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Relationship between pulmonary function, functional independence, and trunk control in patients with stroke


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Objective: Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. Methods: This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results: Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). Conclusion: The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.
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Relationship between pulmonary function,
functional independence, and trunk control in
patients with stroke
Relação entre função pumonar, independência functional e controle de tronco em
pacientes após acidente vascular cerebral
Rafaela Sant’anna dos SANTOS1, Sara Carolina Fontoura DALL’ALBA1, Soraia Genebra Ibrahim
FORGIARINI2, Daniele ROSSATO3, Alexandre Simões DIAS3,4, Luiz Alberto FORGIARINI JUNIOR5
1Centro Universitário Metodista, Porto Alegre, RS, Brasil;
2Centro Universitário Metodista, Curso de Fisioterapia, Porto Alegre, RS, Brasil;
3Hospital de Clínicas de Porto Alegre, Serviço de Fisioterapia, Porto Alegre, RS, Brasil;
4Universidade Federal do Rio Grande do Sul, Programas de Pós-graduação em Ciências Pneumológicas e Ciências do Movimento Humano , Porto Alegre, RS, Brasil.
5Universidade La Salle, Curso de Fisioterapia e Programa de Pós-graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brasil.
Rafaela Sant’anna dos Santos; Sara Carolina Fontoura Dall’Alba;
Soraia Genebra Ibrahim Forgiarini; Daniele Rossato; Luiz Alberto
Forgiarini Junior; Alexandre Simões Dias
Correspondence: Luiz Alberto Forgiarini Junior; Av. Vítor Barreto, 2288 - Canoas - RS, 92010-000 RS, Brasil; E-mail:
Conflict of interest: There is no conflict of interest to declare.
Received 03 September 2018; Received in final form 12 December 2018; Accepted 21 January 2019.
Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting
the motor control required for maintaining the synergy of both peripheral and respiratory muscles. Objective: To evaluate respiratory muscle
strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the
other variables. Methods: This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength,
trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results:
Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the
study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between
the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05);
trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure
(r = 0.77, p < 0.05). Conclusion: The present study showed that respiratory muscle strength, pulmonary function, functional independence,
and trunk control are reduced in patients diagnosed with stroke.
Keywords: Spirometry; manometry; stroke; Physical therapy specialty.
Acidente vascular cerebral (AVC) frequentemente leva a anormalidades no tônus muscular, postura e controle motor que podem comprometer
a função motora voluntária, afetando o controle motor necessário para manter a sinergia dos músculos periféricos e respiratórios. Objetivo:
Avaliar a força muscular respiratória, a função pulmonar, o controle do tronco e a independência funcional em pacientes com AVC e
correlacionar o controle do tronco com as demais variáveis. Métodos: Este foi um estudo transversal, incluindo pacientes diagnosticados
com AVC. Avaliamos a força muscular respiratória, o controle do tronco avaliado pela escala de comprometimento de tronco, as variáveis
espirométricas e a medida de independência funcional. Resultados: Quarenta e quatro pacientes foram incluídos. A função pulmonar e a
força muscular respiratória foram significativamente menores do que o previsto para a população estudada, e o escore médio do escala
de comprometimento de tronco foi de 14,3 pontos. As seguintes correlações significativas foram encontradas entre as variáveis: controle
do tronco vs. pressão inspiratória máxima (r = 0,26, p <0,05); controle do tronco vs capacidade vital forçada (r = 0,28, p <0,05); controle do
tronco versus volume expiratório forçado no primeiro segundo (r = 0,29, p <0,05) e controle do tronco vs. medida de independência funcional
(r = 0,77, p <0,05). Conclusão: O presente estudo demonstrou que a força muscular respiratória, a função pulmonar, a independência
funcional e o controle do tronco estão diminuídos em pacientes diagnosticados com AVC.
Palavra-chave: Espirometria; manovacuometria; acidente vascular cerebral; fisioterapia.
