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Molinaro N, Schena E, Silvestri S, Massaroni C. Breathing Chest Wall Kinematics Assessment through a Single Digital Camera: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6960. [PMID: 37571742 PMCID: PMC10422340 DOI: 10.3390/s23156960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
The identification of respiratory patterns based on the movement of the chest wall can assist in monitoring an individual's health status, particularly those with neuromuscular disorders, such as hemiplegia and Duchenne muscular dystrophy. Thoraco-abdominal asynchrony (TAA) refers to the lack of coordination between the rib cage and abdominal movements, characterized by a time delay in their expansion. Motion capture systems, like optoelectronic plethysmography (OEP), are commonly employed to assess these asynchronous movements. However, alternative technologies able to capture chest wall movements without physical contact, such as RGB digital cameras and time-of-flight digital cameras, can also be utilized due to their accessibility, affordability, and non-invasive nature. This study explores the possibility of using a single RGB digital camera to record the kinematics of the thoracic and abdominal regions by placing four non-reflective markers on the torso. In order to choose the positions of these markers, we previously investigated the movements of 89 chest wall landmarks using OEP. Laboratory tests and volunteer experiments were conducted to assess the viability of the proposed system in capturing the kinematics of the chest wall and estimating various time-related respiratory parameters (i.e., fR, Ti, Te, and Ttot) as well as TAA indexes. The results demonstrate a high level of agreement between the detected chest wall kinematics and the reference data. Furthermore, the system shows promising potential in estimating time-related respiratory parameters and identifying phase shifts indicative of TAA, thus suggesting its feasibility in detecting abnormal chest wall movements without physical contact with a single RGB camera.
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Affiliation(s)
| | | | - Sergio Silvestri
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (N.M.); (E.S.); (C.M.)
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2
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Smyth CME, Winter SL, Dickinson JW. Breathing Pattern Disorders Distinguished from Healthy Breathing Patterns Using Optoelectronic Plethysmography. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2816781. [PMID: 38655165 PMCID: PMC11022780 DOI: 10.1155/2022/2816781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 04/26/2024]
Abstract
There is no gold standard diagnostic method for breathing pattern disorders (BPD) which is commonly diagnosed through the exclusion of other pathologies. Optoelectronic plethysmography (OEP) is a 3D motion capture technique that provides a comprehensive noninvasive assessment of chest wall during rest and exercise. The purpose of this study was to determine if OEP can distinguish between active individuals classified with and without BPD at rest and during exercise. Forty-seven individuals with a healthy breathing pattern (HBP) and twenty-six individuals with a BPD performed a submaximal exercise challenge. OEP measured the movement of the chest wall through the calculation of timing, percentage contribution, and phase angle breathing pattern variables. A mixed model repeated measures ANOVA analysed the OEP variables between the groups classified as HBP and BPD at rest, during exercise, and after recovery. At rest, regional contribution variables including ribcage percentage contribution (HBP: 71% and BPD: 69%), abdominal ribcage contribution (HBP: 13% and BPD: 11%), abdomen percentage contribution (HBP: 29% and BPD: 31%), and ribcage and abdomen volume index (HPB: 2.5 and BPD: 2.2) were significantly (p < 0.05) different between groups. During exercise, BPD displayed significantly (p < 0.05) more asynchrony between various thoracic compartments including the ribcage and abdomen phase angle (HBP: -1.9 and BPD: -2.7), pulmonary ribcage and abdomen phase angle (HBP: -0.5 and BPD, 0.5), abdominal ribcage and shoulders phase angle (HBP: -0.3 and BPD: 0.6), and pulmonary ribcage and shoulders phase angle (HBP: 0.2 and BPD: 0.6). Additionally, the novel variables inhale deviation (HBP: 8.8% and BPD: 19.7%) and exhale deviation (HBP: -10.9% and BPD: -17.6%) were also significantly (p < 0.05) different between the groups during high intensity exercise. Regional contribution and phase angles measured via OEP can distinguish BPD from HBP at rest and during exercise. Characteristics of BPD include asynchronous and thoracic dominant breathing patterns that could form part of future objective criteria for the diagnosis of BPD.
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Affiliation(s)
- Carol M. E. Smyth
- School of Sport and Exercise Sciences, University of Kent, Chipperfield Building, Canterbury Kent CT2 7NZ, UK
| | - Samantha L. Winter
- School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine, Loughborough LE11 3TT, UK
| | - John W. Dickinson
- School of Sport and Exercise Sciences, University of Kent, Chipperfield Building, Canterbury Kent CT2 7NZ, UK
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Zaltieri M, Massaroni C, Di Tocco J, Bravi M, Morrone M, Sterzi S, Caponero MA, Schena E, Lo Presti D. Preliminary Assessment of a Flexible Multi-Sensor Wearable System Based on Fiber Bragg Gratings for Respiratory Monitoring of Hemiplegic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13525. [PMID: 36294108 PMCID: PMC9603331 DOI: 10.3390/ijerph192013525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Respiratory diseases are common in post-stroke hemiplegic patients and represent a major social problem as they worsen the quality of life and reduce the life span. As a consequence, being able to monitor respiratory parameters such as the respiratory rate (RR) and assess the presence of respiratory asynchronies could be of paramount importance to define hemiplegics' health status. Moreover, RR is a useful parameter to investigate the level of fatigue and distress that these patients undergo during rehabilitation processes. Although motion capture systems and flowmeters are the leading instruments for respiratory pattern evaluation, smart wearable systems are gaining ever more acceptance since they allow continuous monitoring by detecting chest wall breathing displacements, ensuring reduced costs and no need for dedicated spaces. Among other sensing technologies, fiber Bragg grating (FBG) sensors have emerged thanks to their high sensitivity to strain, lightness, and multiplexing capability. In this work, a wearable system composed of four flexible dumbbell-shaped sensing modules is proposed for respiratory monitoring in hemiplegic patients. The system is light and easy to wear and can be adapted to any anthropometry thanks to the modular anchoring system. Its feasibility assessment in RR evaluation was performed on seven hemiplegic volunteers in eupnea and tachypnea breathing conditions. In addition, an explorative investigation was conducted to assess the system's ability to detect asynchronies between torso compartments. The good results suggest that this device could be a useful instrument to support clinicians and operators in hemiplegic patients' management.
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Affiliation(s)
- Martina Zaltieri
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Joshua Di Tocco
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Marco Bravi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michelangelo Morrone
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Naz I, Aktas B, Sahin H, Ozer Kaya D. Static and Dynamic Postural Characteristics in Patients with Chronic Obstructive Pulmonary Disease: The Relationship with Dyspnea and Pulmonary Functions. Heart Lung 2022; 54:27-33. [PMID: 35313256 DOI: 10.1016/j.hrtlng.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is little evidence about posture influence and its relationship with pulmonary functions in chronic obstructive pulmonary diseases(COPD) patients. OBJECTIVES To compare spinal curvature, mobility, and postural competency in participants with and without COPD and investigate the relationship of postural characteristics with dyspnea and pulmonary functions in COPD patients. METHODS We included 47 COPD patients and 47 age and gender-matched controls in our cross-sectional study. Participants underwent the following evaluations: modified Medical Research Council Dyspnea Scale, respiratory function test, and postural measurements in the sagittal plane in a standing position using a non-invasive, computer-assisted electromechanical device. Postural variables were compared between groups, and the relationship between postural variables with dyspnea and pulmonary functions was analyzed by multivariate regression analysis. RESULTS Thoracic and lumbar curvature were higher (p<0.05), thoracic mobility and spinal inclination were lower (p=0.011, p=0.030, respectively) in patients with COPD. Thoracic angle and spinal inclination increased in COPD patients (p=0.040, p=0.011, respectively) while only spinal tilt increased in the control group (p=0.010) under spinal loading. Thoracic angle and mobility were related with dyspnea (r2=0.25, p<0.001), forced expiratory volume in the first second (r2=0.56, p<0.001), forced vital capacity (r2=0.41, p<0.001), and RV (r2 = 0.42, p<0.001). CONCLUSION COPD patients had greater thoracic and lumbar angles in the static upright posture and lower thoracic mobility and spinal inclination in the sagittal plane. It was observed that patients increase their thoracic angles to maintain postural stability in dynamic conditions. Thoracic angle and mobility were related to dyspnea and pulmonary functions.
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Affiliation(s)
- Ilknur Naz
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey.
