volume constancy. This element was then utilized in discretizing the diaphragm and transversus abdominis, forming an IAP-muscle coupling system of the abdominal cavity. Based on this methodology, a forward dynamic simulation of spinal flexion was presented to examine the unloading effect of abdominal breathing. The results confirm that core muscle contraction during the abdominal breathing cycle can substantially reduce the forces of spinal compression together with trunk extensor muscles, and this effect is more pronounced when the IAP increase is produced by contraction of the transversus abdominis. This unloading effect still holds even with the co-activation of other abdominal muscles, providing a potential choice when designing trunk movements during weight-lifting tasks.
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Affiliation(s)
- Jianqiao Guo
- MOE Key Laboratory of Dynamics and Control of Flight Vehicle, School of Aerospace Engineering, Beijing Institute of Technology, Beijing, 100081, China.
| | - Wei Guo
- Air Force Medical Center, PLA, Beijing, 100142, China
| | - Gexue Ren
- Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
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Relationship between Respiratory Muscle Function and Postural Stability in Male Soccer Players: A Case-Control Study. Healthcare (Basel) 2021; 9:healthcare9060644. [PMID: 34072426 PMCID: PMC8228465 DOI: 10.3390/healthcare9060644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
The important role of postural stability in exercise performance has been determined by several authors. Despite this, few studies have analyzed the relationship between respiratory muscles’ strength and postural stability in athletes. For this reason, the aim of this study was to investigate the relationship between postural stability and respiratory muscles’ function in male soccer players. A case-control study was conducted over twenty-eight healthy men (18 soccer players; 10 non-athletes). Inspiratory muscle strength (MIP) and respiratory resistance (MVV) were obtained through a digital spirometer. Stability variables were obtained in standing position on a stabilometric platform and in open and closed eyes conditions. The area and length of the center of pressures and displacements in the X and Y range were analyzed. Pearson’s coefficient was used to measure the linear correlation between MIP, MVV and stabilometric variables. In the soccer players’ group, MIP and MIP % predictive were inversely correlated with length (r = −0.535 and r = −0.585; p < 0.05) and X range (r = −0.527 and r = −0.560; p < 0.05), whereas MVV was directly correlated with length (r = 0.606; p < 0.01) and Y range (r = 0.558; p < 0.05). Our results show that the greater the inspiratory muscle strength, the less displacement of the pressure center, while at higher respiratory rates there is greater displacement.
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Pouw W, de Jonge‐Hoekstra L, Harrison SJ, Paxton A, Dixon JA. Gesture-speech physics in fluent speech and rhythmic upper limb movements. Ann N Y Acad Sci 2021; 1491:89-105. [PMID: 33336809 PMCID: PMC8246948 DOI: 10.1111/nyas.14532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 12/18/2022]
Abstract
It is commonly understood that hand gesture and speech coordination in humans is culturally and cognitively acquired, rather than having a biological basis. Recently, however, the biomechanical physical coupling of arm movements to speech vocalization has been studied in steady-state vocalization and monosyllabic utterances, where forces produced during gesturing are transferred onto the tensioned body, leading to changes in respiratory-related activity and thereby affecting vocalization F0 and intensity. In the current experiment (n = 37), we extend this previous line of work to show that gesture-speech physics also impacts fluent speech. Compared with nonmovement, participants who are producing fluent self-formulated speech while rhythmically moving their limbs demonstrate heightened F0 and amplitude envelope, and such effects are more pronounced for higher-impulse arm versus lower-impulse wrist movement. We replicate that acoustic peaks arise especially during moments of peak impulse (i.e., the beat) of the movement, namely around deceleration phases of the movement. Finally, higher deceleration rates of higher-mass arm movements were related to higher peaks in acoustics. These results confirm a role for physical impulses of gesture affecting the speech system. We discuss the implications of gesture-speech physics for understanding of the emergence of communicative gesture, both ontogenetically and phylogenetically.
