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Viccaro F, Lecci A, Baccolini V, Sciurti A, Piamonti D, Inghilleri M, D'Antoni L, Palange P. Prediction of cough effectiveness in amyotrophic lateral sclerosis patients assessed by ultrasuond of the diaphragm during the cough expiration phase. Respir Physiol Neurobiol 2024; 327:104299. [PMID: 38879100 DOI: 10.1016/j.resp.2024.104299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
Assessing cough effectiveness, using Cough Peak Flow, is crucial for patients with Neuromuscular Diseases, such as Amyotrophic Lateral Sclerosis. Impaired cough function can contribute to respiratory decline and failure. The goal of the study is to determine the correlation between diaphragmatic excursion and cough expiratory phase, potentially utilizing ultrasonographic indices to estimate Cough Peak Flow in these patients. Twenty-two patients were enrolled in this study. The upward displacement of the diaphragm was measured with ultrasonography during voluntary cough expiration and Cough Peak Flow was simultaneously measured. A multivariable linear regression model was built to quantify the association between Cough Peak Flow and diaphragm expiratory excursion. There is significative relationship between Cough Peak Flow and diaphragm excursion with a Pearson's r coefficient of 0.86 observed in the patients group. Multiple linear regression analysis for Cough Peak Flow (Adjusted R2 = 0.86) revealed significant associations between Cough Peak Flow and expiratory excursion (adjusted β-coefficient: 64.78, 95 %, CI: 51.50-78.07, p<0.001) and sex (adjusted β-coefficient: -69.06; 95 % CI: -109.98 to -28.15, p=0.001). Our results predict the cough effectiveness by using M-mode diaphragmatic sonography with a potentially significant impact on therapeutic choices.
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Affiliation(s)
- Fausta Viccaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Altea Lecci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy.
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Antonio Sciurti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Daniel Piamonti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Letizia D'Antoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Pulmonary Division, Policlinico Umberto I Hospital, Rome, Italy
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Zhou EF, Fu SN, Huang C, Huang XP, Wong AYL. Reliability and validity of ultrasonography in evaluating the thickness, excursion, stiffness, and strain rate of respiratory muscles in non-hospitalized individuals: a systematic review. BMC Oral Health 2023; 23:959. [PMID: 38042780 PMCID: PMC10693145 DOI: 10.1186/s12903-023-03558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/19/2023] [Indexed: 12/04/2023] Open
Abstract
OBJECTIVE To summarize the reliability and validity of ultrasonography in evaluating the stiffness, excursion, stiffness, or strain rate of diaphragm, intercostals and abdominal muscles in healthy or non-hospitalized individuals. LITERATURE SEARCH PubMed, Embase, SPORTDiscus, CINAHL and Cochrane Library were searched from inception to May 30, 2022. STUDY SELECTION CRITERIA Case-control, cross-sectional, and longitudinal studies were included if they investigated the reliability or validity of various ultrasonography technologies (e.g., brightness-mode, motion-mode, shear wave elastography) in measuring the thickness, excursion, stiffness, or strain rate of any respiratory muscles. DATA SYNTHESIS Relevant data were summarized based on healthy and different patient populations. The methodological quality by different checklist depending on study design. The quality of evidence of each psychometric property was graded by the Grading of Recommendations, Assessment, Development and Evaluations, respectively. RESULTS This review included 24 studies with 787 healthy or non-hospitalized individuals (e.g., lower back pain (LBP), adolescent idiopathic scoliosis (AIS), and chronic obstructive pulmonary disease (COPD)). Both inspiratory (diaphragm and intercostal muscles) and expiratory muscles (abdominal muscles) were investigated. Moderate-quality evidence supported sufficient (intra-class correlation coefficient > 0.7) within-day intra-rater reliability of B-mode ultrasonography in measuring right diaphragmatic thickness among people with LBP, sufficient between-day intra-rater reliability of M-mode ultrasonography in measuring right diaphragmatic excursion in non-hospitalized individuals. The quality of evidence for all other measurement properties in various populations was low or very low. High-quality evidence supported sufficient positive correlations between diaphragm excursion and forced expiratory volume in the first second or forced vital capacity (r > = 0.3) in healthy individuals. CONCLUSIONS Despite the reported sufficient reliability and validity of using ultrasonography to assess the thickness, excursion, stiffness, and strain rate of respiratory muscles in non-hospitalized individuals, further large-scale studies are warranted to improve the quality of evidence regarding using ultrasonography for these measurements in clinical practice. Researchers should establish their own reliability before using various types of ultrasonography to evaluate respiratory muscle functions. TRIAL REGISTRATION PROSPERO NO. CRD42022322945.