388 Arq Neuropsiquiatr 2019;77(6):387-392
Stroke is one of the most common causes of long-
term disability worldwide and a major public health prob-
lem1. Each year, nearly 11 million people worldwide have a
stroke, of whom ve million remain functionally limited2,3.
According to the World Health Organization, stroke is a
rapidly-progressing syndrome characterized by clinical
signs of focal or global brain function impairment of pos-
sible vascular origin and lasting for at least 24 hours4. Nearly
50% to 70% of aected patients recover functional indepen-
dence and, within six months, nearly 50% still present with
Stroke often leads to abnormalities in muscle tone, pos-
ture, and motor control that may compromise voluntary
motor function, thus aecting the motor control required for
maintaining the synergy of both peripheral and respiratory
muscles1,5. Pulmonary infections are the most prevalent com-
plications, causing the death of 30% of patients before hospi-
tal discharge6,7. Nevertheless, the lack of strength in muscles
of the trunk could impact in respiratory function.
e eect of stroke on the respiratory system depends on
the injured structures, and maintenance of normal ventila-
tion requires functional components of the neuromuscular
system to be intact. Ventilatory disorders occur when the
disease aects the nervous system, muscle paths and/or rib
cage movements8,9. erefore, we hypothesized that stroke
patients present with several sequelae usually leading to def-
icits in functional capacity and pulmonary function. Hence,
the objectives of this study were to assess respiratory muscle
strength, pulmonary function, trunk control, and functional
independence in patients with stroke, and to correlate trunk
control with the other variables.
is was a cross-sectional study conducted at the
Department of Neurology of Hospital de Clínicas de Porto
Alegre from November 2014 to May 2015. e research proj-
ect was approved by the Research Ethics Committee of
Hospital de Clínicas de Porto Alegre (process no. 14-0582).
Patients who met the inclusion criteria and agreed to partici-
pate in the study provided written informed consent prior to
their participation.
is study included male and female patients, over
18 years of age, clinically diagnosed with stroke by the neu-
rology team. Exclusion criteria were an inability to per-
form study-related procedures, presence of respiratory tract
metastases, hemodynamic instability, and altered cognitive
status compromising the patient’s ability to perform the tests.
Patients with pulmonary complications such as broncho-
aspiration and pneumonia during hospitalization were not
included. After inclusion in the study, all patients were simul-
taneously assessed for functional independence, trunk con-
trol, respiratory muscle strength, and pulmonary function.
Data on age, weight, height, body mass index, length of hos-
pital stay, time elapsed after stroke, type of stroke, and num-
ber of previous strokes were collected directly from medi-
cal records. e patients eligible to participate in the study
were evaluated by the clinical team and underwent physio-
therapy treatment. All patients were hemodynamically sta-
ble, with controlled blood pressure, no syncope, and absence
of tumors or clinical diseases that could interfere with the
evaluation process.
Physical functioning was assessed using the Functional
Independence Measure scale, an instrument designed to
quantitatively assess the burden of care required for someone
to perform a series of everyday motor and cognitive activi-
ties, such as self-care, transfer, locomotion, sphincter con-
trol, communication, and social cognition, including mem-
ory, social interaction, and problem solving. Each category is
given a score from 1 (total dependence) to 7 (complete inde-
pendence). is yields a total score ranging from 18 to 12610.
e trunk control was assessed using the Trunk
Impairment Scale, an instrument comprising seven main
domains scored from 0 (minimum) to 21 (maximum) points.
ese domains assessed the perception and impairment of
trunk verticality, abdominal muscle strength, trunk rota-
tion muscle strength, and righting reex, all of which were
assessed bilaterally. e Trunk Impairment Scale was admin-
istered by the same examiner, providing a score that indi-
cated the patient’s status at the time of assessment11.
e respiratory muscle strength was assessed using an
analog manometer (Marshall Town, MVM 120, USA) to mea-
sure maximal inspiratory pressure (MIP) and maximal expi-
ratory pressure (MEP). Measures were assessed with patients
in the sitting position using a nose clip and a mouthpiece
positioned rmly between their lips. e MIP was acquired at
residual volume, and the MEP at total lung capacity. In both
cases, measures were taken in triplicate or more, the high-
est of which was considered for analysis, and dierences
between measures could not be greater than 10%2,4,12,13.