| | - Büsra Aktas
- Izmir Kâtip Celebi University, Institute of Health Sciences, Izmir, Turkey
| | - Hulya Sahin
- University of Health Sciences, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Clinic, Izmir, Turkey
| | - Derya Ozer Kaya
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
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Sánchez Romero EA, Corbellini C, Rossino E, Massaccesi R, Battaglino A, Pedersini P, Villafañe JH. Improvements in Perimeter Thoracic Mobility on Patients with COPD after Pulmonary Rehabilitation: A Case Series. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/11671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hino T, Tsunomori A, Hata A, Hida T, Yamada Y, Ueyama M, Yoneyama T, Kurosaki A, Kamitani T, Ishigami K, Fukumoto T, Kudoh S, Hatabu H. Vector-field dynamic x-ray (VF-DXR) using optical flow method in patients with chronic obstructive pulmonary disease. Eur Radiol Exp 2022; 6:4. [PMID: 35099604 PMCID: PMC8802288 DOI: 10.1186/s41747-021-00254-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We assessed the difference in lung motion during inspiration/expiration between chronic obstructive pulmonary disease (COPD) patients and healthy volunteers using vector-field dynamic x-ray (VF-DXR) with optical flow method (OFM). METHODS We enrolled 36 COPD patients and 47 healthy volunteers, classified according to pulmonary function into: normal, COPD mild, and COPD severe. Contrast gradient was obtained from sequential dynamic x-ray (DXR) and converted to motion vector using OFM. VF-DXR images were created by projection of the vertical component of lung motion vectors onto DXR images. The maximum magnitude of lung motion vectors in tidal inspiration/expiration, forced inspiration/expiration were selected and defined as lung motion velocity (LMV). Correlations between LMV with demographics and pulmonary function and differences in LMV between COPD patients and healthy volunteers were investigated. RESULTS Negative correlations were confirmed between LMV and % forced expiratory volume in one second (%FEV1) in the tidal inspiration in the right lung (Spearman's rank correlation coefficient, rs = -0.47, p < 0.001) and the left lung (rs = -0.32, p = 0.033). A positive correlation between LMV and %FEV1 in the tidal expiration was observed only in the right lung (rs = 0.25, p = 0.024). LMVs among normal, COPD mild and COPD severe groups were different in the tidal respiration. COPD mild group showed a significantly larger magnitude of LMV compared with the normal group. CONCLUSIONS In the tidal inspiration, the lung parenchyma moved faster in COPD patients compared with healthy volunteers. VF-DXR was feasible for the assessment of lung parenchyma using LMV.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Akinori Tsunomori
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Tsutomu Yoneyama
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Takenori Fukumoto
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, 1-3-12 Kanda-Misakicho, Chiyoda-ku, Tokyo, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Measurement of chest wall motion using a motion capture system with the one-pitch phase analysis method. Sci Rep 2021; 11:21497. [PMID: 34728740 PMCID: PMC8563798 DOI: 10.1038/s41598-021-01033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
Spirometry is a standard method for assessing lung function. However, its use is challenging in some patients, and it has limitations such as risk of infection and inability to assess regional chest wall motion. A three-dimensional motion capture system using the one-pitch phase analysis (MCO) method can facilitate high precision measurement of moving objects in real-time in a non-contacting manner. In this study, the MCO method was applied to examine thoraco-abdominal (TA) wall motion for assessing pulmonary function. We recruited 48 male participants, and all underwent spirometry and chest wall motion measurement with the MCO method. A significant positive correlation was observed between the vital capacity (Spearman’s ρ = 0.68, p < 0.0001), forced vital capacity (Spearman’s ρ = 0.62, p < 0.0001), and tidal volume (Spearman’s ρ = 0.61, p < 0.0001) of spirometry and the counterpart parameters of MCO method. Moreover, the MCO method could detect regional rib cage and abdomen compartment contributions and could assess TA asynchrony, indicating almost complete synchronous movement (phase angle for each compartment: − 5.05° to 3.86°). These findings suggest that this technique could examine chest wall motion, and may be effective in analyzing chest wall volume changes and pulmonary function.
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Morales Tellez JF, Moeyersons J, Testelmans D, Buyse B, Borzée P, Van Hoof C, Groenendaal W, Van Huffel S, Varon C. Technical aspects of cardiorespiratory estimation using subspace projections and cross entropy. Physiol Meas 2021; 42. [PMID: 34571494 DOI: 10.1088/1361-6579/ac2a70] [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: 06/02/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Respiratory sinus arrhythmia (RSA) is a form of cardiorespiratory coupling. Its quantification has been suggested as a biomarker to diagnose different diseases. Two state-of-the-art methods, based on subspace projections and entropy, are used to estimate the RSA strength and are evaluated in this paper. Their computation requires the selection of a model order, and their performance is strongly related to the temporal and spectral characteristics of the cardiorespiratory signals. OBJECTIVE To evaluate the robustness of the RSA estimates to the selection of model order, delays, changes of phase and irregular heartbeats as well as to give recommendations for their interpretation on each case. APPROACH Simulations were used to evaluate the model order selection when calculating the RSA estimates explained before, as well as 3 different scenarios that can occur in signals acquired in non-controlled environments and/or from patient populations: the presence of irregular heartbeats; the occurrence of delays between heart rate variability (HRV) and respiratory signals; and the changes over time of the phase between HRV and respiratory signals. MAIN RESULTS It was found that using a single model order for all the calculations suffices to characterize the RSA estimates correctly. In addition, the RSA estimation in signals containing more than 5 irregular heartbeats in a period of 5 minutes might be misleading. Regarding the delays between HRV and respiratory signals, both estimates are robust. For the last scenario, the two approaches tolerate phase changes up to 54°, as long as this lasts less than one fifth of the recording duration. SIGNIFICANCE Guidelines are given to compute the RSA estimates in non-controlled environments and patient populations.
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Affiliation(s)
- John Fredy Morales Tellez
- ESAT - STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Flanders, BELGIUM
| | - Jonathan Moeyersons
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Flanders, BELGIUM
| | - Dries Testelmans
- Department of Pneumology, KU Leuven University Hospitals Leuven, Leuven, BELGIUM
| | - Bertien Buyse
- Department of Respiratory Diseases, KUL UZ Gasthuisberg, Leuven, Flanders, BELGIUM
| | - Pascal Borzée
- Department of Pneumology, KU Leuven University Hospitals Leuven, Leuven, BELGIUM
| | | | | | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Flanders, BELGIUM
| | - Carolina Varon
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Flanders, BELGIUM
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9
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Marques L, Fregonezi GADF, Marcelino AA, Dourado-Júnior MET, Sarmento A, Pennati F, Aliverti A, Resqueti VR. Thoracoabdominal asynchrony and paradoxical motion in Duchenne muscular dystrophy and healthy subjects during cough: A case control study. Pediatr Pulmonol 2021; 56:2136-2145. [PMID: 33866686 DOI: 10.1002/ppul.25412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess thoracoabdominal asynchrony (TAA) and inspiratory paradoxical motion at different positionings in subjects with Duchenne muscular dystrophy (DMD) versus healthy subjects during quiet spontaneous breathing (QB) and cough. METHODS This is a case control study with a matched-pair design. We assessed 14 DMD subjects and 12 controls using optoelectronic plethysmography (OEP) during QB and spontaneous cough in 3 positions: supine, supine with headrest raised at 45°, and sitting with back support at 80°. The TAA was assessed using phase angle (θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB), as well as the percentage of inspiratory time the RCp (IPRCp ), RCa (IPRCa ), and AB (IPAB ) moved in opposite directions. RESULTS During cough, DMD group showed higher RCp and RCa θ (p < .05), RCp and AB θ (p < .05) in supine and 45° positions, and higher RCp and Rca θ (p = .006) only in supine position compared with controls. Regarding the intragroup analysis, during cough, DMD group presented higher RCp and AB θ (p = .02) and RCa and AB θ (p = .002) in supine and higher RCa and AB θ (p = .002) in 45° position when compared to 80°. Receiver operating characteristic curve analyzes were able to discriminate TAA between controls and DMD in RCa supine position (area under the curve: 0.81, sensibility: 78.6% and specificity: 91.7%, p = .001). CONCLUSION Subjects with DMD yields TAA with insufficient deflation of chest wall compartments and rib cage distortion during cough, by noninvasive assessment.
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Affiliation(s)
- Layana Marques
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Guilherme Augusto de Freitas Fregonezi
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Ana Aline Marcelino
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | | | - Antonio Sarmento
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
| | - Francesca Pennati
- The Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- The Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Vanessa Regiane Resqueti
- Departamento de Fisioterapia, Pneumo CardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil.,Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil
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10
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Vieira DSR, Mendes LPS, Alencar MCN, Hoffman M, Albuquerque ALP, Silveira BMF, Aguiar SC, Parreira VF. Rib cage distortion and dynamic hyperinflation during two exercise intensities in people with COPD. Respir Physiol Neurobiol 2021; 293:103724. [PMID: 34174483 DOI: 10.1016/j.resp.2021.103724] [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: 01/03/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between rib cage (RC) motion abnormalities, dynamic hyperinflation (DH), and exercise capacity in people with COPD is controversial. AIM To investigate RC distortion and operational chest wall volumes during moderate and high constant-rate exercises in people with COPD. METHODS Seven male participants [median(Q1-Q3) age: 63(60.0-66.0) years; FEV1: 39.0(38.0-63.0)% of predicted] performed a symptom-limited incremental exercise testing on cycle ergometer, followed by constant-rate tests (60 % and 80 % of peak work rate). Optoelectronic plethysmography was used to evaluate RC distortion: phase angle-PhAng, inspiratory phase ratio-PhRIB, expiratory phase ratio-PhREB; and chest wall volumes: end-inspiratory volume-Vei and end-expiratory volume-Vee. RESULTS PhRIB and PhREB significantly increased during both constant-rate exercise tests, without difference between them. In general, Vei of the chest wall significantly increased in both exercise intensities while Vee did not change. CONCLUSIONS The occurrence of RC distortion seemed not to limit the exercise capacity in people with COPD evaluated, and it was present even in the absence of DH.