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Affiliation(s)
- Emma FengMing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiu Ping Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Arnold Yu Lok Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Mariscal G, Burgos J, Antón-Rodrigálvarez L, Hevia E, Barrios C. Abolition of sagittal T7-T10 dynamics during forced ventilation in AIS patients with Lenke 1A curves. Sci Rep 2023; 13:6634. [PMID: 37095169 PMCID: PMC10126165 DOI: 10.1038/s41598-023-33445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
In healthy subjects, respiratory maximal volumes are highly dependent on the sagittal range of motion of the T7-T10 segment. In AIS, the abolition of T7-T10 dynamics related to the stiffness induced by the apex region in Lenke IA curves could harm ventilation during maximal breathing. The aim of this study was to analyze the dynamics of the thoracic spine during deep breathing in AIS patients and in healthy matched controls. This is a cross-sectional, case-control study. 20 AIS patients (18 girls, Cobb angle, 54.7 ± 7.9°; Risser 1.35 ± 1.2) and 15 healthy volunteers (11 girls) matched in age (12.5 versus 15.8 years mean age) were included. In AIS curves, the apex was located at T8 (14) and T9 (6). Conventional sagittal radiographs of the whole spine were performed at maximal inspiration and exhalation. The ROM of each spinal thoracic functional segment (T1-T7, T7-T10, T10-T12) and the global T1-T12 ROM were measured. In healthy subjects, the mean T1-T12 ROM during forced breathing was 16.7 ± 3.8. AIS patients showed a T1-T12 ROM of 1.1 ± 1.5 (p < 0.05), indicating a sagittal stiffness of the thoracic spine. A wide T7-T10 ROM (15.3 ± 3.0) was found in healthy controls (91.6% of the T1-T12 ROM). AIS patients showed only 0.4 ± 1.4 ROM at T7-T10 (36.4% of the T1-T12 ROM) (p < 0.001). There was a linear relationship between the magnitude of T7-T10 kyphosis in maximal exhalation and both FVC (% of predicted FVC) and FEV1. In conclusion, Lenke 1A AIS patients show a restriction of the thoracic spine motion with an almost complete abolition of T7-T10 ROM, a crucial segment for deep breathing. T7-T10 stiffness could explain the ventilatory limitations found in AIS patients.
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Affiliation(s)
- Gonzalo Mariscal
- School of Doctorate, Valencia Catholic University, Valencia, Spain
| | - Jesús Burgos
- Spine Surgery Unit, Hospital Viamed Fuensanta, Madrid, Spain
| | | | - Eduardo Hevia
- Spine Surgery Unit, Hospital la Fraternidad-Muprespa, Madrid, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Quevedo, 2, 46001, Valencia, Spain.
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Chen Y, Zhou S, Liao L, He J, Tang D, Wu W, Wang K. Diaphragmatic ultrasound can help evaluate pulmonary dysfunction in patients with stroke. Front Neurol 2023; 14:1061003. [PMID: 37144002 PMCID: PMC10151578 DOI: 10.3389/fneur.2023.1061003] [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: 10/04/2022] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
Objective Pulmonary dysfunction after stroke is increasingly gaining attention from clinical and rehabilitation specialists. However, owing to cognitive and motor dysfunction in patients with stroke, determining the pulmonary function of these patients remains challenging. The present study aimed to devise a simple method for an early evaluation of pulmonary dysfunction in patients with stroke. Methods Overall, 41 patients with stroke in the recovery period (stroke group) and 22 matched healthy controls (control group) were included in the study. We first collected data regarding baseline characteristics for all participants. Furthermore, the participants with stroke were examined using additional scales, such as the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment scale (FMA), and modified Barthel Index (MBI). Subsequently, we examined the participants with simple pulmonary function detection and diaphragm ultrasound (B-mode). Ultrasound indices calculated were as follows: the thickness of the diaphragm under the position of functional residual capacity (TdiFRC), the thickness of the diaphragm under the position of forced vital capacity (TdiFVC), thickness fraction, and diaphragmatic mobility. Finally, we compared and analyzed all data to identify group differences, the correlation between pulmonary function and diaphragmatic ultrasound indices, and the correlation between pulmonary function and assessment scale scores in patients with stroke, respectively. Results Compared with the control group, patients in the stroke group exhibited lower values for indices of pulmonary and diaphragmatic function (p < 0.001), except for TdiFRC (p > 0.05). The majority of the patients with stroke had restrictive ventilatory dysfunction, as indicated by a significantly higher incidence ratio (36 in 41 patients) than that in the control group (0 in 22 patients) (p < 0.001). Moreover, significant correlations were found between pulmonary function and diaphragmatic ultrasound indices (p < 0.05), with the strongest correlation between TdiFVC and pulmonary indices. In the stroke group, pulmonary function indices were negatively correlated with the NIHSS scores (p < 0.001) and positively correlated with the FMA scores (p < 0.001). No (p > 0.05) or weak (p < 0.05) correlation was found between pulmonary function indices and the MBI scores. Conclusion We found that patients with stroke had pulmonary dysfunction even in the recovery period. Diaphragmatic ultrasound can be used as a simple and effective tool for detecting pulmonary dysfunction in patients with stroke, with TdiFVC being the most effective index.
