Annals of Rehabilitation Medicine

Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients: Ra Yu Yun, Ho Eun Park, Ji Won Hong, Yong Beom Shin, Jin A Yoon; Ann Rehabil Med 2019;43(2):156-162. Published online April 30, 2019; DOI: https://doi.org/10.5535/arm.2019.43.2.156

Abstract
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Objective
To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement.
Methods
A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured.
Results
Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018).
Conclusion
We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

Citations

Citations to this article as recorded by

The Impact of Ageing on Diaphragm Function and Maximal Inspiratory Pressure: A Cross-Sectional Ultrasound Study
Toru Yamada, Taro Minami, Takahiro Shinohara, Shuji Ouchi, Suguru Mabuchi, Shunpei Yoshino, Ken Emoto, Kazuharu Nakagawa, Kanako Yoshimi, Mitsuko Saito, Ayane Horike, Kenji Toyoshima, Yoshiaki Tamura, Atsushi Araki, Ryoichi Hanazawa, Akihiro Hirakawa, Tak
Diagnostics.2025; 15(2): 163. CrossRef
Methods for Diagnosing and Predicting Diaphragm Dysfunction in the Recovery Period of a Stroke: a Narrative Review
Ekaterina A. Melnikova, Elena Yu. Starkova, Nadezhda N. Vladimirova, Evgeniya M. Tsvetkova, Vladislav Yu. Litau
Bulletin of Rehabilitation Medicine.2023; 22(4): 138. CrossRef
Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function
Xiaoman Liu, Qingming Qu, Panmo Deng, Yuehua Zhao, Chenghong Liu, Conghui Fu, Jie Jia
Brain Sciences.2022; 12(7): 882. CrossRef
Respiratory‐swallow coordination in a rat model of chemoradiation
Linda M. Rowe, Nadine P. Connor, John A. Russell
Head & Neck.2021; 43(10): 2954. CrossRef
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Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients
Sung-Hyoun Cho, Ki-Bok Choi
Healthcare.2020; 8(3): 222. CrossRef

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A Survey of Respiratory Care in Amyotrophic Lateral Sclerosis Patients Using Non-invasive Ventilatory Support.: Kim, Jung Yoon , Min, Yusun , Kim, Myoung Soo , Kim, Jung Soon , Kim, Hyun Li , Shin, Hyung Ik; J Korean Acad Rehabil Med 2010;34(1):49-53.

Abstract
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Objective
To investigate the current status of respiratory care in community-dwelling amyotrophic lateral sclerosis (ALS) patients using non-invasive ventilatory support. Method: Trained investigators visited patients' homes in order to conduct the survey. Questions regarding the time since diagnosis and ventilatory support, department and type of ventilator were asked. The parameters of mechanical ventilation were noted. The presence of respiratory symptoms, frequency of oxygen saturation monitoring, maneuvers for sputum clearance and frequency of air stacking exercise were also investigated. Results: Data from 169 individuals were analyzed. The mean age was 59.1±12.5 years, time since diagnosis was 48.0±42.8 months and duration of ventilatory support was 25.7±20.8 months. The types of ventilator used were significantly different according to the medical departments where they had been prescribed. More than 50% of the subjects had sleep awakening, shortness of breath or daytime drowsiness despite ventilatory support. Air stacking exercises were performed in 8.8%. Sputum clearing maneuvers such as manually assisted cough, mechanical in/ex-sufflation or postural drainage were used by 13.6% of the individuals. Only 16.0% of the patients checked their oxygen saturation level more than once a day. Conclusion: Current respiratory care is inappropriate in ALS patients using non-invasive ventilatory support at home. The current system for ventilator prescription and monitoring needs modification to improve the respiratory care status. (J Korean Acad Rehab Med 2010; 34: 49-53)

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Effect of Passive Leg Range of Motion Exercise in Hemiplegic Patients.: Kim, Kweon Young , Kim, Do Gyun , Shin, Soo Beom; J Korean Acad Rehabil Med 2001;25(6):928-933.

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Objective: The purpose of this study was to examine the change of heart rate, mean arterial pressure, respiration rate, and spasticity at passive leg range of motion exercise for one month in hemiplegic patients.

Method: Subjects were composed of twenty hemiplegic patients who had spasticity above two grade in modified Ashworth scale. Passive leg range of motion exercise was performed with passive cycle leg exerciser (Autocybex) at the speed of 40 rpm. Training program consisted of two sessions a day, and each session was done for twenty minutes. The heart rate, mean arterial pressure, and respiration rate were checked for each subject before and after passive leg range of motion exercise at initial state and after one month. Spasticity was measured at knee joint of the affected side at initial state and after one month.

Results: The resting heart rate, mean arterial pressure and respiration rate were significantly decreased after one month (p＜0.05). The changes of heart rate, mean arterial pressure, and respiration rate after passive leg range of motion exercise were significantly decreased after one month (p＜0.05). The grade of spasticity was decreased after one month (p＜0.05).

Conclusion: We concluded that passive leg range of motion exercise during one month stabilized heart rate, mean arterial pressure, and respiration rate, and reduced spasticity.

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Respiration Patterns and Abdominal Muscle Activities during Speech Production in Athetoid Cerebral-Palsied Patients.: Lee, Chyung Ki , Kim, Eun Kyoung; J Korean Acad Rehabil Med 1999;23(5):926-932.

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Objective: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP).

Method: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks.

Results: The followings were observed in the athetoid CP.

1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter.

2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath.

3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks.

Conclusion: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.