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Affiliation(s)
- Danielle S R Vieira
- Rehabilitation Sciences Graduation Program, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil; Department of Health Sciences, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil
| | - Liliane P S Mendes
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Clara N Alencar
- Clinics Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Hoffman
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Andre L P Albuquerque
- Pulmonary Division, Heart Institute (Incor), University of Sao Paulo Medical School, Avenida Dr Enéas de Carvalho Aguiar, 44, Jardim Paulista, 05403-900, Sao Paulo, Brazil
| | - Bruna M F Silveira
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Susana C Aguiar
- Rehabilitation Sciences Graduation Program, Universidade Federal de Santa Catarina, Rodovia Governador Jorge Lacerda, Jardim das Avenidas, 89906-072, Araranguá, Santa Catarina, Brazil
| | - Verônica F Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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de Paula Silveira L, Magalhães FA, de Oliveira Holanda NS, Bezerra MYG, Bomtempo RAB, Pereira SA, Ribeiro SNS. Respiratory synchrony comparison between preterm and full-term neonates using inertial sensors. Pediatr Pulmonol 2021; 56:1763-1770. [PMID: 33631063 DOI: 10.1002/ppul.25323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Due to inefficient respiratory control, newborns become prone to asynchronous thoracoabdominal (TA) movements. The present study quantitatively estimated the synchrony of TA in preterm and full-term newborns through an inertial and magnetic measurement units (IMMUs) system. METHODS This cross-sectional study was conducted with 20 newborns divided into Preterm Group (PTG, n = 10) and Full-Term Group (FTG, n = 10). Each neonate had IMMUs placed on the sternum and near the umbilicus, thus the TA motion was estimated through the resultant inclination angles calculated using a sensor fusion filter. The respiratory incursions were also manually counted and video-recorded for two minutes, then used to validate a Matlab custom-written routine for their automatic identification. The respiratory cycles were used to calculate the phase change angle (φ) between the thoracic and abdominal compartments. Association between the manual and automatic methods were verified by Pearson's correlation and root mean squared errors (RMSE), and the comparison between the groups was performed through the Student's t test with α = .05. RESULTS The values of respiratory incursions measured by both methods showed a high association and low measurement error (r = .96, RMSE = 9.8, p < .001). The FTG presented a higher occurrence of TA synchrony (p = .049) while the PTG group presented a higher occurrence of TA asynchrony (p = .036). No difference was found between the groups regarding the paradoxical classification (p = .071). CONCLUSION The proposed method was valid to quantitatively assess the TA synchrony of hospitalized neonates. Preterm infants had a higher occurrence of the asynchronous respiratory pattern in comparison to full-term infants.
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Affiliation(s)
- Letícia de Paula Silveira
- Graduate Program in Neonatology with emphasis in Physiotherapy, Hospital Maternidade Sofia Feldman, Belo Horizonte, Minas Gerais, Brazil
| | - Fabrício Anicio Magalhães
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Norrara Scarlytt de Oliveira Holanda
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Mickaelly Yanaê Gomes Bezerra
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Raffi Antunes Braga Bomtempo
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Alves Pereira
- Graduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Simone Nascimento Santos Ribeiro
- Graduate Program in Neonatology with emphasis in Physiotherapy, Hospital Maternidade Sofia Feldman, Belo Horizonte, Minas Gerais, Brazil.,Undergraduate Course in Physical Therapy, Faculdade de Ciências Médicas, Belo Horizonte, Brazil
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12
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Kipp S, Leahy MG, Hanna JA, Sheel AW. Partitioning the work of breathing during running and cycling using optoelectronic plethysmography. J Appl Physiol (1985) 2021; 130:1460-1469. [PMID: 33703946 DOI: 10.1152/japplphysiol.00945.2020] [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: 11/22/2022] Open
Abstract
Work of breathing ([Formula: see text]) derived from a single lung volume and pleural pressure is limited and does not fully characterize the mechanical work done by the respiratory musculature. It has long been known that abdominal activation increases with increasing exercise intensity, yet the mechanical work done by these muscles is not reflected in [Formula: see text]. Using optoelectronic plethysmography (OEP), we sought to show first that the volumes obtained from OEP (VCW) were comparable to volumes obtained from flow integration (Vt) during cycling and running, and second, to show that partitioned volume from OEP could be utilized to quantify the mechanical work done by the rib cage ([Formula: see text]RC) and abdomen ([Formula: see text]AB) during exercise. We fit 11 subjects (6 males/5 females) with reflective markers and balloon catheters. Subjects completed an incremental ramp cycling test to exhaustion and a series of submaximal running trials. We found good agreement between VCW versus Vt during cycling (bias = 0.002; P > 0.05) and running (bias = 0.016; P > 0.05). From rest to maximal exercise,[Formula: see text]AB increased by 84% (range: 30%-99%; [Formula: see text]AB: 1 ± 1 J/min to 61 ± 52 J/min). The relative contribution of the abdomen increased from 17 ± 9% at rest to 26 ± 16% during maximal exercise. Our study highlights and provides a quantitative measure of the role of the abdominal muscles during exercise. Incorporating the work done by the abdomen allows for a greater understanding of the mechanical tasks required by the respiratory muscles and could provide further insight into how the respiratory system functions during disease and injury.NEW & NOTEWORTHY We demonstrated that optoelectronic plethysmography (OEP) is a reliable tool to determine ventilatory volume changes during cycling and running, without restricting natural upper arm movements. Second, using OEP volumes coupled with pressure-derived measures, we calculated the work done by the rib cage and abdomen, respectively, during exercise. Collectively, our findings indicate that pulmonary mechanics can be accurately quantified using OEP, and abdominal work performed during ventilation contributes substantially to the overall work of the respiratory musculature.
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Affiliation(s)
- Shalaya Kipp
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob A Hanna
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Santana PV, Cardenas LZ, Ferreira JG, de Carvalho CRR, de Albuquerque ALP, Caruso P. Thoracoabdominal asynchrony associates with exercise intolerance in fibrotic interstitial lung diseases. Respirology 2021; 26:673-682. [PMID: 33860975 DOI: 10.1111/resp.14064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/07/2021] [Accepted: 03/31/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE The precise coordination of respiratory muscles during exercise minimizes work of breathing and avoids exercise intolerance. Fibrotic interstitial lung disease (f-ILD) patients are exercise-intolerant. We assessed whether respiratory muscle incoordination and thoracoabdominal asynchrony (TAA) occur in f-ILD during exercise, and their relationship with pulmonary function and exercise performance. METHODS We compared breathing pattern, respiratory mechanics, TAA and respiratory muscle recruitment in 31 f-ILD patients and 31 healthy subjects at rest and during incremental cycle exercise. TAA was defined as phase angle (PhAng) >20°. RESULTS During exercise, when compared with controls, f-ILD patients presented increased and early recruitment of inspiratory rib cage muscle (p < 0.05), and an increase in PhAng, indicating TAA. TAA was more frequent in f-ILD patients than in controls, both at 50% of the maximum workload (42.3% vs. 10.7%, p = 0.01) and at the peak (53.8% vs. 23%, p = 0.02). Compared with f-ILD patients without TAA, f-ILD patients with TAA had lower lung volumes (forced vital capacity, p < 0.01), greater dyspnoea (Medical Research Council > 2 in 64.3%, p = 0.02), worse exercise performance (lower maximal work rate % predicted, p = 0.03; lower tidal volume, p = 0.03; greater desaturation and dyspnoea, p < 0.01) and presented higher oesophageal inspiratory pressures with lower gastric inspiratory pressures and higher recruitment of scalene (p < 0.05). CONCLUSION Exercise induces TAA and higher recruitment of inspiratory accessory muscle in ILD patients. TAA during exercise occurred in more severely restricted ILD patients and was associated with exertional dyspnoea, desaturation and limited exercise performance.
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Affiliation(s)
- Pauliane Vieira Santana
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Leticia Zumpano Cardenas
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Jeferson George Ferreira
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sírio-Libanês Teaching and Research Institute, Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Pedro Caruso
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil
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14
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Sustained Abdominal Exercises Affect Abdominal Muscle Activation and Maximal Expiratory Pressures Differently in Healthy Men and Women. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Pinto TF, Fagundes Xavier R, Lunardi AC, Marques da Silva CCB, Moriya HT, Lima Vitorasso R, Torsani V, Amato MBP, Stelmach R, Salge JM, Carvalho-Pinto RM, Carvalho CR. Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD. J Appl Physiol (1985) 2020; 129:492-499. [DOI: 10.1152/japplphysiol.00690.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.
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Affiliation(s)
- Thiago Fernandes Pinto
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Renato Lima Vitorasso
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo Brito Passos Amato
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Celso R.F. Carvalho
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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16
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Capeletti AM, Sousa ADCS, Feitoza CL, Basso-Vanelli RP, Gomes EL, Costa D. Can a physical activity similar to activities of daily living cause dynamic hyperinflation and change the thoracoabdominal configuration in patients with chronic obstructive pulmonary disease? Int J Chron Obstruct Pulmon Dis 2019; 14:1281-1287. [PMID: 31354257 PMCID: PMC6578583 DOI: 10.2147/copd.s196223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/12/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: COPD is characterized by the ventilatory limitation, with reduction of the inspiratory reserve volume and dynamic hyperinflation (DH), which changes the configuration of the thoracic compartment, resulting in a disadvantage in respiratory muscle kinetics, and reduced functional capacity. The optoelectronic plethysmography (OEP) has been used to monitor changes in thoracoabdominal mobility. The Glittre-ADL test is a short battery of functional tests that simulate activities of daily living. In mild and moderate COPD, the effect of Glittre-ADL on thoracoabdominal kinetics and DH is understudied. Objective: The aim of our study was to evaluate the acute effects of the Glittre-ADL test on lung function and thoracoabdominal mobility using OEP in patients with mild and moderate COPD. Materials and methods: Twenty-five male and female patients between 45 and 80 years of age with COPD were submitted to the exercises that simulated Glittre-ADL test. Spirometry and OEP were performed before and after the test. Results: After the Glittre test, increases were found in EV (p=0.005), percentage of contribution of the abdominal compartment (p=0.054) and expiratory reserve volume (ERV) (p=0.006) and reductions were found in the contribution of the upper thoracic compartment (p=0.008) and inspiratory capacity (IC) (p=0.040). Conclusion: The acute effect of ADL was a change in thoracoabdominal kinetics, especially the percentage of contribution of the abdominal compartment, as demonstrated by OEP. These findings, together with the reduction in IC and increase in ERV, after the Glittre-ADL test suggest the occurrence of DH, even in patients with mild to moderate COPD according to the GOLD classification.
