Abstract
Objective
To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia
and determine whether they present reduced diaphragm excursion during voluntary cough
compared with stroke patients without dysphagia and healthy subjects.
Design
Prospective cross-sectional study.
Setting
University rehabilitation hospital.
Participants
Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia
(n=24), and healthy control participants (n=27) (N=74).
Interventions
Not applicable.
Main Outcome Measures
Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were
recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory
pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured.
Results
The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet
breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7
(P<.001); 23.8±7.1, 32.7±10.6, and 44.7±10.3 (P<.001); and 16.8±4.8, 28.5±4.9, and 36.0±8.2 (P<.001), respectively. The differences were statistically significant. Differences
were observed in the maximum inspiratory (P<.001) and expiratory (P<.001) pressures and peak cough flow (P=.027) among the 3 groups. Forward selection stepwise regression analysis, which was
performed to determine variables that help predict diaphragm excursion during voluntary
coughing, showed that the presence of dysphagia explained up to 60% (P<.001) of the hemiplegic diaphragm movement during voluntary coughing in patients
with stroke.
Conclusions
M-mode ultrasonography showed that stroke patients with dysphagia have decreased diaphragm
excursion and compromised respiratory function during voluntary coughing.
Keywords
List of abbreviations:
DB (deep breathing), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), MBI (Modified Barthel Index), MEP (maximum expiratory pressure), MIP (maximum inspiratory pressure), NIHSS (National Institutes of Health Stroke Scale), PCF (peak cough flow), QB (quiet breathing), VC (voluntary cough)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 15, 2014
Footnotes
Supported by the Catholic Medical Center Research Foundation (grant no. 5-2012-B0001-0002).
Clinical Trial Registration No.: NCT01637649.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
