Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study

Investigating the relationship of trunk and postural control with pulmonary functions in subacute stroke patients

Stroke is a disease with high mortality and morbidity that not only causes weakness in the extremities, loss of balance, and disturbances in trunk and postural control, but also affects respiratory function. The aim of this study was to investigate the relationship between trunk and postural control and pulmonary function in subacute stroke patients. Herein, 32 volunteer patients who were diagnosed with hemiplegia by a competent physician after unilateral hemorrhagic or ischemic stroke and who met the inclusion criteria participated in the study. Functional independence of the participants was evaluated using the Modified Rankin Scale (mRS) and their cognitive function was assessed with the Standardized Mini Mental State Examination. Respiratory function was evaluated with spirometric measurements, inspiratory muscle strength was evaluated with intraoral pressure measurements, trunk control was evaluated using the Trunk Impairment Scale (TIS), postural control was evaluated using the Postural Assessment Scale for Stroke Patients (PASS-T), computerized postural sway evaluation, and static posture analysis. A significant correlation was found between the TIS scores and inspiratory muscle strength (p < 0.05). A significant correlation was also found between the PASS-T scores and inspiratory muscle strength and pulmonary function (p < 0.05). All of the COP parameters measured were significantly correlated with the PEF(L/s) and FEF25-75 (L/s) (p < 0.05). In conclusion, this study showed that trunk and postural control are associated with inspiratory muscle strength and pulmonary function. It is recommended that evaluation of trunk and postural control and respiratory functions, as well as exercise training to improve these parameters, should be included in rehabilitation programs for individuals with stroke.

Impact of COVID-19 on Diaphragmatic Function: Understanding Multiorgan Involvement and Long-Term Consequences

The COVID-19 pandemic has brought significant attention to the respiratory system, with much focus on lung-related disorders. However, the diaphragm, a crucial component of respiratory physiology, has not been adequately studied, especially in the context of long COVID. This review explores the multipotential role of the diaphragm in both respiratory health and disease, emphasizing its involvement in long-term complications following SARS-CoV-2 infection. The diaphragm's fundamental role in respiratory physiology and its impact on balance and posture control, breathing patterns, and autonomic nervous system regulation are discussed. This review examines complications arising from COVID-19, highlighting the diaphragm's involvement in neurological, musculoskeletal, and inflammatory responses. Particular attention is given to the neuroinvasive impact of SARS-CoV-2, the inflammatory response, and the direct viral effects on the diaphragm. The diaphragm's role in long COVID is explored, with a focus on specific symptoms such as voice disorders, pelvic floor dysfunction, and sleep disturbances. Diagnostic challenges, current methods for assessing diaphragmatic dysfunction, and the complexities of differentiating it from other conditions are also explored. This article is the first to comprehensively address diaphragmatic dysfunction resulting from COVID-19 and long COVID across various physiological and pathological aspects, offering a new perspective on its diagnosis and treatment within a multisystem context.

Effects of cardiorespiratory physiotherapy on lung function in stroke: a network meta-analysis

BACKGROUND

The efficacy of various physiotherapy interventions for improving lung function has not been compared.

OBJECTIVES

To evaluate cardiorespiratory physiotherapy interventions on lung function in patients with stroke, prioritize intervention types, and establish hierarchy.

METHODS

Twelve randomized controlled trials published during 2000-2022 in PubMed, EMBASE, Cochrane Library, and Web of Science were selected. Interventions included aerobic training (AT), combined inspiratory and expiratory training (CIET), inspiratory training (IT), combined aerobic and breadth training (CABT), and conventional training (CT). Outcome variables were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC.

RESULTS

CIET and IT were more effective than CT for FEV1 and FVC. CIET and IT showed larger effect sizes compared to AT for FEV1. The intervention rankings were as follows: IT (86.62%), CIET (63.31%), CABT (50.79%), AT (28.72%), and CT (20.55%) for FEV1; IT (93.89%), CIET (75.06%), CT (42.38%), CABT (37.73%), and AT (0.94%) for FVC; and IT (78.30%), CT (54.14%), CABT (42.62%), CIET (41.65%), and AT (33.29%) for FEV1/FVC. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years.

CONCLUSIONS

Besides FEV1/FVC, IT and CIET inhalation exercises improved lung function more effectively than other therapies, with IT or CIET being more effective than AT or CT. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years than in those <60 years. These findings highlight the significance of breathing training for patients with stroke and support clinical decision-making.

Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction

There can be many reasons that damage the function of the diaphragm, either transiently or permanently, involving one hemilate or both muscle portions. The diaphragm is associated only with breathing, but many other functions are related to it. The patient is not always aware of the presence of diaphragmatic dysfunction, and it is not always immediate to identify non-respiratory diaphragmatic symptoms. Pseudoanginal pain, night sweats, difficulty memorizing, or muscular and visceral problems of the pelvic floor are just some of the disorders linked to reduced diaphragmatic contractility. A decline in respiratory contractile force can be the basis for further pathological conditions that can increase the rate of mortality and morbidity. The article reviews the possible symptoms that may be presented by the patient, which are not necessarily related to lung function.