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Affiliation(s)
| | | | | | - Renata Pedrolongo Basso-Vanelli
- Spirometry and Respiratory Physiotherapy Laboratory - LEFiR, Universidade Federal de São Carlos - UFSCar , São Carlos, São Paulo, Brazil
| | | | - Dirceu Costa
- Rehabilitation Sciences Program, UNINOVE, São Paulo, Brazil
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17
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De la Fuente C, Weinstein A, Guzman-Venegas R, Arenas J, Cartes J, Soto M, Carpes FP. Use of accelerometers for automatic regional chest movement recognition during tidal breathing in healthy subjects. J Electromyogr Kinesiol 2019; 47:105-112. [PMID: 31158729 DOI: 10.1016/j.jelekin.2019.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 05/11/2019] [Accepted: 05/23/2019] [Indexed: 11/29/2022] Open
Abstract
Recognition of breathing patterns helps clinicians to understand acute and chronic adaptations during exercise and pathological conditions. Wearable technologies combined with a proper data analysis provide a low cost option to monitor chest and abdominal wall movements. Here we set out to determine the feasibility of using accelerometry and machine learning to detect chest-abdominal wall movement patterns during tidal breathing. Furthermore, we determined the accelerometer positions included in the clusters, considering principal component domains. Eleven healthy participants (age: 21 ± 0.2 y, BMI: 23.4 ± 0.7 kg/m2, FEV1: 4.1 ± 0.3 L, VO2: 4.6 ± 0.2 mL/min kg) were included in this cross-sectional study. Spirometry and ergospirometry assessments were performed with participants seated with 13 accelerometers placed over the thorax. Data collection lasted 10 min. Following signal pre-processing, principal components and clustering analyses were performed. The Euclidean distances in respect to centroids were compared between the clusters (p < 0.05), identifying two clusters (p < 0.001). The first cluster included sensors located at the right and left second rib midline, body of sternum, left fourth rib midline, right and left second thoracic vertebra midline, and fifth thoracic vertebra. The second cluster included sensors at the fourth right rib midline, right and left seventh ribs, abdomen at linea alba, and right and left tenth thoracic vertebra midline. Costal-superior and costal-abdominal patterns were also recognized. We conclude that accelerometers placed on the chest and abdominal wall permit the identification of two clusters of movements regarding respiration biomechanics.
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Affiliation(s)
- Carlos De la Fuente
- Laboratorio integrativo de biomecánica y fisiología del esfuerzo, LIBFE, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile; Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile; Centro de Salud Deportivo, Clínica Santa María, Santiago, Chile; Magìster en Ciencias de la Ingenieria, School of Biomedical Engineer, Universidad de Valparaiso, Valparaíso, Chile.
| | - Alejandro Weinstein
- School of Biomedical Engineer, Universidad de Valparaiso, Valparaíso, Chile; Magìster en Ciencias de la Ingenieria, School of Biomedical Engineer, Universidad de Valparaiso, Valparaíso, Chile.
| | - Rodrigo Guzman-Venegas
- Laboratorio integrativo de biomecánica y fisiología del esfuerzo, LIBFE, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile.
| | - Juan Arenas
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile.
| | - Jorge Cartes
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile.
| | - Marcos Soto
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile.
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Universidade Federal do Pampa, Campus Uruguaiana, Uruguaiana, Brazil.
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Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study. PLoS One 2019; 14:e0216641. [PMID: 31095580 PMCID: PMC6522099 DOI: 10.1371/journal.pone.0216641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/26/2019] [Indexed: 11/22/2022] Open
Abstract
Background The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Methods Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. Results In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Conclusion Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.
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19
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de Farias CAC, Gualdi LP, da Silva SB, Parreira VF, Montemezzo D, Resqueti VR, Fregonezi GAF. Effects of different modalities of inspiratory muscle training as an add-on to conventional treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a randomized controlled trial. Trials 2019; 20:231. [PMID: 31014365 PMCID: PMC6480485 DOI: 10.1186/s13063-019-3271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes. METHODS This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals. DISCUSSION The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD. TRIAL REGISTRATION Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.
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Affiliation(s)
- Catharinne Angélica Carvalho de Farias
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Lucien Peroni Gualdi
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte Brazil
| | - Selma Bruno da Silva
- Centro de Reabilitação Cardíaca e Metabólica, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Verônica Franco Parreira
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Dayane Montemezzo
- Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina Brazil
| | - Vanessa R. Resqueti
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Guilherme A. F. Fregonezi
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
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20
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Florêncio RB, Aliverti A, Fagundes MLLC, Batista IPDS, da Nóbrega AJS, Resqueti VR, Fregonezi GADF. Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study. PLoS One 2019; 14:e0213773. [PMID: 30889207 PMCID: PMC6424428 DOI: 10.1371/journal.pone.0213773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chest physiotherapy can be an alternative to increase lung volumes through pulmonary expansion therapies, but there is still inconsistency in the literature in order to determine which device can promote a greater volume increase at the expense of a better ventilatory pattern. Therefore, the aim of this study was to evaluate and compare the chest wall kinematics of healthy subjects submitted to the use of three different devices for pulmonary reexpansion. METHODS Chest wall compartmental and operational volumes, breathing pattern and thoracoabdominal asynchrony were evaluated in 12 healthy individuals through optoelectronic plethysmography during quiet breathing, pulmonary reexpansion and recovery. Three different devices (volume-oriented incentive spirometer-IS-v; positive expiratory pressure-PEP; and incentive spirometer volume and pressure oriented-IS-vp) were administered in a random order with at least 48h between the devices. RESULTS A greater volume variation in the chest wall and its compartments was observed when the IS-vp was used in comparison with the other devices (p<0.05). Furthermore, the IS-vp mobilizes a greater amount of volume accompanied by greater synchronism between the compartments when compared to IS-v (p <0.05). CONCLUSION The IS-vp may be able to increase total and compartmental chest wall volumes, as well as improve synchrony among compartments when compared to IS-v and PEP devices, thus constituting an important tool for treating patients with restrictive ventilatory pattern.
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Affiliation(s)
- Rêncio Bento Florêncio
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Marina Lyra Lima Cabral Fagundes
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ilsa Priscila dos Santos Batista
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antônio José Sarmento da Nóbrega
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Vanessa Regiane Resqueti
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Guilherme Augusto de Freitas Fregonezi
- PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Comparison of Diaphragmatic Stretch Technique and Manual Diaphragm Release Technique on Diaphragmatic Excursion in Chronic Obstructive Pulmonary Disease: A Randomized Crossover Trial. Pulm Med 2019; 2019:6364376. [PMID: 30719351 PMCID: PMC6335861 DOI: 10.1155/2019/6364376] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/06/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) impairs the function of the diaphragm by placing it at a mechanical disadvantage, shortening its operating length and changing the mechanical linkage between its various parts. This makes the diaphragm's contraction less effective in raising and expanding the lower rib cage, thereby increasing the work of breathing and reducing the functional capacity. Aim of the Study To compare the effects of diaphragmatic stretch and manual diaphragm release technique on diaphragmatic excursion in patients with COPD. Materials and Methods This randomised crossover trial included 20 clinically stable patients with mild and moderate COPD classified according to the GOLD criteria. The patients were allocated to group A or group B by block randomization done by primary investigator. The information about the technique was concealed in a sealed opaque envelope and revealed to the patients only after allocation of groups. After taking the demographic data and baseline values of the outcome measures (diaphragm mobility by ultrasonography performed by an experienced radiologist and chest expansion by inch tape performed by the therapist), group A subjects underwent the diaphragmatic stretch technique and the group B subjects underwent the manual diaphragm release technique. Both the interventions were performed in 2 sets of 10 deep breaths with 1-minute interval between the sets. The two outcome variables were recorded immediately after the intervention. A wash-out period of 3 hours was maintained to neutralize the effect of given intervention. Later the patients of group A and group B were crossed over to the other group. Results In the diaphragmatic stretch technique, there was a statistically significant improvement in the diaphragmatic excursion before and after the treatment. On the right side, p=0.00 and p=0.003 in the midclavicular line and midaxillary line. On the left side, p=0.004 and p=0.312 in the midclavicular and midaxillary line. In manual diaphragm release technique, there was a statistically significant improvement before and after the treatment. On the right side, p=0.000 and p=0.000 in the midclavicular line and midaxillary line. On the left side, p=0.002 and p=0.000 in the midclavicular line and midaxillary line. There was no statistically significant difference in diaphragmatic excursion in the comparison of the postintervention values of both techniques. Conclusion The diaphragmatic stretch technique and manual diaphragm release technique can be safely recommended for patients with clinically stable COPD to improve diaphragmatic excursion.
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Sarmento A, Fregonezi G, Dourado-Junior MET, Aliverti A, de Andrade AD, Parreira VF, Resqueti V. Thoracoabdominal asynchrony and paradoxical motion in middle stage amyotrophic lateral sclerosis. Respir Physiol Neurobiol 2018; 259:16-25. [PMID: 29969705 DOI: 10.1016/j.resp.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 11/26/2022]
Abstract
AIM To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,CW), breathing pattern and cough peak flow (CPF). METHODS Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPRCa) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons. RESULTS During quiet breathing, significantly higher RCa and AB θ (p < .05), IPRCa (p = 0.001) and IPAB (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB θ with forced vital capacity (FVC) (r=-0.773, p < 0.01), vital capacity (r=-0.663, p < 0.05) and inspiratory capacity (IC) (r=-0.754, p < 0.01), as well as between RCp and RCa θ with FVC (r=-0.608, p < 0.05) and CPF (r=-0.601, p < 0.05) were found. During coughing, correlations between RCp and AB θ with CPF (r=-0.590, p < 0.05), IC (r=-0.748, p < 0.01) and VT,CW (r=-0.608, p < 0.05), as well as between RCa and AB θ with CPF (r=-0.670, p < 0.05), IC (r=-0.713, p < 0.05) and peak expiratory flow (r=-0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC%pred (p < 0.05) compared to those without paradoxical motion. CONCLUSIONS Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population.
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Affiliation(s)
- Antonio Sarmento
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil
| | - Guilherme Fregonezi
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil
| | | | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | | | | | - Vanessa Resqueti
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte, Brazil.
