The Effect of Upper Chest Wall Restriction on Diaphragmatic Function

Thoracic Mobilization and Respiratory Muscle Endurance Training Improve Diaphragm Thickness and Respiratory Function in Patients with a History of COVID-19

Background and Objectives: Common problems in people with COVID-19 include decreased respiratory strength and function. We investigated the effects of thoracic mobilization and respiratory muscle endurance training (TMRT) and lower limb ergometer (LE) training on diaphragm thickness and respiratory function in patients with a history of COVID-19. Materials and Methods: In total, 30 patients were randomly divided into a TMRT training group and an LE training group. The TMRT group performed thoracic mobilization and respiratory muscle endurance training for 30 min three times a week for 8 weeks. The LE group performed lower limb ergometer training for 30 min three times a week for 8 weeks. The participants' diaphragm thickness was measured via rehabilitative ultrasound image (RUSI) and a respiratory function test was conducted using a MicroQuark spirometer. These parameters were measured before the intervention and 8 weeks after the intervention. Results: There was a significant difference (p < 0.05) between the results obtained before and after training in both groups. Right diaphragm thickness at rest, diaphragm thickness during contraction, and respiratory function were significantly more improved in the TMRT group than in the LE group (p < 0.05). Conclusions: In this study, we confirmed the effects of TMRT training on diaphragm thickness and respiratory function in patients with a history of COVID-19.

Effects of Maitland Thoracic Joint Mobilization and Lumbar Stabilization Exercise on Diaphragm Thickness and Respiratory Function in Patients with a History of COVID-19

Objective: We investigated the effects of maitland thoracic joint mobilization and lumbar stabilization exercise on diaphragm thickness and respiratory function in patients with a history of COVID-19. Methods: Thirty patients who had passed one month after COVID-19 onset were randomly divided into maitland thoracic mobilization and lumbar stabilization and combined breathing exercise groups; each group performed thoracic mobilization and lumbar stabilization exercises and combined breathing exercise and ergometer exercises, respectively, for 50 min, three times a week, for eight weeks. We used the MYSONO U5 MicroQuark to evaluate diaphragm thickness and respiratory function (forced vital capacity, forced expiratory volume in the one second, peak expiratory flow), respectively. Results: There were no significant between-group differences in general patient characteristics and change in diaphragm thickness and respiratory function. Both groups showed significant improvement within each parameter. However, the maitland thoracic mobilization and lumbar stabilization group showed more significant improvements than did the combined breathing exercise group (p < 0.05). Conclusion: In this study, we confirmed the maitland thoracic joint mobilization and lumbar stabilization exercise on the diaphragm thickness and respiratory function in patients with a history of COVID-19.

Is the diaphragm thickness related to gait speed in patients with hemiplegia caused by cerebrovascular accident?

[Purpose] We aimed to determine the relationship between gait speed and diaphragm thickness in community-residing patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] We recruited 11 elderly participants (six male and five female, mean age 71.1 ± 13.6 years) from an outpatient rehabilitation unit. The inclusion criteria were as follows: patients with hemiplegia caused by cerebrovascular accidents, those able to walk without assistance, and those able to understand our instructions. We measured the diaphragm thickness on both the paretic and non-paretic sides in each participant during maximum exhalation and inhalation during three laboured breaths by ultrasonography with a 7.5-MHz linear scanner. The liner scanner was placed on the eighth or ninth rib between the anterior and middle axillary lines. And their gait speed was measured during a 10 m walk. [Results] There was a strong positive correlation between gait speed and the ratio of diaphragm thickness between the paretic and the non-paretic sides during maximal inspiration. The other measured parameters did not show significant correlation with gait speed. [Conclusion] The symmetrical thickness of the diaphragm is a key factor in increasing gait speed in patients with hemiplegia. These findings may contribute to the development of trunk muscle strength-training programs that improve trunk function and gait speed in patients with hemiplegia.

Contractile capability of the diaphragm assessed by ultrasonography predicts nocturnal oxygen saturation in COPD

BACKGROUND AND OBJECTIVE

Diaphragm function might be useful to predict nocturnal oxygen desaturation in COPD. Ultrasonography has been widely used for the assessment of the diaphragm. We aimed to investigate the relationship between the contractile capability of the diaphragm assessed by ultrasonography and the nocturnal percutaneous arterial oxygen saturation (NSpO₂ ) in COPD.

METHODS

Twenty-eight male patients with COPD (age, 73 ± 7 years; forced expiratory volume in 1 s (FEV₁ ), 54.2 ± 17.0% predicted) were included. The thickness of the diaphragm (Tdi) was assessed by ultrasonography. We calculated the change ratio of Tdi at the end of maximal inspiration and expiration (%ΔTdi). The mean value of NSpO₂ (NSpO_2mean ), the percentage of total sleep time (TST) with desaturation above 4% (DA4%) and the percentage of TST with saturation below 90% (SB90%) were measured by overnight oximetry. Daytime arterial oxygen pressure (PaO₂ ) and maximal inspiratory mouth pressure (PI_max ) were also measured.

RESULTS

All participants had mild or no daytime hypoxaemia (PaO₂ , 77.3 ± 8.6 mm Hg). The NSpO_2mean , DA4% and SB90% were significantly correlated with %ΔTdi, PaO₂ , %PI_max of the predicted value and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The %ΔTdi and PaO₂ were predictors of NSpO₂ mean by multiple regression analysis.

CONCLUSION

This study suggested a close relationship between the NSpO₂ and the contractile capability of the diaphragm assessed by ultrasonography in COPD. The %ΔTdi combined with PaO₂ might predict NSpO₂ in COPD patients with mild or no daytime hypoxaemia.