Chest wall volume and asynchrony in stroke and Parkinson’s disease subjects: A case-control study

Abstract

Background The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson’s disease and post-Stroke in comparison to healthy individuals. Methods Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson’s disease subjects). Post-stroke and Parkinson’s disease subjects were also grouped according to the length of diagnosis. Results In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (V RCp ) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson’s subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson’s disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). Conclusion Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson’s disease individuals. Half of the subjects with post-Stroke and Parkinson’s disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.

Measurement of chest wall motion using a motion capture system with the one-pitch phase analysis method

“…Asynchrony was presented as degrees: 0° represented a perfect synchrony between the two compartments and 180° total asynchrony. A positive angle indicated that the motion of the area drawn on the y-axis was followed by the motion of the area drawn on the x-axis, and a negative angle suggested an opposite situation, as previously described 23 – 27 . For asynchronous analysis, the inspiratory paradox time (IPT) and expiratory paradox time (EPT) of the upper RC, lower RC, and ABD were also calculated.…”

“…Finally, the anatomical definition of upper RC, lower RC, and ABD for MCO method is not well-established. In OEP, the chest wall area covers entire compartment and is divided into three compartments (pulmonary RC, abdominal RC, and ABD) based on the 89 retroreflective markers placed on specific anatomical points in the thorax and ABD 27 , 44 , 49 , 53 . These methods are validated both in healthy participants and those with diseases, and they have good reproducibility.…”

Respiratory Dysfunctions in Parkinson’s Disease Patients

“…Florêncio et al compared 27 Parkinson’s disease patients with healthy subjects and confirmed the presence of restrictive respiratory disease with reduction in the volume of the pulmonary rib cage compartment, as well as observed that half of the Parkinson’s disease patients exhibited paradoxical breathing [ 26 ]. Furthermore, different levels of respiratory muscle dysfunction have been observed in patients with Parkinson’s disease.…”

“…In the same study by Florêncio et al, the Parkinson’s disease patients obtained significantly lower absolute values for FVC and FEV1 as compared with the healthy controls. Regarding respiratory muscle strength, the Parkinson’s disease patients obtained lower scores for maximal inspiratory pressure and maximal expiratory pressure than the control group [ 26 , 27 ]. Nonetheless, an improvement regarding the rigidity of the thoracic wall significantly improved kinesics and coordination at a precise level.…”

Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients

“…According to previous studies, the diaphragm and intercostal muscles, responsible for inhalation and exhalation in stroke patients, are mainly controlled by the unilateral cerebral cortex and subcortical spinal nerve pathways [10][11][12]. In particular, because the diaphragm is an important muscle responsible for approximately 10-70% of ventilation in the sitting and prone positions, a unilateral diaphragm paralysis can cause a significant decrease in respiratory function [13].…”