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Affiliation(s)
- Wim Pouw
- Center for the Ecological Study of Perception and ActionUniversity of ConnecticutStorrsConnecticut
- Donders Institute for Brain, Cognition and BehaviourRadboud University NijmegenNijmegenthe Netherlands
- Institute for PsycholinguisticsMax Planck NijmegenNijmegenthe Netherlands
| | - Lisette de Jonge‐Hoekstra
- Center for the Ecological Study of Perception and ActionUniversity of ConnecticutStorrsConnecticut
- Faculty of Behavioral and Social SciencesUniversity of GroningenGroningenthe Netherlands
- Royal Dutch KentalisSint‐Michielsgestelthe Netherlands
| | - Steven J. Harrison
- Center for the Ecological Study of Perception and ActionUniversity of ConnecticutStorrsConnecticut
- Department of KinesiologyUniversity of ConnecticutStorrsConnecticut
| | - Alexandra Paxton
- Center for the Ecological Study of Perception and ActionUniversity of ConnecticutStorrsConnecticut
- Department of Psychological SciencesUniversity of ConnecticutStorrsConnecticut
| | - James A. Dixon
- Center for the Ecological Study of Perception and ActionUniversity of ConnecticutStorrsConnecticut
- Department of Psychological SciencesUniversity of ConnecticutStorrsConnecticut
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Osakabe J, Ohya T, Koizumi J, Inada R, Matsumoto T, Umemura Y. Tennis singles match play induces inspiratory muscle fatigue in female tennis players. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2021. [DOI: 10.7600/jpfsm.10.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Jun Koizumi
- School of Health and Sport Sciences, Chukyo University
| | - Ryosuke Inada
- School of Health and Sport Sciences, Chukyo University
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Aguilar-Zafra S, Del Corral T, Montero-González N, de-Gabriel-Hierro A, López-de-Uralde-Villanueva I. Urinary incontinence and impaired physical function are associated with expiratory muscle weakness in patients with multiple sclerosis. Disabil Rehabil 2021; 44:3531-3539. [PMID: 33427502 DOI: 10.1080/09638288.2020.1867908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients with multiple sclerosis (MS) with respiratory muscle weakness could have physical function impairments, given the functional/biomechanical link of the trunk stabilising system. Thus, clinicians could employ new treatment strategies targeting respiratory muscles to improve their physical function. This study pretends to evaluate the relationship between respiratory muscle strength, pulmonary function and pelvic floor function, and also to correlate these variables with physical function (gait function, disability and quality of life) in patients with MS. METHODS 41 patients participated in this descriptive cross-sectional study. Respiratory muscle strength [maximal respiratory pressures (MIP/MEP)], pulmonary function (forced spirometry), pelvic floor function [urinary incontinence (UI)], physical function [Timed Up & Go (TUG) test, Barthel index and health status questionnaire (SF-12)] were evaluated. RESULTS Respiratory muscle strength and pulmonary function were moderately related to UI (MIP: rho = -0.312; MEP: rho = -0.559). MEP was moderately related to physical function (TUG: rho = -0.508; Barthel index: rho = 0.418). Patients with and without expiratory muscle weakness showed differences in UI, pulmonary and physical function. CONCLUSION Patients with MS with greater deterioration in pulmonary function and respiratory muscle strength, especially expiratory muscles, showed greater deterioration in UI and physical function. Expiratory muscle weakness had a negative impact on urinary, physical and pulmonary function.Implications for rehabilitationPulmonary function is associated with urinary incontinence and gait functionality in patients with multiple sclerosis (MS).Expiratory muscle weakness is associated with impaired urinary and physical function in patients with MS.The inclusion of respiratory muscle training to the rehabilitation programs of patients with MS could improve their pelvic floor disorders and physical function.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Téxum S.L Physiotherapy Center, Coslada, Madrid, Spain
| | - Tamara Del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Noelia Montero-González
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Almudena de-Gabriel-Hierro
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther 2020; 44:85-94. [PMID: 33248744 DOI: 10.1016/j.jmpt.2020.07.006] [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: 01/14/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cutoff scores for the Biodex Balance System (BBS) and verify if they could be used to discriminate older people with nonspecific low back pain (NSLBP) with poor postural performance from those with good postural performance. METHODS This cross-sectional study included 52 participants with NSLBP older than 65 years. One level of stability (level 5; intraclass correlation ≥0.70) and 2 conditions (eyes open and eyes closed) were selected for the testing procedure. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI) scores were calculated. The participants were classified into 2 groups: high risk of falling and low risk of falling. Both the receiver operating characteristic and the area under the curve were used to determine the best BBS cutoff values. Binary logistic regression analysis was used to investigate the ability of BBS scores to predict risk of falling. RESULTS BBS cutoff scores in the eyes-open condition (APSI = 2.60, MLSI = 1.95, OSI = 2.95) and eyes-closed condition (APSI = 3.05, MLSI = 2.17, OSI = 3.25) were found to be sensitive and specific in determining postural performance. Participants with index values lower than the cutoff scores had, respectively, 6.42, 4.20, and 3.72 times lower risk of falling in the eyes-open condition and 3.33, 5.50, and 3.00 times lower risk of falling in the eyes-closed condition. The predictive characteristics of the models for risk analysis were excellent and good to excellent. CONCLUSION Our study shows that BBS cutoff scores are sensitive and specific in distinguishing between poor and good postural performance in older people with NSLBP.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
