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Lee CT, Chien JY, Hsu MJ, Wu HD, Wang LY. Inspiratory muscle activation during inspiratory muscle training in patients with COPD. Respir Med 2021; 190:106676. [PMID: 34773734 DOI: 10.1016/j.rmed.2021.106676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/07/2021] [Accepted: 10/30/2021] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The main target of inspiratory muscle training (IMT) is to improve diaphragm function in patients with COPD who have inspiratory muscle weakness. Ventilatory demand is already increased during quiet breathing in patients with COPD, and whether threshold load imposed by IMT would active more accessory muscle remained to be determined. The purpose of this study was to examine diaphragm and sternocleidomastoid (SCM) activation during IMT with intensities of 30% and 50% maximal inspiratory pressure (PImax). METHODS Patients with COPD and a PImax lower than 60 cmH2O were recruited for the study. Surface electromyography (EMG) was used to measure diaphragm and SCM activation, and group-based trajectory modeling (GBTM) was used to identify activation patterns during IMT. The generalized estimating equation (GEE) was then used to detect differences of variables between various breathing tasks. Statistical significance was established at p < 0.05. RESULTS A total of 30 patients with COPD participated in this study. All patients demonstrated significant increases in diaphragm and SCM activation during 30% and 50% PImax of IMT than during quiet breathing (all p < 0.001). Diaphragm demonstrated two distinct patterns in response to IMT: low activation (n = 8) and high activation (n = 22) group using GBTM analysis. CONCLUSION Diaphragm and SCM were substantially activated during IMT in patients with COPD who had inspiratory muscle weakness. Regardless of whether diaphragm activation was high or low, SCM was activated to a greater extent in response to IMT.
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Affiliation(s)
- Chien-Tzu Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Miao-Ju Hsu
- Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huey-Dong Wu
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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AbuNurah HY, Russell DW, Lowman JD. The validity of surface EMG of extra-diaphragmatic muscles in assessing respiratory responses during mechanical ventilation: A systematic review. Pulmonology 2020; 26:378-385. [PMID: 32247711 PMCID: PMC8085814 DOI: 10.1016/j.pulmoe.2020.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/22/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Evidence supporting the utilization of surface EMG (sEMG) of extra-diaphragmatic muscles for monitoring of mechanical ventilation (MV) assistance is unclear. The purpose of this review was to assess the quality of literature available on using extra-diaphragmatic sEMG as an assessment technique of respiratory responses during MV. METHODS Studies using sEMG of extra-diaphragmatic respiratory muscles during MV were selected by two independent researchers after performing a database search of PubMed, CINAHL, GOOGLE SCHOLAR. Exclusion criteria were studies of patients with neuromuscular disorders, receiving neuromuscular blocking agents, receiving non-invasive MV, using needle EMG, and studies written in languages other than English. Quality of identified studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). This study is registered with PROSPERO, number (CRD42018081341). RESULTS 596 references were identified. Of the identified studies, 7 studies were included in the review. Findings demonstrate that sEMG of extra-diaphragmatic muscle activity is a valid and applicable tool to evaluate mechanical loading/unloading of respiratory muscles and respiratory drive or sensation. However, the quality of literature supporting sEMG as monitoring tool of respiratory responses were characterized by a high and unclear risk of bias. CONCLUSIONS Although it appears to be a valid and applicable tool, there is a scarcity of literature that directly demonstrates the diagnostic accuracy of sEMG of extra-diaphragmatic muscles in monitoring respiratory mechanics and respiratory drive or sensation during MV assistance across wide populations and conditions.