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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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Ziaeifar M, Noorizadeh Dehkordi S, Haghighatkhah HR, Sarrafzadeh J, Arabloo AM, Zendehdel Jadehkenari A. Intrarater Reliability of Diaphragm Excursion and Resting Thickness Using Ultrasound Imaging in Subjects With Nonspecific Chronic Low Back Pain. J Chiropr Med 2022; 21:15-22. [DOI: 10.1016/j.jcm.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
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Ziaeifar M, Sarrafzadeh J, Noorizadeh Dehkordi S, Arab AM, Haghighatkhah H, Zendehdel Jadehkenari A. Diaphragm thickness, thickness change, and excursion in subjects with and without nonspecific low back pain using B-mode and M-mode ultrasonography. Physiother Theory Pract 2021; 38:2441-2451. [PMID: 34061721 DOI: 10.1080/09593985.2021.1926022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Previous studies have demonstrated that respiratory dysfunction has a potential association with low back pain (LBP). Despite the role of the diaphragm for respiration and spinal stability, knowledge of the function of both sides of the diaphragm in subjects with LBP is still limited.Objective: This study aimed to compare the structural integrity and function of the right and left hemidiaphragm by ultrasonography (USG) in subjects with and without nonspecific chronic low back pain (NS-CLBP).Methods: A total of 37 subjects with NS-CLBP and 34 healthy subjects participated in this case-control study. The thickness, thickness change, and excursion of the right and left hemidiaphragm were compared within and between the groups during quiet breathing (QB) and deep breathing (DB) through B-mode and M-mode ultrasound imaging.Results: The LBP group had a significantly smaller degree of right hemidiaphragm thickness change (P = .001) compared with the healthy control group, with a strong effect size. Nevertheless, there was no significant change for diaphragm thickness and excursion between the two groups. The result showed that, in the healthy group, the right hemidiaphragm had a significantly smaller thickness at expiration and larger thickness change compared with the left hemidiaphragm, with a moderate effect size. Based on the multivariate prediction analysis, the right hemidiaphragm thickness change might significantly predict LBP.Conclusion: We found that participants with LBP had a smaller degree of right hemidiaphragm thickness change. Also, the right hemidiaphragm thickness change might significantly predict LBP.
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Affiliation(s)
- Maryam Ziaeifar
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Javad Sarrafzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
| | - Amir Massoud Arab
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Haghighatkhah
- Radiology Department of Diagnosis Imaging Shohadae Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Alieh Zendehdel Jadehkenari
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mirdamad Blvd, Tehran, Iran
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Ellis R, Helsby J, Naus J, Bassett S, Fernández-de-Las-Peñas C, Carnero SF, Hides J, O'Sullivan C, Teyhen D, Stokes M, Whittaker JL. Exploring the use of ultrasound imaging by physiotherapists: An international survey. Musculoskelet Sci Pract 2020; 49:102213. [PMID: 32861368 DOI: 10.1016/j.msksp.2020.102213] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND National surveys in New Zealand, Australia and the United Kingdom suggest ultrasound imaging (USI) use by physiotherapists is increasing. However, concerns exist regarding clarity for scopes of practice, and availability and standardisation of training. OBJECTIVES To investigate physiotherapists' understanding of scopes of practice for the use of USI; clarify the professional contexts, clinical uses and levels of training; and identify barriers preventing physiotherapists' USI use. DESIGN A cross-sectional, observational survey. METHODS An Internet-based survey, offered in 20 different languages, was used including items covering five domains: (1) demographic and professional characteristics; (2) knowledge of scope of practice; (3) USI use; (4) USI training content and duration; and (5) perceived barriers to physiotherapists' use of USI. RESULTS 1307 registered physiotherapists from 49 countries responded; 30% were unsure of the scope of practice for physiotherapists' USI use. 38% of participants were users of USI, reporting varied contexts and clinical uses, reflected in the broader categories of: (i) biofeedback; (ii) diagnosis; (iii) assessment; (iv) injection guidance; (v) research; (vi) and teaching. The training users received varied, with formal training more comprehensive. 62% were non-users, the most common barrier was lack of training (76%). CONCLUSION These findings suggest physiotherapists' USI use is increasing in various contexts; however, there is uncertainty regarding scopes of practice. There are discrepancies in training offered, with a lack of training the most common barrier to physiotherapists' use of USI. International guidelines, including a USI training framework, are needed to support the consistent and sustainable use of USI in physiotherapy.