For pulmonary function analysis, forced expiratory vol-
ume in one second (FEV1), forced vital capacity (FVC), and
the Tieneau index (TIFF) (FEV1/FVC) were measured
through spirometry (One Flow micro spirometer, Clement
Clarke International, Edinburgh, Scotland)14. eir predicted
values were also calculated based on the equation proposed
by Derumond et al.15, to assess levels of pulmonary function
in a healthy population. is equation was compared with
two other equations in a previous study that found no signi-
cantly relevant dierences between equations16.
Sample size was calculated based on a previous study
conducted by our group17, resulting in a sample size of at least
38 patients for an alpha of 5% and a power of 80. Continuous
data were expressed as mean ± standard deviation, and cat-
egorical variables as absolute and percentage values. e
Shapiro-Wilk test was used to assess the normality of data
distribution. Pulmonary function and maximal respiratory
Santos RS et al. Trunk control in patients with stroke
pressures were compared using the Student’s t test, and the
correlation between trunk control and the other variables
was assessed using Pearsons correlation. e level of signi-
cance was set at 5%.
Fifty-four patients participated in the study from
November 2014 to May 2015. ere was a predominance of
females (65.7%), the mean patient age was 59.4 ± 12.2 years,
and ischemic stroke was the most prevalent type (92.1%).
e demographic characteristics of the population are
shown in Table 1. Results for pulmonary function, respiratory
muscle strength, and trunk control are presented in Table 2,
and functional independence as assessed by the Functional
Independence Measure is described in Table 3.
We also assessed the correlation of trunk control with pul-
monary function, respiratory muscle strength, and functional
independence. Trunk control was found to be signicantly
correlated with MIP (r = 0.26, p < 0.05), FVC (r = 0.28, p < 0.05),
FEV1 (r = 0.29, p < 0.05), and the Functional Independence
Measure (r = 0.77, p < 0.05) (Figure).
Trunk control has a primary function in pulmonary
mechanics—when diaphragmatic function is compro-
mised in individuals after stroke, it is perceived that mus-
cular paresis leads to unilateral hypoventilation and con-
sequent decrease of pulmonary complacency, with greater
elastic and nonelastic resistance of the lung, which fails to
maintain lung volumes and decreases ventilation and per-
fusion capacity. In the present study, most of participants
showed restrictive ventilatory disorder (81.6%), character-
ized by impairment of total lung capacity and vital capac-
ity, demonstrating that respiratory biomechanics is altered
in patients with stroke, as well as thoracic and pulmonary
compliance. is data corroborates the nding between the
Trunk Impairment Scale and spirometric data, conrming
the ndings in the literature, which demonstrate the rela-
tionship between a decrease in pulmonary capacity and
hemiparesis presented by individuals, and this may occur
because the trunk exor and extensor muscles directly inter-
fere in respiratory mechanics and trunk stabilization18,19.
Regarding sociodemographic data and risk factors for
cerebrovascular injury, the mean age of our patients was
59.4 years, corresponding to the age group at the highest
risk of stroke in Brazil, which includes individuals older than
55 years of age12. e incidence of stroke increases the risk,
showing a two-fold increase for every 10 years of age beyond
557. Additionally, most patients were classied as overweight
according to their body mass index and were female, both of
which are important risk factors for stroke13. Together with
these factors, other modiable risk factors for cerebrovascu-
lar diseases in this population have been reported in the lit-
erature, such as high levels of blood cholesterol, high blood
pressure, diabetes, and smoking14,15.
e mean length of hospital stay, for our patients, was
14.6 days, similar to that reported in a study conducted in a
Table 1. Demographic characteristics of the study population.