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Fregonezi G, Sarmento A, Pinto J, LoMauro A, Resqueti V, Aliverti A. Thoracoabdominal Asynchrony Contributes to Exercise Limitation in Mild Asthmatic Subjects. Front Physiol 2018; 9:719. [PMID: 29951002 PMCID: PMC6009101 DOI: 10.3389/fphys.2018.00719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to better understand how subjects with stable asthma and without exercise-induced bronchoconstriction respond to mild exercise. Breathing pattern, chest wall compartmental and operational volumes, and thoracoabdominal asynchrony were assessed in 11 stable asthmatic subjects and 10 healthy subjects at rest and during exercise in a cycle-ergometer through optoelectronic plethysmography. Dyspnea and sensation of leg effort were assessed through Borg scale. During exercise, with similar minute ventilation, a significant lower chest wall tidal volume (p = 0.003) as well as a higher respiratory rate (p < 0.05) and rapid shallow breathing (p < 0.05) were observed in asthmatic when compared to healthy subjects. Asthmatic subjects exhibited a significantly lower inspiratory (p < 0.05) and expiratory times (p < 0.05). Intergroup analysis found a significant higher end-expiratory chest wall volume in asthmatic subjects, mainly due to a significant increase in volume of the pulmonary ribcage (RCp; 170 ml, p = 0.002), indicating dynamic hyperinflation (DH). Dyspnea and sensation of leg effort were both significantly greater (p < 0.0001) in asthmatic when compared to healthy subjects. In addition to a higher thoracoabdominal asynchrony found between RCp and abdominal (AB) (p < 0.005) compartments in asthmatic subjects, post-inspiratory action of the inspiratory ribcage and diaphragm muscles were observed through the higher expiratory paradox time of both RCp (p < 0.0001) and AB (p = 0.0002), respectively. Our data suggest that a different breathing pattern is adopted by asthmatic subjects without exercise-induced bronchoconstriction during mild exercise and that this feature, associated with DH and thoracoabdominal asynchrony, contributes significantly to exercise limitation.
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Affiliation(s)
- Guilherme Fregonezi
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Antonio Sarmento
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Janaína Pinto
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Vanessa Resqueti
- PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Breath-stacking and incentive spirometry in Parkinson's disease: Randomized crossover clinical trial. Respir Physiol Neurobiol 2018; 255:11-16. [PMID: 29727719 DOI: 10.1016/j.resp.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
Patients with Parkinson's disease often exhibit respiratory disorders and there are no Respiratory Therapy protocols which are suggested as interventions in Parkinson's patients. The aim of this study is to evaluate the effects of Breathing-Stacking (BS) and incentive spirometer (IS) techniques in volume variations of the chest wall in patients with Parkinson's Disease (PD). 14 patients with mild-moderate PD were included in this randomized cross-over study. Volume variations of the chest wall were assessed before, immediately after, then 15 and 30 min after BS and IS performance by optoelectronic plethysmography. Tidal volume (VT) and minute ventilation (MV) significantly increased after BS and IS techniques (p < 0.05). There was greater involvement of pulmonary and abdominal compartments after IS. The results suggest that these re-expansion techniques can be performed to immediately improve volume.
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Sarro KJ, Mombrini CL, Tonole TB. Reliability and minimal detectable change of thoracoabdominal mobility measurements using photogrammetry. Physiother Theory Pract 2018; 34:730-739. [DOI: 10.1080/09593985.2017.1423525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karine J. Sarro
- Faculty of Physical Education, University of Campinas – UNICAMP, Campinas, SP, Brazil
| | - Camila L. Mombrini
- Health Sciences Center, Federal University of Espírito Santo – UFES, Vitória, ES, Brazil
| | - Thais B. Tonole
- Health Sciences Center, Federal University of Espírito Santo – UFES, Vitória, ES, Brazil
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Gonçalves MA, Francisco DDS, Medeiros CSD, Brüggemann AKV, Mazo GZ, Paulin E. Postural alignment of patients with Chronic Obstructive Pulmonary Disease. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.003.ao13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: In chronic obstructive pulmonary disease (COPD), airflow resistance impairs respiratory mechanics that may compromise postural alignment. There is a lack of studies that have investigated compromised postures and their possible associations with pulmonary function. Objectives: To compare the postural alignment of COPD patients with apparently healthy individuals; To correlate pulmonary function with postural alignment in the COPD group. Methods: 20 COPD patients and 20 apparently healthy individuals performed: anthropometry, spirometry and postural evaluation. The following postural changes were assessed: lateral head tilt (LHT), shoulder asymmetry (SA1), anterior pelvic asymmetry (APA), lateral trunk tilt (LTT), scapular asymmetry (SA2), posterior pelvic asymmetry (PPA), head protrusion (HP), shoulder protrusion (SP), anterior pelvic tilt (APT) and thoracic kyphosis (TK). Results: There was a statistically significant difference between COPD patients and apparently healthy individuals in the following variables: PPT (p= 0.021), APT (p=0.014) and TK (p=0.011). There was a correlation between pulmonary variables and postural alignment in the COPD group: Forced Volume in one second (FEV1% pred) and HP (°) (r=0.488, p=0.029), FEV1 (% pred) and APT (°) (r= -0.472, p= 0.036); Forced Vital Capacity (FVC % pred) and HP (°) (r=0.568, p=0.009); FVC (% pred) and APT (°) (r=-0.461, p=0.041). Conclusion: Postural alignment of the anterior tilt of the right and left pelvis and thoracic kyphosis is different when compared with COPD patients and healthy individuals. There is a relationship between pulmonary function and postural alignment in COPD patients.
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Pereira MC, Porras DC, Lunardi AC, da Silva CCBM, Barbosa RCC, Cardenas LZ, Pletsch R, Ferreira JG, de Castro I, de Carvalho CRF, Caruso P, de Carvalho CRR, de Albuquerque ALP. Thoracoabdominal asynchrony: Two methods in healthy, COPD, and interstitial lung disease patients. PLoS One 2017; 12:e0182417. [PMID: 28767680 PMCID: PMC5540557 DOI: 10.1371/journal.pone.0182417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Thoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different. Methods 27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle. Results Thoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis. Conclusion Thoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.
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Affiliation(s)
- Mayra Caleffi Pereira
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
| | - Desiderio Cano Porras
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Claudia Lunardi
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Renata Cléia Claudino Barbosa
- Department of Physical Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Letícia Zumpano Cardenas
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata Pletsch
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jeferson George Ferreira
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isac de Castro
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
| | | | - Pedro Caruso
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Sírio-Libanês Teaching and Research Institute, São Paulo, Brazil
- * E-mail:
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Cabral EEA, Resqueti VR, Lima INDF, Gualdi LP, Aliverti A, Fregonezi GAF. Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study. Braz J Phys Ther 2017; 21:416-424. [PMID: 28736210 PMCID: PMC5693280 DOI: 10.1016/j.bjpt.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/22/2016] [Accepted: 01/25/2017] [Indexed: 12/04/2022] Open
Abstract
The PEP device at 10 cmH2O may be a potential home treatment for stroke group. The intensities above 10 cmH2O may lead to lung hyperinflation in stroke group. Stroke group reduced shortening velocity index for expiratory muscles during use PEP.
Background Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. Objective To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. Methods 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20 cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. Results During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32 L, 0.56 vs. 1.54 L, 0.52 vs. 1.8 L, at 10, 15, 20 cmH2O positive expiratory pressure, for stroke and control groups; p < 0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage. Conclusion Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10 cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.
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Affiliation(s)
- Elis E A Cabral
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Vanessa R Resqueti
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Illia N D F Lima
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brazil
| | - Lucien P Gualdi
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brazil
| | - Andrea Aliverti
- Politecnico Di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Laboratorio di Tecnologie Biomediche, Milan, Italy
| | - Guilherme A F Fregonezi
- Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil.
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Cano Porras D, Lunardi AC, Marques da Silva CCB, Paisani DM, Stelmach R, Moriya HT, Carvalho CRF. Comparison between the phase angle and phase shift parameters to assess thoracoabdominal asynchrony in COPD patients. J Appl Physiol (1985) 2017; 122:1106-1113. [DOI: 10.1152/japplphysiol.00508.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/22/2022] Open
Abstract
Determining the presence of thoracoabdominal asynchrony in chronic obstructive pulmonary disease (COPD) patients is clinically relevant, but there is no consensus on the optimal parameters for performing this analysis. We assessed 22 COPD patients (FEV1 40 ± 10% predicted) and 13 healthy controls during rest and exercise with optoelectronic plethysmography (70% maximum workload) on a cycle ergometer. Thoracoabdominal asynchrony was calculated by using phase angle and phase shift parameters following a three-compartment model involving the upper and lower rib cages and abdomen. Patients were classified as having thoracoabdominal asynchrony (TAA+) or not (TAA−) based on control values (mean ± 2 SDs). The chest wall volume and compartmental contribution were also measured. Thoracoabdominal asynchrony was observed in the lower rib cage. The phase angle detected more TAA+ patients at rest (15 vs. 7 patients) and during exercise (14 vs. 8 patients) compared with the phase shift. TAA+ patients also presented a lower chest wall volume, lower rib cage contribution, and higher abdominal contribution to chest wall volume compared with the control and TAA− patients. Thoracoabdominal asynchrony was more detectable during rest and exercise using the phase angle parameter, and it was observed in the lower rib cage compartment, reducing the chest wall volume during exercise in patients with COPD. NEW & NOTEWORTHY This study contributes to advance the knowledge over the previous lack of consensus on the assessment of thoracoabdominal asynchrony. We rigorously evaluated the related features that interfere in the measurement of the asynchrony (measurement tool, chest wall model and calculation parameter). Our results suggest that phase angle detects more suitably thoracoabdominal asynchrony that occurs on the lower ribcage and leads to a reduction in the chest wall volume during exercise in COPD patients.
