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To evaluate diaphragmatic motion via M-mode ultrasonography and to correlate it with pulmonary function in stroke patients.
This was a preliminary study comprised of ten stroke patients and sixteen healthy volunteers. The M-mode ultrasonographic probe was positioned in the subcostal anterior region of the abdomen for transverse scanning of the diaphragm during quiet breathing, voluntary sniffing, and deep breathing. We analyzed diaphragmatic motion and the relationship between diaphragmatic motion and pulmonary function.
All stroke patients had restrictive pulmonary dysfunction. Compared to that exhibited by control subjects, stroke patients exhibited a significant unilateral reduction in motion on the hemiplegic side, primarily during volitional breathing. Diaphragmatic excursion in right-hemiplegic patients was reduced on both sides compared to that in control subjects. However, diaphragmatic excursion was reduced only on the left side and increased on the right side in left-hemiplegic patients compared to that in control subjects. Left diaphragmatic motion during deep breathing correlated positively with forced vital capacity (rho=0.86, p=0.007) and forced expiratory volume in 1 second (rho=0.79, p=0.021).
Reductions in diaphragmatic motion and pulmonary function can occur in stroke patients. Thus, this should be assessed prior to the initiation of rehabilitation therapy, and M-mode ultrasonography can be used for this purpose. It is a non-invasive method providing quantitative information that is correlated with pulmonary function.
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Objective: To confirm the clinical utility of diaphragmatic needle electromyography (EMG) in patients with respiratory dysfunction.
Method: Needle electorode was inserted into the muscle just above the lower costal margin between anterior axillary and medial clavicular lines. Case 1 who showed no response bilaterally in a phrenic NCS and a complete denervation of the diaphragm on needle EMG was unable to be weaned off from the ventilator. Case 2 who showed normal electrodiagnostic findings was successfully weaned off from the ventilator. Case 3 who showed a respiratory insufficiency from organophosphate intoxication had normal electrodiagnostic findings and was able to be successfully weaned off from the ventilator with a psychiatric support.
Result: We ruled out the possibility of lack in central respiratory drive and weaned off patients from the ventilator, based on a normal firing pattern of motor unit potentials.
Conclusion: Phrenic nerve conduction study (NCS) alone is not sufficient to find out the nature of respiratory dysfunction. Needle EMG of the diaphragm can be helpful in determining the pathogenesis, but its utility has been limited due to its potential risks. However we have confirmed that the needle EMG of diaphragm is a safe and easy study to perform and can provide a valuable information in the evaluation and management of respiratory dysfunction.
Objective: This study was designed to measure the range of normal values of the diaphragmatic latency, central motor conduction time and the extent of right-left agreement after a magnetic stimulation and to measure the parameters of diaphragmatic activity after magnetic stimulation in stroke patients and to compare them with the results of pulmonary function test (PFT).
Method: In seventeen healthy adults and sixteen well-cooperated stroke patients, a magnetic stimulation with 90 mm circular coil (Magstim 200) on cerebral cortex during inspiration and on C7 spinous process, and a transcutaneous electric stimulation of phrenic nerve were performed. An active electrode was attached at 5 cm superior to the tip of the xiphoid process, a reference electrode at chestwall along the midclavicular line at the lower margin of rib cage, and a ground electrode at sternum. Pulmonary function test was checked in the stroke patients.
Results: The latencies of magnetically evoked Compound muscle action potential (CMAP) were 15.1 ms on cortical stimulation, 7.7 ms on cervical stimulation and the central motor conduction time (CMCT) of diaphragm was 7.4 ms in a control group. Normal limits of each parameter were 17.7 ms, 8.9 ms and 9.8 ms in 95% CI and right-left difference of each parameter was not found. In stroke patients, twelve patients showed delayed CMCT or unevokable CMAP, and among them eleven patients showed restrictive pattern in PFT. Patients with delayed CMCT or unevokable CMAP had significantly high risk of restrictive pulmonary dysfunction.
Conclusions: We measured the normal values of evoked response of the diaphragm for cortical and cervical stimulation. In stroke patients, those with delayed CMCT or unevokable CMAP for diaphragm showed higher incidence of restrictive pulmonary dysfunction. Motor evoked potentials of the diaphragm could be used to detect the respiratory dysfunction of central origin.
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