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Affiliation(s)
- H Y AbuNurah
- Department of Respiratory Therapy, King Saud bin Abdulaziz University for Health Sciences, KSA & the PhD in Rehabilitation Science Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - D W Russell
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - J D Lowman
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Wang LY, Yang PY, Chen YJ, Wu HD, Huang YH, Hsieh CH. Inspiratory muscle training attenuates irradiation-induced diaphragm dysfunction. Am J Transl Res 2019; 11:5599-5610. [PMID: 31632532 PMCID: PMC6789230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
Abstract
Because radiotherapy (RT) can induce diaphragm dysfunction, this study investigated the protective effect of inspiratory muscle training (IMT) on RT-induced diaphragm damage in patients with esophageal cancer during concurrent chemoradiotherapy (CCRT) in a preclinical setting, and an animal model was designed to confirm and explore the underlying mechanism. Six subjects who underwent CCRT were randomly enrolled in the control or concurrent-IMT group (n=3 per group). The training intensity was set to 30% maximal effort. The diaphragmatic function and functional exercise capacity were assessed weekly during the course of CCRT. Furthermore, Sprague-Dawley (SD) rats were randomly assigned to receive IMT using the tracheal banding method over a 1-week period (n=6) or the sham group (n=6). After training was completed, 5-Gy RT was applied to the diaphragm. All the rats were sacrificed 24 h following RT, and their diaphragms were removed and examined for contractile function, antioxidant capacity, and oxidative injury. In patients receiving IMT, the diaphragm activation efficiency and fatigability and the functional exercise capacity were improved during the CCRT course. The animals belonging to the training group demonstrated significantly higher peak twitch (P<0.01) and tetanus tension (P<0.001), less fatigue (P=0.04), lower protein carbonyl levels (P<0.01) and higher Cu/Zn-SOD and Mn-SOD mRNA expression levels (both P<0.05) compared with those belonging to the control group. Preclinical human and animal models show that the IMT-conditioned diaphragm exhibits better resistance to off-target irradiation damage, but studies with a larger patient sample size are warranted to confirm the applicability of this concept in clinical practice.
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Affiliation(s)
- Li-Ying Wang
- Physical Therapy Center, National Taiwan University HospitalTaipei, Taiwan, Republic of China
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan UniversityTaipei, Taiwan, Republic of China
| | - Pei-Yu Yang
- Physical Therapy Center, National Taiwan University HospitalTaipei, Taiwan, Republic of China
| | - Yu-Jen Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming UniversityTaipei, Taiwan, Republic of China
- Department of Radiation Oncology, Mackay Memorial HospitalTaipei, Taiwan, Republic of China
- Department of Medical Research, Mackay Memorial HospitalTaipei, Taiwan, Republic of China
| | - Huey-Dong Wu
- Department of Integrated Diagnostic and Therapeutics, National Taiwan University HospitalTaipei, Taiwan, Republic of China
| | - Yi-Hsuan Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan UniversityTaipei, Taiwan, Republic of China
| | - Chen-Hsi Hsieh
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming UniversityTaipei, Taiwan, Republic of China
- Faculty of Medicine, School of Medicine, National Yang-Ming UniversityTaipei, Taiwan, Republic of China
- Department of Radiation Oncology, Far Eastern Memorial HospitalTaipei, Taiwan, Republic of China
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Dos Reis IMM, Ohara DG, Januário LB, Basso-Vanelli RP, Oliveira AB, Jamami M. Surface electromyography in inspiratory muscles in adults and elderly individuals: A systematic review. J Electromyogr Kinesiol 2019; 44:139-155. [PMID: 30658230 DOI: 10.1016/j.jelekin.2019.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/21/2018] [Accepted: 01/09/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Electromyography (EMG) helps to evaluate disorders and pulmonary behavior, as impairments in respiratory muscle function are associated with the development of diseases. There is a wide range of methods and protocols used to record and analyze EMG obtained from respiratory muscles, demonstrating a lack of standardization. OBJECTIVE To identify the most common procedures used to record surface EMG (sEMG) of inspiratory muscles in adults and elderly individuals through a systematic review (primary), and to evaluate the quality of the report presented by the studies (secondary). METHOD Studies published from January 1995 until June 2018 were searched for in the Web of Science, PubMed, LILACS, EBSCO and Embase databases. Only studies evaluating sEMG of inspiratory muscles were included. RESULTS The electronic search retrieved a total of 6697 titles and 92 of them were included. A great variability on the methods applied to both recording and processing/analyzing data was found. Therefore, the synthesis of practical/clinical evidence to support immediate recommendations was impaired. In general, the descriptions presented by the studies are poor. CONCLUSION The most common procedures used for sEMG were identified. Methodological studies with objective comparisons were fundamental for improving standardization, given the impossibility of recommendations from this review.
