Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients

Abstract

ObjectiveTo 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.

Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function

“…However, balance impairment was associated with reduced strength [ 31 ]. Although certain studies have demonstrated that there is a relationship between diaphragm and pulmonary function [ 32 ], swallowing function [ 33 , 34 ], trunk control [ 9 , 35 ], and respiratory muscular strength, no study has examined its correlation with extremity motor function, balance function of hemiplegic side. In this context, the present study has two objectives.…”

Neck Stabilization Exercises Enhance Respiratory Function after Stroke: Respiratory Function Index Change Trajectory Analyzed Using a Hierarchical Linear Model

“…Moreover, for dysphagia requiring comprehensive neck muscle intervention in stroke patients, shallow neck muscles such as the oblique neck muscles are mobilized first at the beginning of head bending training, and the activity of the oblique neck muscles decreases as deep neck muscle strengthening training progresses [31]. Although this study did not investigate the subject's dysphagia, swallowing is related to the movement of the diaphragm, the principal respiratory muscle, as it shares several anatomical structures and muscles with respiratory function [32,33]. Dysphagia tends to appear longer in patients with left-sided paralysis [34].…”

Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients

“…Tables 5 and 6 present the results of the surveys conducted in this study. In combination with the CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness 10 Menezes et al […”

“…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].…”