Diaphragmatic movement in hemiplegic patients measured by ultrasonography.

Abstract

Background -It is known that automatic breathing is controlled by centres in the lower brain stem, whereas volitional breathing is controlled by the cerebral cortical centres. In hemiplegia, lesions above the brain stem result in paralysis of limb muscles. This study was performed to determine whether the diaphragm might also be affected in patients with hemiplegia. Methods -Studies were performed in six normal control subjects and in eight patients with complete hemiplegia caused by a lesion above the brain stem, all with no known chest disease. Full lung function tests were performed. Diaphragmatic excursion and inspired volume (VT) were measured simultaneously by M mode ultrasonography and respiratory airflow measurements. Recordings of diaphragmatic excursion were performed on each side separately during volitional and automatic breathing at a similar range of VT. Results -Lung function tests lay within the normal range in all the control subjects. In the hemiplegic patients mean (SD) vital capacity was 79 (18)% and residual volume was 123(30)% of predicted. Total lung capacity and functional residual capacity were in the normal range. In the control subjects no significant difference in diaphragmatic excursion was found between volitional and automatic breathing for the same range of inspired volume. By contrast, there was a significant decrease in diaphragmatic excursion during volitional breathing compared with automatic breathing on the affected side in four of the eight hemiplegic patients. Conclusions -In four of eight hemiplegic patients reduced diaphragmatic movement was present on the paralysed side during volitional inspiration when compared with automatic inspiration. The hemidiaphragm may be involved on the affected side in patients with hemiplegia.

Ultrasonographic evaluation of diaphragmatic motion.

“…The rule of thumb described for fluoroscopy in 1966 still applies to ultrasonography; it states that "the unequal movement of the two leaves of the diaphragm is usual, and unlikely to be of significance unless one excursion is at least twice as great as the other." 6 On ultrasonography, Cohen et al 21 found that 4 of 8 patients with hemiplegia had reduced diaphragm motion during voluntary inspiration on the same side of the body paralysis. This finding was not seen during quiet respiration.…”

Feedback Respiratory Training to Enhance Chest Expansion and Pulmonary Function in Chronic Stroke: A Double-Blind, Randomized Controlled Study

“…Impaired hemispheric lesions result in contralateral dysfunction of ventilatory muscles 4) and hemidiaphragmatic elevation on the normal and the affected side during deep inspiration was shown on the unaffected side 5) . A small reduction in movement of the upper chest on the hemiplegic side during quiet breathing, but not of the lower chest, has also been reported.…”

Comparison of respiratory muscle strength between elderly subjects after a stroke

“…The first study developed that reported on this impairment was by Smith,16 who evaluated the thoracic radiography of acute and chronic hemiparetic individuals and observed an elevation of the diaphragm of the affected hemibody. Around three decades later, Cohen et al 17 confirmed the reduction in the diaphragmatic excursion while evaluating the voluntary and spontaneous respiration among hemiparetics by means of ultrasonography. Flucks…”