Ann Rehabil Med.  2014 Feb;38(1):29-37. 10.5535/arm.2014.38.1.29.

Ultrasonographic Diaphragmatic Motion Analysis and Its Correlation With Pulmonary Function in Hemiplegic Stroke Patients

• Jung KJ
• Park JY
• Hwang DW
• Kim JH
• Kim JH

• KMID: 2266537
• DOI: http://doi.org/10.5535/arm.2014.38.1.29

Abstract

OBJECTIVE
To evaluate diaphragmatic motion via M-mode ultrasonography and to correlate it with pulmonary function in stroke patients.
METHODS
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.
RESULTS
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).
CONCLUSION
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.

Keyword

Stroke; Hemiplegia; Diaphragm; Ultrasonography; Pulmonary function tests

MeSH Terms

Abdomen
Diaphragm
Forced Expiratory Volume
Healthy Volunteers
Hemiplegia
Humans
Methods
Rehabilitation
Respiration
Respiratory Function Tests
Stroke*
Ultrasonography
Vital Capacity

Figure

• 

  Fig. 1 (A) Ultrasonographic approach to the right diaphragm. The transducer was placed on the anterior subcostal region at the right mid-clavicular line. (B) Right diaphragm viewed as a hyperechogenic line on the B-mode screen. The inferior vena cava (IVC) is visible on the right side of the screen, and the gall bladder is present at the center of the screen. The M-beam line is angled approximately 30° to the vertical line.

• 

  Fig. 2 (A) Ultrasonographic approach to the left diaphragm. The transducer was placed on the anterior subcostal region between the anterior and midaxillary lines. (B) Left diaphragm viewed as a hyperechogenic line on the B-mode screen. The hilum of the spleen is viewed at the maximum distance on the screen. The M-beam line is angled approximately 30° to the vertical line.

• 

  Fig. 3 (A) Measurement of diaphragmatic excursion (DE) during quiet breathing on the M-mode screen. (B) Measurement of DE during deep breathing on the M-mode screen. DE is represented by the vertical axis between the line passing through the end of the normal expiration and inspiratory peaks. (C) Measurement of DE during voluntary sniffing on the M-mode screen. DE is represented by the vertical line between the baseline and the peak of the inspiration graph.

• 

  Fig. 4 (A) Right diaphragmatic excursion in control subjects and right- and left-hemiplegic stroke patients. (B) Left diaphragmatic excursion in control subjects and right- and left-hemiplegic stroke patients. *p<0.05, **p<0.01.

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