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Affiliation(s)
- Desiderio Cano Porras
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Adriana C. Lunardi
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Denise M. Paisani
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; and
| | - Henrique T. Moriya
- Biomedical Engineering Laboratory, Department of Telecommunication and Control Engineering, School of Engineering, University of São Paulo, São Paulo, Brazil
| | - Celso R. F. Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Chest Wall Kinematics Using Triangular Cosserat Point Elements in Healthy and Neuromuscular Subjects. Ann Biomed Eng 2017; 45:1963-1973. [PMID: 28451990 DOI: 10.1007/s10439-017-1840-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
Optoelectronic plethysmography (OEP) is a noninvasive method for assessing lung volume variations and the contributions of different anatomical compartments of the chest wall (CW) through measurements of the motion of markers attached to the CW surface. The present study proposes a new method for analyzing the local CW kinematics from OEP measurements based on the kinematics of triangular Cosserat point elements (TCPEs). 52 reflective markers were placed on the anterior CW to create a mesh of 78 triangles according to an anatomical model. Each triangle was characterized by a TCPE and its kinematics was described using four time-variant scalar TCPE parameters. The total CW volume ([Formula: see text]) and the contributions of its six compartments were also estimated, using the same markers. The method was evaluated using measurements of ten healthy subjects, nine patients with Pompe disease, and ten patients with Duchenne muscular dystrophy (DMD), during spontaneous breathing (SB) and vital capacity maneuvers (VC) in the supine position. TCPE parameters and compartmental volumes were compared with [Formula: see text] by computing the phase angles [Formula: see text] (for SB) and the correlation r (for VC) between them. Analysis of [Formula: see text] and r of the outward translation parameter [Formula: see text] of each TCPE revealed that for healthy subjects it provided similar results to those obtained by compartmental volumes, whereas for the neuromuscular patients the TCPE method was capable of detecting local asynchronous and paradoxical movements also in cases where they were undistinguished by volumes. Therefore, the TCPE approach provides additional information to OEP that may enhance its clinical evaluation capabilities.
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Albuquerque ALPD, Quaranta M, Chakrabarti B, Aliverti A, Calverley PM. Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation. J Bras Pneumol 2017; 42:121-9. [PMID: 27167433 PMCID: PMC4853065 DOI: 10.1590/s1806-37562015000000078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/04/2015] [Indexed: 12/04/2022] Open
Abstract
Objective: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.
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Vieira DSR, Mendes LPS, Elmiro NS, Velloso M, Britto RR, Parreira VF. Breathing exercises: influence on breathing patterns and thoracoabdominal motion in healthy subjects. Braz J Phys Ther 2016; 18:544-52. [PMID: 25590447 PMCID: PMC4311599 DOI: 10.1590/bjpt-rbf.2014.0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/26/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The mechanisms underlying breathing exercises have not been fully elucidated. OBJECTIVES: To evaluate the impact of four on breathing exercises (diaphragmatic breathing,
inspiratory sighs, sustained maximal inspiration and intercostal exercise) the on
breathing pattern and thoracoabdominal motion in healthy subjects. METHOD: Fifteen subjects of both sexes, aged 23±1.5 years old and with normal pulmonary
function tests, participated in the study. The subjects were evaluated using the
optoelectronic plethysmography system in a supine position with a trunk
inclination of 45° during quiet breathing and the breathing exercises. The order
of the breathing exercises was randomized. Statistical analysis was performed by
the Friedman test and an ANOVA for repeated measures with one factor (breathing
exercises), followed by preplanned contrasts and Bonferroni correction. A
p<0.005 value was considered significant. RESULTS: All breathing exercises significantly increased the tidal volume of the chest wall
(Vcw) and reduced the respiratory rate (RR) in
comparison to quiet breathing. The diaphragmatic breathing exercise was
responsible for the lowest Vcw, the lowest contribution of the rib
cage, and the highest contribution of the abdomen. The sustained maximal
inspiration exercise promoted greater reduction in RR compared to
the diaphragmatic and intercostal exercises. Inspiratory sighs and intercostal
exercises were responsible for the highest values of minute ventilation.
Thoracoabdominal asynchrony variables increased significantly during diaphragmatic
breathing. CONCLUSIONS: The results showed that the breathing exercises investigated in this study
produced modifications in the breathing pattern (e.g., increase
in tidal volume and decrease in RR) as well as in
thoracoabdominal motion (e.g., increase in abdominal contribution
during diaphragmatic breathing), among others.
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Affiliation(s)
| | - Liliane P S Mendes
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Marcelo Velloso
- Departamento de Fisioterapia, UFMG, Belo Horizonte, MG, Brazil
| | - Raquel R Britto
- Departamento de Fisioterapia, UFMG, Belo Horizonte, MG, Brazil
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Wada JT, Borges-Santos E, Porras DC, Paisani DM, Cukier A, Lunardi AC, Carvalho CRF. Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial. Int J Chron Obstruct Pulmon Dis 2016; 11:2691-2700. [PMID: 27822031 PMCID: PMC5094573 DOI: 10.2147/copd.s114548] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with COPD present a major recruitment of the inspiratory muscles, predisposing to chest incoordination, increasing the degree of dyspnea and impairing their exercise capacity. Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity; however, the systemic effects of stretching remain unknown. OBJECTIVE The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD. DESIGN This study was a randomized and controlled trial. PARTICIPANTS A total of 30 patients were allocated to a treatment group (TG) or a control group (CG; n=15, each group). INTERVENTION The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching. Both groups performed 24 sessions (twice a week, 12 weeks) of aerobic training. EVALUATIONS Functional exercise capacity (6-minute walk test), thoracoabdominal kinematics (optoelectronic plethysmography), and respiratory muscle activity (surface electromyography) were evaluated during exercise. Analysis of covariance was used to compare the groups at a significance level of 5%. RESULTS After the intervention, the TG showed improved abdominal (ABD) contribution, compartmental volume, mobility, and functional exercise capacity with decreased dyspnea when compared with the CG (P<0.01). The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG (P<0.001). CONCLUSION Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional exercise capacity with decreased dyspnea in patients with COPD. These effects are associated with an increased efficacy of the respiratory muscles and participation of the ABD compartment.
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Affiliation(s)
| | | | | | | | - Alberto Cukier
- Department of Cardiopneumology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Reinaux CMA, Aliverti A, da Silva LGM, da Silva RJ, Gonçalves JN, Noronha JB, Filho JEC, de Andrade AD, de Amorim Britto MC. Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph. Pediatr Pulmonol 2016; 51:850-7. [PMID: 26991671 DOI: 10.1002/ppul.23394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/18/2015] [Accepted: 01/15/2016] [Indexed: 11/11/2022]
Abstract
Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Cyda Maria Albuquerque Reinaux
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | | | - Rafael Justino da Silva
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Juliane Neves Gonçalves
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica Brito Noronha
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Baba F, Tanaka S, Nonogaki Y, Hasegawa S, Nishihashi M, Ayakawa S, Yamada M, Shibamoto Y. Effects of audio coaching and visual feedback on the stability of respiration during radiotherapy. Jpn J Radiol 2016; 34:572-8. [DOI: 10.1007/s11604-016-0560-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/30/2016] [Indexed: 01/25/2023]
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Troyer AD, Wilson TA. Action of the diaphragm on the rib cage. J Appl Physiol (1985) 2016; 121:391-400. [PMID: 27283911 DOI: 10.1152/japplphysiol.00268.2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Abstract
When the diaphragm contracts, pleural pressure falls, exerting a caudal and inward force on the entire rib cage. However, the diaphragm also exerts forces in the cranial and outward direction on the lower ribs. One of these forces, the "insertional force," is applied by the muscle at its attachments to the lower ribs. The second, the "appositional force," is due to the transmission of abdominal pressure to the lower rib cage in the zone of apposition. In the control condition at functional residual capacity, the effects of these two forces on the lower ribs are nearly equal and outweigh the effect of pleural pressure, whereas for the upper ribs, the effect of pleural pressure is greater. The balance between these effects, however, may be altered. When the abdomen is given a mechanical support, the insertional and appositional forces are increased, so that the muscle produces a larger expansion of the lower rib cage and, with it, a smaller retraction of the upper rib cage. In contrast, at higher lung volumes the zone of apposition is decreased, and pleural pressure is the dominant force on the lower ribs as well. Consequently, although the force exerted by the diaphragm on these ribs remains inspiratory, rib displacement is reversed into a caudal-inward displacement. This mechanism likely explains the inspiratory retraction of the lateral walls of the lower rib cage observed in many subjects with chronic obstructive pulmonary disease (Hoover's sign). These observations support the use of a three-compartment, rather than a two-compartment, model to describe chest wall mechanics.