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Affiliation(s)
- Ivanize Mariana Masselli Dos Reis
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Spirometry and Respiratory Physiotherapy Laboratory (LEFiR) at UFSCar, São Carlos/SP, Brazil.
| | - Daniela Gonçalves Ohara
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Federal University of Amapá (UNIFAP), Macapá/AP, Brazil
| | - Letícia Bergamin Januário
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Laboratory of Clinical and Occupational Kinesiology (LACO) at UFSCar, São Carlos/SP, Brazil
| | - Renata Pedrolongo Basso-Vanelli
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; University Hospital of UFSCar, São Carlos/SP, Brazil
| | - Ana Beatriz Oliveira
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Laboratory of Clinical and Occupational Kinesiology (LACO) at UFSCar, São Carlos/SP, Brazil
| | - Mauricio Jamami
- Department of Physical Therapy, Biological and Health Sciences Center, Federal University of São Carlos (UFSCar), São Carlos/SP, Brazil; Spirometry and Respiratory Physiotherapy Laboratory (LEFiR) at UFSCar, São Carlos/SP, Brazil
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Jung JH, Kim NS. Changes in training posture induce changes in the chest wall movement and respiratory muscle activation during respiratory muscle training. J Exerc Rehabil 2018; 14:771-777. [PMID: 30443522 PMCID: PMC6222142 DOI: 10.12965/jer.1836366.183] [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: 07/30/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Abstract
Postural changes induce changes in chest wall kinematics and eventually pulmonary function, and affect chest wall shape and chest motion. This study aimed to examine the effects of postural change on changes in the chest wall during respiratory muscle training. Using a repeated measures design, this study followed 13 healthy adults (13 men; mean age, 23.73 years). All participants performed four postures (neutral, full trunk rotation, half-range trunk rotation, and lateral ribcage shift postures) during respiratory muscle training. The chest wall movement during the four postures was measured using a three-dimensional motion-analysis system during respiratory muscle training. Surface electromyography data were collected from the diaphragm and sternocleidomastoid muscles, and the asymmetric ratio of muscle activation was calculated based on the collected data. The chest wall movements of the upper costal and middle costal region were greater in the neutral posture than in the full rotation, half rotation, and lateral ribcage shift postures (P<0.05). The respiratory muscle activation on diaphragm of left was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). The asymmetric ratio of muscle activation was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). This study verified that postural change during respiratory muscle training may affect chest wall movement and muscle activation. Thus, this study recommends respiratory muscle training to be performed in neutral posture.
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Affiliation(s)
- Ju-Hyeon Jung
- Department of Physical Therapy, Gimhae College, Gimhae, Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea
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Cabral EEA, Fregonezi GAF, Melo L, Basoudan N, Mathur S, Reid WD. Surface electromyography (sEMG) of extradiaphragm respiratory muscles in healthy subjects: A systematic review. J Electromyogr Kinesiol 2018; 42:123-135. [PMID: 30077087 DOI: 10.1016/j.jelekin.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of this systematic review was to examine procedures used and outcome measures reported from surface EMG (sEMG) of extradiaphragm inspiratory muscles in healthy people. Relevant articles were searched using the concepts "electromyography (EMG)", "respiratory muscles (sternocleidomastoid [SM], scalene, intercostal [IC] and parasternal)" and "healthy" in the electronic databases: MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and Database of Systematic Reviews, CINAHL, SPORTDiscus, LILACS, and PEDro. Twenty-five papers were included and quality assessment was performed using an adapted Downs and Black checklist. Twenty-eight percent of included papers were classified as moderate quality and the rest were low quality. The SM was the muscle most often investigated. Description of EMG techniques were often incomplete for features such as the procedure before electrode placement, description of the surface electrodes, the EMG detection mode and amplification. Of note, descriptions of the IC muscle electrode positioning varied widely. Comparison of outcomes among studies was challenging because of the very diverse EMG outcomes reported. There are many controversies regarding methods and technique used to assess sEMG of extradiaphragm inspiratory muscles. Therefore, studies with higher methodological quality utilizing standardized EMG procedures including electrode positioning will enable accurate and reliable comparison among studies of the extradiaphragm inspiratory muscles.