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Affiliation(s)
- Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jake Helsby
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jade Naus
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Sandra Bassett
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | - Julie Hides
- School of Allied Health Sciences, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Deydre Teyhen
- Commander, U.S. Army Walter Reed Army Institute of Research, 503 Robert Grant Road, Silver Spring, MD, 20910, USA
| | - Maria Stokes
- School of Health Sciences, University of Southampton, Building 67, Highfield Campus, Southampton SO17 1BJ, UK
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada/Arthrite-recherche Canada, Richmond, Canada
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Yoon SY, Moon HI, Kim JS, Yi TI, Park YG. Comparison Between M-Mode Ultrasonography and Fluoroscopy for Diaphragm Excursion Measurement in Patients With Acquired Brain Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:535-542. [PMID: 31512782 DOI: 10.1002/jum.15130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patients with acquired brain injury show decreased pulmonary function and diaphragm excursion (DE), which can affect functional outcomes. This study aimed to compare ultrasonography (US) and fluoroscopy for DE assessment and to determine how the relationship between pulmonary function test results and DE differs according to the paralytic condition. METHODS From September 2017 to April 2018, we prospectively enrolled patients with acquired brain injury. The patients underwent a pulmonary function test, including the functional vital capacity, forced expiratory volume at 1 second, forced expiratory volume at 1 second-to-functional vital capacity ratio, peak cough flow, and respiratory muscle strength such as the maximal inspiratory pressure and maximal expiratory pressure. Diaphragm excursion was measured with M-mode US and fluoroscopy on admission. A partial correlation analysis was used to assess the correlation between US and fluoroscopy for DE assessment. RESULTS During the study period, 50 patients with acquired brain injury were enrolled. After adjusting for age, sex, height, and weight, the correlation coefficients between US and fluoroscopy were 0.744 for the right side (P < .001) and 0.631 for the left side (P < .001). In a subgroup analysis for patients with hemiplegia, the correlation coefficients were 0.507 for the paretic side (P = .007) and 0.677 for the nonparetic side (P < .001). Diaphragm excursion in the nonparetic side was significantly correlated with the maximal inspiratory pressure, maximal expiratory pressure, and peak cough flow (P < .05). CONCLUSIONS M-mode US can be an alternative method for DE measurement in patients with impaired locomotion function after acquired brain injury. Preserved function of the nonparetic side might affect pulmonary function after brain injury, which suggests the importance of prestroke respiratory function.
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Affiliation(s)
- Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Joo-Sup Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Use of thoracic ultrasound by physiotherapists: a scoping review of the literature. Physiotherapy 2018; 104:367-375. [PMID: 29958691 DOI: 10.1016/j.physio.2018.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear. OBJECTIVE The aim of this scoping review is to gain an understanding of the emerging evidence base surrounding physiotherapy use of TUS to inform research and clinical practice. DATA SOURCES A systematic search was conducted of the following databases: Cochrane, EPPI centre, PROSPERO, Medline, CINAHL, AMED, EMBASE, HMIC, and BNI. STUDY SELECTION Inclusion criteria: primary research reporting the use of diagnostic TUS; a physiotherapist as part of the study design or as the chief investigator; published in English. SYNTHESIS METHODS Data regarding demographics, design, type of conditions and anatomical structures investigated and profession leading the TUS of included papers were compiled in a tabular format. RESULTS Of the 26 included papers, nine studied healthy participants, four studied COPD and four studied critical care patients. Most papers (n=23) involved scanning the diaphragm. In eight studies the physiotherapist operated the TUS. LIMITATIONS The paper selection process was performed by one author; with no cross-checking by another individual. CONCLUSION Use of TUS by physiotherapists is an emerging area in both diaphragm and lung diagnostics. A wide range of patient populations may benefit from physiotherapists using TUS. Papers in this review are heterogeneous making any generalisability difficult but does show its potential for varied uses. TUS is an innovative skill in the hands of physiotherapists, but more research is needed.
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