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Affiliation(s)
- André De Troyer
- Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, Brussels, Belgium; Chest Service, Erasme University Hospital, Brussels, Belgium; and
| | - Theodore A Wilson
- Department of Aerospace Engineering and Mechanics, University of Minnesota, Minneapolis, Minnesota
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LoMauro A, Cesareo A, Agosti F, Tringali G, Salvadego D, Grassi B, Sartorio A, Aliverti A. Effects of a multidisciplinary body weight reduction program on static and dynamic thoraco-abdominal volumes in obese adolescents. Appl Physiol Nutr Metab 2016; 41:649-58. [PMID: 27175804 DOI: 10.1139/apnm-2015-0269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objective of this study was to characterize static and dynamic thoraco-abdominal volumes in obese adolescents and to test the effects of a 3-week multidisciplinary body weight reduction program (MBWRP), entailing an energy-restricted diet, psychological and nutritional counseling, aerobic physical activity, and respiratory muscle endurance training (RMET), on these parameters. Total chest wall (VCW), pulmonary rib cage (VRC,p), abdominal rib cage (VRC,a), and abdominal (VAB) volumes were measured on 11 male adolescents (Tanner stage: 3-5; BMI standard deviation score: >2; age: 15.9 ± 1.3 years; percent body fat: 38.4%) during rest, inspiratory capacity (IC) maneuver, and incremental exercise on a cycle ergometer at baseline and after 3 weeks of MBWRP. At baseline, the progressive increase in tidal volume was achieved by an increase in end-inspiratory VCW (p < 0.05) due to increases in VRC,p and VRC,a with constant VAB. End-expiratory VCW decreased with late increasing VRC,p, dynamically hyperinflating VRC,a (p < 0.05), and progressively decreasing VAB (p < 0.05). After MBWRP, weight loss was concentrated in the abdomen and total IC decreased. During exercise, abdominal rib cage hyperinflation was delayed and associated with 15% increased performance and reduced dyspnea at high workloads (p < 0.05) without ventilatory and metabolic changes. We conclude that otherwise healthy obese adolescents adopt a thoraco-abdominal operational pattern characterized by abdominal rib cage hyperinflation as a form of lung recruitment during incremental cycle exercise. Additionally, a short period of MBWRP including RMET is associated with improved exercise performance, lung and chest wall volume recruitment, unloading of respiratory muscles, and reduced dyspnea.
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Affiliation(s)
- Antonella LoMauro
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ambra Cesareo
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Fiorenza Agosti
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Gabriella Tringali
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy
| | - Desy Salvadego
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Bruno Grassi
- c Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Alessandro Sartorio
- b Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Piancavallo (VB), Italy.,d Division of Metabolic Diseases and Auxology, Istituto Auxologico Italiano, IRCCS, Piancavallo (VB), Italy
| | - Andrea Aliverti
- a Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Estrada L, Torres A, Sarlabous L, Fiz JA, Gea J, Martinez-Llorens J, Jane R. Estimation of bilateral asynchrony between diaphragm mechanomyographic signals in patients with chronic obstructive pulmonary disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:3813-6. [PMID: 25570822 DOI: 10.1109/embc.2014.6944454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to measure bilateral asynchrony in patients suffering from Chronic Obstructive Pulmonary Disease (COPD) performing an incremental inspiratory load protocol. Bilateral asynchrony was estimated by the comparison of respiratory movements derived from diaphragm mechanomyographic (MMGdi) signals, acquired by means of capacitive accelerometers placed on left and right sides of the rib cage. Three methods were considered for asynchrony evaluation: Lissajous figure, Hilbert transform and Motto's algorithm. Bilateral asynchrony showed an increase at 20, 40 and 60% (values of normalized inspiratory pressure by their maximum value reached in the last inspiratory load) while the very severe group showed an increase at 20, 40, 80, and 100 % during the protocol. These increments in the phase's shift can be due to an increase of the inspiratory load along the protocol, and also as a consequence of distress and fatigue. In summary, this work evidenced the capability to estimate bilateral asynchrony in COPD patients. These preliminary results also showed that the use of capacitive accelerometers can be a suitable sensor for recording of respiratory movement and evaluation of asynchrony in COPD patients.
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Rocha T, Souza H, Brandão DC, Rattes C, Ribeiro L, Campos SL, Aliverti A, de Andrade AD. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. J Physiother 2015; 61:182-9. [PMID: 26386894 DOI: 10.1016/j.jphys.2015.08.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/10/2015] [Accepted: 08/07/2015] [Indexed: 01/08/2023] Open
Abstract
QUESTIONS In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. PARTICIPANTS Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease. INTERVENTION The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen. OUTCOME MEASURES The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments. RESULTS The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small. CONCLUSION The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease. TRIAL REGISTRATION NCT02212184.
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Affiliation(s)
- Taciano Rocha
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Helga Souza
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Daniela Cunha Brandão
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Catarina Rattes
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Luana Ribeiro
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Shirley Lima Campos
- Department of Physical Therapy, Universidade Federal de Pernambuco - UFPE, Recife, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, Milan, Italy
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Laviola M, Zanini A, Priori R, Macchini F, Leva E, Torricelli M, Ceruti C, Aliverti A. Thoraco-abdominal asymmetry and asynchrony in congenital diaphragmatic hernia. Pediatr Pulmonol 2015; 50:915-24. [PMID: 25052453 DOI: 10.1002/ppul.23081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/09/2014] [Accepted: 06/01/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) consists of an incomplete formation of the diaphragm and the subsequent herniation of abdominal bowels. Diaphragmatic defect can be repaired by primary closure or placing a patch. Respiratory follow up usually focuses on spirometric and clinical evaluation. The aim of the study was to assess thoraco-abdominal volumes in CDH patients and to verify whether the action of the diaphragm on the chest wall is altered leading to an asymmetric and asynchronous expansion of the different thoracoabdominal compartments. PATIENTS AND METHODS Total and compartmental chest wall volumes and asynchronies were measured by Opto-Electronic Plethysmography in 14 CDH patients (7 M/7F, age 5 ± 2 years, 12 left side operated) and in 9 age matched healthy subjects during quiet spontaneous breathing in supine position. Patients were divided in two groups: five patients with suture (group S) and nine patients with diaphragmatic patch (group P). Pulmonary function was assessed by spirometry and spirometric parameters were expressed as Z-score. RESULTS In group P abdominal contribution to tidal volume was lower than healthy controls and group S. Unlike controls, in both CDH groups the right side of pulmonary rib cage moved inward with a correspondent left side expansion during inspiration. In group S, thoraco-abdominal asynchronies were higher than in group P and controls, especially in the right side. Five patients belonging to group P had a spirometric obstructive pattern. CONCLUSIONS In overall CDH patients a reduced action of the treated (left) hemi-diaphragm is evident. In patients treated by primary suture, a compensatory action of the right side allows to reach a normal total diaphragmatic displacement and a proper contribution of the whole diaphragm to tidal volume. In patients treated by diaphragmatic patch, instead, thoraco-abdominal asynchronies are prevented.
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Affiliation(s)
- Marianna Laviola
- Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Andrea Zanini
- Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Rita Priori
- Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Francesco Macchini
- Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Ernesto Leva
- Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Maurizio Torricelli
- Chirurgia Pediatrica, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Clara Ceruti
- Clinica De Marchi, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Andrea Aliverti
- Dipartimentodi Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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Movement analysis of the chest compartments and a real-time quality feedback during breathing therapy. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13721-015-0093-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fekr AR, Janidarmian M, Radecka K, Zilic Z. Respiration Disorders Classification With Informative Features for m-Health Applications. IEEE J Biomed Health Inform 2015. [PMID: 26208371 DOI: 10.1109/jbhi.2015.2458965] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory disorder is a highly prevalent condition associated with many adverse health problems. As the current means of diagnosis are obtrusive and ill-suited for real-time m-health applications, we explore a convenient and low-cost automatic approach that uses wearable microelectromechanical system sensor technology. The proposed system introduces the use of motion sensors to detect the changes in the anterior-posterior diameter of the chest wall during breathing function as well as extracting the informative respiratory features to be used for breathing disorders classification. Extensive evaluations are provided on six well-known classifiers with novel feature extraction techniques to distinguish among eight different pathological breathing patterns. The effects of the number of sensors, sensor placement, as well as feature selection on the classification performance are discussed. The experimental results conducted with ten subjects show the best accuracy rates of 97.50% by support vector machine and 97.37% with decision tree bagging (DTB) with all features and after feature selection, correspondingly. Furthermore, a binary classification is proposed for distinguishing between healthy people and patients with breath problems. The different assessments of classification parameters are provided by measuring the accuracy, sensitivity, specificity, F1-score and Mathew correlation coefficient. The accuracy rates above 98% suggest superior performance of DTB in binary recognition supported by the suggested new features.
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Zoumot Z, LoMauro A, Aliverti A, Nelson C, Ward S, Jordan S, Polkey MI, Shah PL, Hopkinson NS. Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony. Chest 2015; 148:185-195. [PMID: 25654309 PMCID: PMC4493874 DOI: 10.1378/chest.14-2380] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/11/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known. METHODS We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months after LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen [Vab]) and phase shift angles (θ) calculated for the asynchrony between Vrc,p and Vrc,a (θRC), and between Vrc,a and Vab (θDIA). RESULTS Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°). Between-group difference in the change in θRC and θDIA during quiet breathing following treatment was 44.3° (95% CI, -78 to -10.6; P = .003) and 34.5° (95% CI, 1.4 to 67.5; P = .007) toward 0° (representing perfect synchrony), respectively, favoring the LVR group. Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides. CONCLUSIONS Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.
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Affiliation(s)
- Zaid Zoumot
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England; Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Christopher Nelson
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Simon Ward
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England
| | - Simon Jordan
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England
| | - Michael I Polkey
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England
| | - Pallav L Shah
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England
| | - Nicholas S Hopkinson
- National Institute for Health Research Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, England
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Borges-Santos E, Wada JT, da Silva CM, Silva RA, Stelmach R, Carvalho CR, Lunardi AC. Anxiety and depression are related to dyspnea and clinical control but not with thoracoabdominal mechanics in patients with COPD. Respir Physiol Neurobiol 2015; 210:1-6. [PMID: 25620656 DOI: 10.1016/j.resp.2015.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the relationship between the presence of symptoms of anxiety or depression with breathing pattern and thoracoabdominal mechanics at rest and during exercise in COPD. METHODS Cross-sectional study enrolled 54 patients with COPD ranked according to Hospital Anxiety and Depression Scale (HAD) score and compared to dyspnea, clinical control, hypercapnia, breathing pattern and thoracoabdominal mechanics at rest and during exercise. RESULTS Seventeen patients with COPD had no symptoms, 12 had anxiety symptoms, 13 had depressive symptoms and 12 had both symptoms. COPD with depressive symptoms presented greater degree of dyspnea (p<0.01). Poor clinical control was observed in COPD with anxious and/or depressive symptoms (p<0.05). Breathing pattern and thoracoabdominal mechanics were similar among all groups at rest and during exercise. CONCLUSIONS COPD with symptoms of depression report more dyspnea. Anxiety and depression are associated with poor clinical control without impact on breathing pattern and thoracoabdominal mechanics in COPD.
