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Xie Y, Zhang L, Guo S, Peng R, Gong H, Yang M. Changes in respiratory structure and function after traumatic cervical spinal cord injury: observations from spinal cord and brain. Front Neurol 2023; 14:1251833. [PMID: 37869136 PMCID: PMC10587692 DOI: 10.3389/fneur.2023.1251833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Respiratory difficulties and mortality following severe cervical spinal cord injury (CSCI) result primarily from malfunctions of respiratory pathways and the paralyzed diaphragm. Nonetheless, individuals with CSCI can experience partial recovery of respiratory function through respiratory neuroplasticity. For decades, researchers have revealed the potential mechanism of respiratory nerve plasticity after CSCI, and have made progress in tissue healing and functional recovery. While most existing studies on respiratory plasticity after spinal cord injuries have focused on the cervical spinal cord, there is a paucity of research on respiratory-related brain structures following such injuries. Given the interconnectedness of the spinal cord and the brain, traumatic changes to the former can also impact the latter. Consequently, are there other potential therapeutic targets to consider? This review introduces the anatomy and physiology of typical respiratory centers, explores alterations in respiratory function following spinal cord injuries, and delves into the structural foundations of modified respiratory function in patients with CSCI. Additionally, we propose that magnetic resonance neuroimaging holds promise in the study of respiratory function post-CSCI. By studying respiratory plasticity in the brain and spinal cord after CSCI, we hope to guide future clinical work.
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Affiliation(s)
- Yongqi Xie
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Liang Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Shuang Guo
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Run Peng
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Huiming Gong
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Mingliang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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Pałac M, Sikora D, Wolny T, Linek P. Relationship between respiratory muscles ultrasound parameters and running tests performance in adolescent football players. A pilot study. PeerJ 2023; 11:e15214. [PMID: 37090113 PMCID: PMC10117394 DOI: 10.7717/peerj.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose Assessing the relationship between ultrasound imaging of respiratory muscles during tidal breathing and running tests (endurance and speed) in adolescent football players. Methods Ultrasound parameters of the diaphragm and intercostal muscles (shear modulus, thickness, excursion, and velocity), speed (30-m distance), and endurance parameters (multi-stage 20-m shuttle run test) were measured in 22 male adolescent football players. The relation between ultrasound and running tests were analysed by Spearman's correlation. Results Diaphragm shear modulus at the end of tidal inspiration was moderately negatively (R = - 0.49; p = 0.2) correlated with the speed score at 10 m. The diaphragm and intercostal muscle shear modulus ratio was moderately to strongly negatively correlated with the speed score at 10 m and 30 m (about R = - 0.48; p = 0.03). Diaphragm excursion was positively correlated with the speed score at 5 m (R = 0.46; p = 0.04) and 10 m (R = 0.52; p = 0.02). Diaphragm velocity was moderately positively correlated with the speed score at 5 m (R = 0.42; p = 0.06) and 30 m (R = 0.42; p = 0.07). Ultrasound parameters were not significantly related to all endurance parameters (R ≤ 0.36; p ≥ 0.11). Conclusions Ultrasound parameters of the respiratory muscles are related to speed score in adolescent football players. The current state of knowledge does not allow us to clearly define how important the respiratory muscles' ultrasound parameters can be in predicting some performance parameters in adolescent athletes.
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Affiliation(s)
- Małgorzata Pałac
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Śląskie, Poland
- Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Damian Sikora
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Śląskie, Poland
| | - Tomasz Wolny
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Śląskie, Poland
- Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Śląskie, Poland
- Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Pałac M, Linek P. Intra-Rater Reliability of Shear Wave Elastography for the Quantification of Respiratory Muscles in Adolescent Athletes. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176622. [PMID: 36081075 PMCID: PMC9460867 DOI: 10.3390/s22176622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 05/09/2023]
Abstract
The aim of this study was to assess the intra-rater reliability and agreement of diaphragm and intercostal muscle elasticity and thickness during tidal breathing. The diaphragm and intercostal muscle parameters were measured using shear wave elastography in adolescent athletes. To calculate intra-rater reliability, intraclass correlation coefficient (ICC) and Bland-Altman statistics were used. The reliability/agreement for one-day both muscle measurements (regardless of probe orientation) were at least moderate. During the seven-day interval between measurements, the reliability of a single measurement depended on the measured parameter, transducer orientation, respiratory phase, and muscle. Excellent reliability was found for diaphragm shear modulus at the peak of tidal expiration in transverse probe position (ICC3.1 = 0.91-0.96; ICC3.2 = 0.95), and from poor to excellent reliability for the intercostal muscle thickness at the peak of tidal inspiration with the longitudinal probe position (ICC3.1 = 0.26-0.95; ICC3.2 = 0.15). The overall reliability/agreement of the analysed data was higher for the diaphragm measurements (than the intercostal muscles) regardless of the respiratory phase and probe position. It is difficult to identify a more appropriate probe position to examine these muscles. The shear modulus/thickness of the diaphragm and intercostal muscles demonstrated good reliability/agreement so this appears to be a promising technique for their examination in athletes.