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THE USE OF POSTURAL RESTORATION FOR TREATMENT OF CHRONIC ROTATOR CUFF PATHOLOGY: A CASE REPORT. Int J Sports Phys Ther 2020; 15:832-839. [PMID: 33110703 DOI: 10.26603/ijspt20200832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Postural Restoration Institute® (PRI) theories and rehabilitation techniques focus on restoring balance to anatomical systems. Common postural asymmetries can present in athletes as dysfunctions and limitations. The purpose of this case report was to examine the use of PRI exercises and theories to address pelvic alignment, along with core stabilization, during treatment of shoulder dysfunction in a collegiate volleyball player. Case Description A 22-year-old female volleyball athlete reported unresolved right rotator cuff tendinopathy. She presented with bilateral rib cage flare, anterior pelvic tilt, and bilateral ROM differences in hip and shoulder internal and external rotation. PRI® special test findings included a positive left and right Adduction Drop Test (ADT), positive left Extension Drop, and Hruska Adduction Lift test (left=2, right=3) indicating posterior exterior chain (PEC) pattern of dysfunction. The traditional shoulder rehabilitation program from the previous season was eliminated and a PRI based intervention was performed. Intervention exercises included the 90/90 dead bug diaphragmatic breathing, 90/90 hamstring hip lift, and right sidelying respiratory left adductor pull back. Exercises were performed as three sets of ten diaphragmatic breathing repetitions, a minimum of three times weekly prior to activity. Outcomes Likert scale ratings of pain decreased from a six pre-intervention to two. The left hip gained 10° of internal rotation and the right hip gained 14° of external rotation. Right shoulder internal rotation increased 15°. Hruska Adduction Lift improved to a four bilaterally (right by day 24, and left by day 31). Left extension drop test was negative following day 17. Discussion PRI® exercises focusing on core and pelvic stability translated to improved hip and shoulder ROM, and decreased shoulder pain associated with rotator cuff tendinopathy. By treating pelvic alignment with the PRI® exercises, the ROM imbalance and pain at the shoulder joint were addressed. Conclusion Incorporating PRI exercises and theories into the rehabilitation program of a volleyball player was useful in addressing underlying imbalances throughout the kinetic chain. Level of Evidence 3b.
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Andrýsková A, Lee JH. The Guidelines for Application of Kinesiology Tape for Prevention and Treatment of Sports Injuries. Healthcare (Basel) 2020; 8:healthcare8020144. [PMID: 32466467 PMCID: PMC7349891 DOI: 10.3390/healthcare8020144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/05/2022] Open
Abstract
The number of kinesiology tape’s users is increasing year by year. However, the insufficiency of fundamental knowledge about the appropriate usage of kinesiology tapes can generate undesired side-effects caused by incorrect application of kinesiology tapes and/or denouncement of kinesiology tapes as an ineffective practice. Therefore, it is necessary to arrange a set of general guidelines of kinesiology taping that must be followed. If not, the treatment may have to be ceased due to the side-effects such as skin’s troubles. Another problem, which impeaches effectivity of treatment by kinesiology tapes, is focusing solely on the present area of pain or discomfort. However, such solution is only short-termed and the likelihood of reappearance of the pain is remarkably high. Therefore, it is essential to find and eliminate the origin of the problem. If these fundamentals conditions of tape’s application are satisfied, the treatment by kinesiology tapes may bring us far more better results.
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Affiliation(s)
- Adéla Andrýsková
- Integrated Physical Medicine Institute, Dong-Eui University, Busan 47340, Korea;
| | - Jung-Hoon Lee
- Integrated Physical Medicine Institute, Dong-Eui University, Busan 47340, Korea;
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan 47340, Korea
- Correspondence: ; Tel.: +82-51-890-4222
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Ferraro FV, Gavin JP, Wainwright TW, McConnell AK. Comparison of balance changes after inspiratory muscle or Otago exercise training. PLoS One 2020; 15:e0227379. [PMID: 31978126 PMCID: PMC6980667 DOI: 10.1371/journal.pone.0227379] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.
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Affiliation(s)
- Francesco Vincenzo Ferraro
- Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, England, United Kingdom
- * E-mail:
| | - James Peter Gavin
- School of Health Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Thomas William Wainwright
- Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, England, United Kingdom
- Orthopaedic Research Institute, Bournemouth University Research Institute, Bournemouth University, Bournemouth, England, United Kingdom
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