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Affiliation(s)
- Elis E A Cabral
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), UFRN, Natal, RN, Brazil
| | - Guilherme A F Fregonezi
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil; PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), UFRN, Natal, RN, Brazil
| | - Luana Melo
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Nada Basoudan
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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Effect of Different Head-Neck Postures on the Respiratory Function in Healthy Males. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4518269. [PMID: 30112389 PMCID: PMC6077663 DOI: 10.1155/2018/4518269] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
Abstract
Normal respiration is a very intricate function that comprises mechanical as well as nonmechanical components. It is shown to be affected by various factors including age, lifestyle, disease, and change in posture. With the increased use of hand held devices, everyone is prone to poor sitting postures like forward head posture. The purpose of this study was to evaluate the effect of assumed forward head posture and torticollis on the diaphragm muscle strength. A sample of 15 healthy males, aged 18-35 years, was recruited for this study. All subjects performed spirometry to measure the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and FEV1/FVC ratio. SNIP was measured during upright sitting, induced forward head posture, and torticollis. Subject's mean age (SD) was 23(6) years. The SNIP score of the subjects during sitting with FHP was lower as compared to that during upright sitting. It decreased significantly during induced right torticollis position. This is the first study exploring the impact of different head and neck positions on respiratory function. Alteration of head and neck positions had an immediate negative impact on respiratory function. Clinicians should be prompted to assess respiratory function when assessing individuals with mal-posture.
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Ait Ali L, Pingitore A, Piaggi P, Brucini F, Passera M, Marotta M, Cadoni A, Passino C, Catapano G, Festa P. Respiratory Training Late After Fontan Intervention: Impact on Cardiorespiratory Performance. Pediatr Cardiol 2018; 39:695-704. [PMID: 29349618 DOI: 10.1007/s00246-018-1808-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
Fontan palliation allows patients with "single ventricle" circulation to reach adulthood with an acceptable quality of life, although exercise tolerance is significantly reduced. To assess whether controlled respiratory training (CRT) increases cardiorespiratory performance. 16 Adolescent Fontan patients (age 17. 5 ± 3.8 years) were enrolled. Patients were divided into CRT group (n = 10) and control group (C group, n = 6). Maximal cardiopulmonary test (CPT) was repeated at the end of CRT in the CRT group and after an average time of 3 months in the C group. In the CRT group a CPT endurance was also performed before and after CRT. In the CRT group there was a significant improvement in cardiovascular and respiratory response to exercise after CRT. Actually, after accounting for baseline values, the CRT group had decreased breathing respiratory reserve (- 15, 95% CI -22.3 to - 8.0, p = 0.001) and increased RR peak (+ 4.8, 95% CI 0.7-8.9, p = 0.03), VE peak (+ 13.7, 95% CI 5.6-21.7, p = 0.004), VO2 of predicted (+ 8.5, 95% CI 0.1-17.0, p = 0.05), VO2 peak (+ 4.3, 95% CI 0.3 to 8.2, p = 0.04), and VO2 workslope (+ 1.7, 95% CI 0.3-3.1, p = 0.02) as compared to the control group. Moreover, exercise endurance time increased from 8.45 to 17.7 min (p = 0.01). CRT improves cardiorespiratory performance in post-Fontan patients leading to a better aerobic capacity.
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Affiliation(s)
- Lamia Ait Ali
- Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124, Pisa, Italy.,Fondazione G. Monasterio, Regione Toscana, Pisa, Italy
| | | | - Paolo Piaggi
- National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Phoenix, AZ, USA
| | - Fabio Brucini
- Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Mirko Passera
- Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Marco Marotta
- Fondazione G. Monasterio, Regione Toscana, Pisa, Italy
| | | | - Claudio Passino
- Fondazione G. Monasterio, Regione Toscana, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
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Jo MR, Kim NS. The correlation of respiratory muscle strength and cough capacity in stroke patients. J Phys Ther Sci 2016; 28:2803-2805. [PMID: 27821939 PMCID: PMC5088130 DOI: 10.1589/jpts.28.2803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/16/2016] [Indexed: 12/13/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the correlation between respiratory muscle strength and cough capacity in stroke patients. [Subjects and Methods] Forty-two stroke patients were assigned to 2 different groups (intervention group=21, control group=21). Both groups participated in a conventional stroke rehabilitation program, with the intervention group also receiving respiratory muscle training for 20 to 30 minutes a day, 3 times a week for 8 weeks. Respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure), forced vital capacity, and cough capacity were measured. [Results] The intervention group showed significant increases in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, and cough capacity. The change in maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity showed a significant correlation with cough capacity, with maximal expiratory pressure showing the highest correlation. [Conclusion] The present study showed that the increase in maximal expiratory pressure plays an important role in improving the cough capacity of stroke patients.
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Affiliation(s)
- Myeong-Rae Jo
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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