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Affiliation(s)
- Małgorzata Pałac
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
- Musculoskeletal Diagnostic and Physiotherapy—Research Team, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
- Musculoskeletal Diagnostic and Physiotherapy—Research Team, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
- Correspondence: ; Tel.: +48-661-768-601
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Pałac M, Rutka M, Wolny T, Podgórski M, Linek P. Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review. Respiration 2022; 101:878-892. [PMID: 35760051 DOI: 10.1159/000524785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the potential utility of respiratory muscles ultrasound (US) imaging for assessing respiratory function and identify US variables that best correlate with pulmonary parameters. MATERIALS AND METHODS A search of 5 databases was conducted. Initially, there was no language, study design, or time frame restrictions. All studies assessing the relationship between pulmonary and US parameters were included. Two reviewers independently extracted and documented data regarding to examined population, age, gender, health condition, methodology, US, and pulmonary function measurements. All studies were qualitative synthesis. RESULTS A total of 1,272 participants from 31 studies were included. Diaphragm thickness, diaphragm thickening ratio, and diaphragm excursion amplitude were mainly used as US parameters. Forced vital capacity, forced expiratory volume1sec, and maximal inspiratory pressure were mainly used as pulmonary parameters. The relationships between pulmonary and US parameters varied from negligible to strong (depend on examined population and methodology used). Data were not quantitatively synthesis due to high heterogeneity in terms of study design, population examined, and various pulmonary and US parameters. CONCLUSION A strong relationship between US measurements and pulmonary parameters was demonstrated in some studies but not others. This review confirmed that US measurements can complement spirometry, but the exact role of the US remains to be confirmed. Further studies using standardized methodology are needed to obtain more conclusive evidence on the usefulness of US for assessing respiratory function.
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Affiliation(s)
- Małgorzata Pałac
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magdalena Rutka
- Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Tomasz Wolny
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Michał Podgórski
- Department of Radiology, Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, Łódź, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Musculoskeletal Diagnostic and Physiotherapy - Research Team, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Mikołajowski G, Pałac M, Linek P. Automated ultrasound measurements of lateral abdominal muscles under controlled breathing phases. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106936. [PMID: 35701251 DOI: 10.1016/j.cmpb.2022.106936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A breathing phase during ultrasound measurements of the lateral abdominal muscles (LAMs) are usually indirectly controlled by visual inspection of the position of the transversus abdominis (TrA) muscle. This is due to the lack of devices to directly control airflow that are connected to the ultrasound in order to automatically and simultaneously freeze ultrasound images at the programmed breathing phase. Such indirect control may be related with potential measurement error because LAMs are respiratory muscles. Thus, the aim of this study was to present a newly developed and automatic measurement procedure to directly control airflow and at the same time automatically collect ultrasound images at the programed breathing phase. Additionally, it was decided to compare LAMs measurements obtained manually by the examiner and with an external device controlling the peak phase of tidal inspiration and expiration and compare the elasticity and thickness measurements between tidal inspiration and expiration in young participants. METHODS The study was carried out on 10 healthy youth. The thickness and shear modulus were measured by an Aixplorer ultrasound scanner. The measurements were obtained manually by the examiner and with a newly developed external device controlling the peak phases of tidal inspiration and expiration. RESULTS A significant difference in external/internal oblique thickness between the expiration and inspiration phases depended on the measurement procedure. The TrA thickness was similar during inspiration and expiration. During inspiration, the TrA shear modulus was higher than during expiration, and the TrA shear modulus depended on the measurement procedure. CONCLUSION Although the raw LAMs thickness and external/internal oblique thickness/shear modulus data were similar, the measurement procedure may affect the interpretation of the results. The TrA shear modulus is the most vulnerable to errors related to the measurement procedure. Construction of this study device controlling airflow and automatically collecting ultrasound images at the selected breathing phase seems to be promising in future studies considering measurements of respiratory muscles in a strictly defined breathing phase.
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Affiliation(s)
- Grzegorz Mikołajowski
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland
| | - Małgorzata Pałac
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland.