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Affiliation(s)
- Erickson Borges-Santos
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Juliano Takashi Wada
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Cibele Marques da Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ronaldo A Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rafael Stelmach
- Department of Pneumology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Celso R Carvalho
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana C Lunardi
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
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Kortianou EA, Aliverti A, Louvaris Z, Vasilopoulou M, Nasis I, Asimakos A, Zakynthinos S, Vogiatzis I. Limitation in tidal volume expansion partially determines the intensity of physical activity in COPD. J Appl Physiol (1985) 2014; 118:107-14. [PMID: 25398190 DOI: 10.1152/japplphysiol.00301.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), reduced levels of daily physical activity are associated with the degree of impairment in lung, peripheral muscle, and central hemodynamic function. There is, however, limited evidence as to whether limitations in tidal volume expansion also, importantly, determine daily physical activity levels in COPD. Eighteen consecutive patients with COPD [9 active (forced expiratory volume in 1 s, FEV1: 1.59 ± 0.64 l) with an average daily movement intensity >1.88 m/s(2) and 9 less active patients (FEV1: 1.16 ± 0.41 l) with an average intensity <1.88 m/s(2)] underwent a 4-min treadmill test at a constant speed corresponding to each individual patient's average movement intensity, captured by a triaxial accelerometer during a preceding 7-day period. When chest wall volumes, captured by optoelectronic plethysmography, were expressed relative to comparable levels of minute ventilation (ranging between 14.5 ± 4.3 to 33.5 ± 4.4 l/min), active patients differed from the less active ones in terms of the lower increase in end-expiratory chest wall volume (by 0.15 ± 0.17 vs. 0.45 ± 0.21 l), the greater expansion in tidal volume (by 1.76 ± 0.58 vs. 1.36 ± 0.24 l), and the larger inspiratory reserve chest wall volume (IRVcw: by 0.81 ± 0.25 vs. 0.39 ± 0.27 l). IRVcw (r(2) = 0.420), expiratory flow (r(2) change = 0.174), and Borg dyspnea score (r(2) change = 0.123) emerged as the best contributors, accounting for 71.7% of the explained variance in daily movement intensity. Patients with COPD exhibiting greater ability to expand tidal volume and to maintain adequate inspiratory reserve volume tend to be more physically active. Thus interventions aiming at mitigating restrictions on operational chest wall volumes are expected to enhance daily physical activity levels in COPD.
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Affiliation(s)
- Eleni A Kortianou
- National and Kapodistrian University of Athens, Department of Physical Education and Sports Sciences, Athens, Greece; National and Kapodistrian University of Athens, 1st Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece; Technological Educational Institute of Central Greece, Department of Physiotherapy, Lamia, Greece
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingeneria, Politecnico di Milano, Italy
| | - Zafeiris Louvaris
- National and Kapodistrian University of Athens, Department of Physical Education and Sports Sciences, Athens, Greece
| | - Maroula Vasilopoulou
- National and Kapodistrian University of Athens, Department of Physical Education and Sports Sciences, Athens, Greece
| | - Ioannis Nasis
- National and Kapodistrian University of Athens, Department of Physical Education and Sports Sciences, Athens, Greece
| | - Andreas Asimakos
- National and Kapodistrian University of Athens, 1st Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece
| | - Spyros Zakynthinos
- National and Kapodistrian University of Athens, 1st Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece
| | - Ioannis Vogiatzis
- National and Kapodistrian University of Athens, Department of Physical Education and Sports Sciences, Athens, Greece; National and Kapodistrian University of Athens, 1st Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece;
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Evaristo KB, Saccomani MG, Martins MA, Cukier A, Stelmach R, Rodrigues MR, Santaella DF, Carvalho CRF. Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial. BMC Pulm Med 2014; 14:160. [PMID: 25326140 PMCID: PMC4216357 DOI: 10.1186/1471-2466-14-160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments. METHODS/DESIGN This is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions. DISCUSSION Although the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect. TRIAL REGISTRATION Clinicaltrials.gov; Identifier: NCT02065258.
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Affiliation(s)
| | | | | | | | | | | | | | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, Av, Dr Arnaldo 455, Rm 1210, São Paulo, SP 01246-903, Brazil.
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De Troyer A, Wilson TA. Action of the isolated canine diaphragm on the lower ribs at high lung volumes. J Physiol 2014; 592:4481-91. [PMID: 25063819 PMCID: PMC4287732 DOI: 10.1113/jphysiol.2014.274860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/07/2014] [Indexed: 01/31/2023] Open
Abstract
The normal diaphragm has an inspiratory action on the lower ribs, but subjects with chronic obstructive pulmonary disease commonly have an inward displacement of the lateral portions of the lower rib cage during inspiration. This paradoxical displacement, conventionally called 'Hoover's sign', has traditionally been attributed to the direct action of radially oriented diaphragmatic muscle fibres. In the present study, the inspiratory intercostal muscles in all interspaces in anaesthetized dogs were severed so that the diaphragm was the only muscle active during inspiration. The displacements of the lower ribs along the craniocaudal and laterolateral axes and the changes in pleural pressure (∆Ppl) and transdiaphragmatic pressure were measured during occluded breaths and mechanical ventilation at different lung volumes between functional residual capacity (FRC) and total lung capacity. From these data, the separate effects on rib displacement of ∆Ppl and of the force exerted by the diaphragm on the ribs were determined. Isolated spontaneous diaphragm contraction at FRC displaced the lower ribs cranially and outward, but this motion was progressively reversed into a caudal and inward motion as lung volume increased. However, although the force exerted by the diaphragm on the ribs decreased with increasing volume, it continued to displace the ribs cranially and outward. These observations suggest that Hoover's sign is usually caused by the decrease in the zone of apposition and, thus, by the dominant effect of ∆Ppl on the lower ribs, rather than an inward pull from the diaphragm.
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Affiliation(s)
- André De Troyer
- Laboratory of Cardiorespiratory Physiology, Brussels School of Medicine, Brussels, Belgium Chest Service, Erasme University Hospital, Brussels, Belgium
| | - Theodore A Wilson
- Department of Aerospace Engineering and Mechanics, University of Minnesota, Minneapolis, MN, USA
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Acute respiratory muscle unloading by normoxic helium-O₂ breathing reduces the O₂ cost of cycling and perceived exertion in obese adolescents. Eur J Appl Physiol 2014; 115:99-109. [PMID: 25213005 DOI: 10.1007/s00421-014-2993-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In obesity, an increased work of breathing contributes to a higher O2 cost of exercise and negatively affects exercise tolerance. The purpose of the study was to determine whether, in obese adolescents, acute respiratory muscle unloading via normoxic helium-O2 breathing reduces the O2 cost of cycling and perceived exertion. METHODS Nine males [age 16.8 ± 1.6 (x ± SD) years, body mass 109.9 ± 15.0 kg] performed on a cycle ergometer, breathing room air (AIR) or a 21 % O2-79 % helium mixture (He-O2): an incremental exercise, for determination of [Formula: see text]O2 peak and gas exchange threshold (GET); 12 min constant work rate (CWR) exercises at 70 % of GET (<GET) and 120 % of GET (>GET) determined in AIR. RESULTS [Formula: see text]O2 peak was not different in the two conditions. From the 3rd to the 12th minute of exercise (both during CWR < GET and CWR > GET), [Formula: see text]O2 was lower in He-O2 vs. AIR (end-exercise values: 1.40 ± 0.14 vs. 1.57 ± 0.22 L min(-1) <GET, and 2.23 ± 0.31 vs. 2.54 ± 0.27 L min(-1) >GET). During CWR > GET in AIR, [Formula: see text]O2 linearly increased from the 3rd to the 12th minute of exercise, whereas no substantial increase was observed in He-O2. The O2 cost of cycling was ~10 % (<GET) and ~15 % (>GET) lower in He-O2 vs. AIR. Heart rate and ratings of perceived exertion for dyspnea/respiratory discomfort and leg effort were lower in He-O2. CONCLUSIONS In obese adolescents, acute respiratory muscle unloading via He-O2 breathing lowered the O2 cost of cycling and perceived exertion during submaximal moderate- and heavy-intensity exercise.
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Optoelectronic plethysmography: Intra-rater and inter-rater reliability in healthy subjects. Respir Physiol Neurobiol 2013; 189:473-6. [DOI: 10.1016/j.resp.2013.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022]
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50
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Thoraco-abdominal motion/displacement does not affect dyspnea following exercise training in COPD patients. Respir Physiol Neurobiol 2013; 190:124-30. [PMID: 24140573 DOI: 10.1016/j.resp.2013.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/02/2013] [Accepted: 10/09/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE The interrelations among chest wall kinematics (displacement and configuration), ventilatory profile and dyspnea relief following cycle exercise training (EXT) have not been systematically evaluated in hyperinflated chronic obstructive pulmonary disease (COPD) patients. We hypothesize that a decrease in ventilation affects dyspnea relief, regardless of the changes in chest wall kinematics. METHODS Fourteen patients were studied before and after 24-session exercise training program. We evaluated the volumes of chest wall and its compartments (rib cage, and abdomen) using optoelectronic plethysmography. RESULTS At iso-time EXT (i) reduced ventilation, respiratory frequency and dyspnea (by Borg scale), mildly improved rib cage configuration, but left operational volumes unchanged; (ii) Borg was much smaller for any comparable inspiratory reserve volume (IRVcw), and a decrease in IRVcw was tolerated much better for any given Borg. CONCLUSIONS Regardless of the changes in chest wall kinematics, a decrease in ventilation attenuates dyspnea following EXT.
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