Original article| Volume 96, ISSUE 1, P114-121, January 2015

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Decreased Diaphragm Excursion in Stroke Patients With Dysphagia as Assessed by M-Mode Sonography

Published:September 15, 2014DOI:



      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.


      Prospective cross-sectional study.


      University rehabilitation hospital.


      Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74).


      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.


      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.


      M-mode ultrasonography showed that stroke patients with dysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing.


      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)
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