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Watanabe Y, Tamura T, Imai R, Maruyama K, Iizuka M, Ohashi S, Yamaguchi S, Watanabe T. High-flow nasal cannula oxygen therapy was effective for dysphagia associated with respiratory muscle paralysis due to cervical spinal cord injury: A case report. Medicine (Baltimore) 2021; 100:e26907. [PMID: 34397924 PMCID: PMC8360423 DOI: 10.1097/md.0000000000026907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Respiratory muscle paralysis due to low cervical spinal cord injury (CSCI) can lead to dysphagia. Noninvasive positive airway pressure (PAP) therapy can effectively treat this type of dysphagia. High-flow nasal cannula (HFNC) oxygen therapy can generate a low level of positive airway pressure resembling PAP therapy, it may improve the dysphagia. PATIENT CONCERNS The patient was an 87-year-old man without preexisting dysphagia. He suffered a CSCI due to a dislocated C5/6 fracture, without brain injury, and underwent emergency surgery. Postoperatively (day 2), he complained of dysphagia, and the intervention was initiated. DIAGNOSIS Based on clinical findings, dysphagia in this case, may have arisen due to impaired coordination between breathing and swallowing, which typically occurs in patients with CSCI who have reduced forced vital capacity. INTERVENTIONS HFNC oxygen therapy was started immediately after the surgery, and swallowing rehabilitation was started on Day 2. Indirect therapy (without food) and direct therapy (with food) were applied in stages. HFNC oxygen therapy appeared to be effective because swallowing function temporarily decreased when the HFNC oxygen therapy was changed to nasal canula oxygen therapy. OUTCOMES Swallowing function of the patient improved and he did not develop aspiration pneumonia. LESSONS HFNC oxygen therapy improved swallowing function in a patient with dysphagia associated with respiratory-muscle paralysis following a CSCI. It may have prolonged the apnea tolerance time during swallowing and may have improved the timing of swallowing. HFNC oxygen therapy can facilitate both indirect and direct early swallowing therapy to restore both swallowing and respiratory function.
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Affiliation(s)
- Yoshihiro Watanabe
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Toshiaki Tamura
- Department of Speech, Language, and Hearing Sciences, Niigata University of Health and Welfare, Niigata Prefecture, Japan
| | - Ryota Imai
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Koki Maruyama
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Mayumi Iizuka
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Satomi Ohashi
- Department of Emergency and Critical Care, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Seigo Yamaguchi
- Department of Emergency and Critical Care, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Tatsunori Watanabe
- Department of Anesthesiology, Uonuma Kikan Hospital, Niigata Prefecture, Japan
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Kalın BS, Gürsel G. Does it make difference to measure diaphragm function with M mode (MM) or B mode (BM)? J Clin Monit Comput 2019; 34:1247-1257. [PMID: 31782086 DOI: 10.1007/s10877-019-00432-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/25/2019] [Indexed: 01/12/2023]
Abstract
Diaphragm dysfunction occurs in mechanically ventilated subjects. Recent literature suggests that diaphragm thickening fraction (DTF) measured by ultrasound can be useful to predict weaning outcome. However, there is no standardized approach in the measurement of diaphragm thickness (DT) and limited data exists comparing different measurement techniques of diaphragm thickness (M mode-MM or B mode-BM). The goal of this study was to compare MM with BM in the measurements of DT and excursion in the ICU subjects. DT measurements were obtained from the right diaphragm during tidal and maximal inspiratory breathing. Three measurements of the DT were taken both in MM and BM and their mean values were calculated. DT was measured during inspiration and expiration and DTF was calculated. Excursion of diaphragm was also measured with MM and BM during tidal and maximal inspiratory breathing. Bias and agreement between the two measurement methods were evaluated with Bland and Altman test. Sixty-two subjects were enrolled in the study. While 25 (40%) subjects were receiving invasive mechanical ventilation, 14 (23%) subjects ventilated noninvasively. There were no significant difference between the measurement results of MM and BM. BM and MM tidal diaphragm measurements during the inspiratory (0.3 ± 0.08 and 0.31 ± 0.08 cm; P = 0.022), expiratory (0.24 ± 0.07 and 0.24 ± 0.07 cm; P = 0.315) phases and tidal DTF were (27 ± 16 and 31 ± 14%, P = 0.089) respectively. Results of our study suggests that except tidal inspiratory diaphragm thickness, all thickness and excursion measurements with MM and BM are very compatible with each other. Further studies are necessarry to confirm our results and to standardize the measurements of diaphragm.
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Affiliation(s)
- Burhan Sami Kalın
- Division of Critical Care, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey. .,Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 06560, Ankara, Turkey.
| | - Gül Gürsel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, 06560, Ankara, Turkey
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