Variables n = 44
Sex, female 25 (65.7)
Age, years 59.4 ± 12.2
Weight, kg 73.9 ± 15.1
Height, m 1.6 ± 0.1
Body Mass Index, kg/m² 27.8 ± 5.3
Length of stay, days 14.6 ± 7.1
Stroke, n (%)
Ischemic 52 (92.1)
Hemorrhagic 3 (7.9)
Stroke time, days 14.9 ± 26.3
Values expressed as mean ± standard deviation or number (percentage).
Table 2. Evaluation of pulmonary function, respiratory
muscular strength and trunk control.
Variable Value
value p-value
FEV1 1.9 ± 0.9 3.3 ± 0.6
FVC 2.5 ± 0.9 3.8 ± 0.7
Tiffeneau Index 88.9 ± 12.5
Expiratory flow
peak 227.2 ± 121.3
MIP, cmH2O 47.4 ± 29.1 91.1 ± 13.9 0.001
MEP, cmH2O 36.1 ± 18.6 93.3 ± 18.8 0.001
Trunk Impairment
Scale 14.4 ± 5.8
Data expressed as mean ± standard deviation. FEV1: forced expiratory volume
in the first second; FVC: forced vital capacity; Tiffeneau Index - relationship
between FEV1/FVC; MIP: maximum inspiratory pressure; MEP: maximum
expiratory pressure/ cmH2O: centimeter of water.
Table 3. Evaluation of functionality through the Functional
Independence Measure.
Variables n = 44
Self Care 29.0 ± 11.4
Sphincter Control 12.2 ± 3.3
Transfers 13.0 ± 7.1
Locomotion 6.4 ± 4.0
Communication 6.4 ± 4.0
Social Cognition 12.1 ± 2.8
Total 91.2 ± 26.4
390 Arq Neuropsiquiatr 2019;77(6):387-392
neurology ward (16.8 days)17. In the present study, 92% of the
patients were diagnosed with ischemic stroke. is percent-
age was higher than that in previous Brazilian studies (53 to
85%)16,17, which may be related to our treatment regimen for
patients with hemorrhagic stroke, who remain in the inten-
sive care unit for a longer time.
e mean MIP and MEP were lower than predicted for
our patients, thus corroborating ndings from the literature,
such as those by Meneghetti et al.12, who also found mean
MIP and MEP lower than predicted for the Brazilian popula-
tion (62.7 cmH2O and 69.8 cmH2O, respectively). ese results
suggest that the patients showed reduced respiratory muscle
strength (diaphragmatic and abdominal dysfunction) and,
therefore, their rehabilitation program should include respi-
ratory muscle training12.
Similarly, pulmonary function measures were lower
than predicted for our sample, which is in agreement with
previous studies showing that pulmonary function was
reduced in stroke patients assessed by spirometry16,17,20.
Some studies also found that impaired respiratory muscles
and pulmonary function may have a direct impact on the
cough mechanism, as the compression phase of this mech-
anism involves the activation of the diaphragm, chest and
abdominal wall muscles21,22.
e mean Trunk Impairment Scale score in our patients
(14.3 points) may be considered a fairly good result, consid-
ering that this score ranges from 0 to 21 points, with 0 being
the worst result and 21 the best. We also observed that trunk
control was weakly correlated with the FVC and FEV1 (r =
0.28 and r = 0.29, respectively), which indicated that muscu-
loskeletal changes experienced by hemiplegic or hemiparetic
patients aected pulmonary biomechanics23. is was espe-
cially so if these changes involved the exor and extensor
muscles of the trunk, as they have a key role in chest expan-
sion, diaphragm excursion, and cough eciency24,25.
e correlation of trunk control and MIP, although
weak (r = 0.34; p < 0.05), provided evidence of the relation-
ship between muscular postures and respiratory muscle
Figure. Correlation between the Trunk Impairment Scale (TIS) and forced vital capacity (FVC) (A - r = 0.28; p < 0.05); forced
expiratory volume in the first second (FEV1) (B - r = 0.29, p < 0.05); maximal inspiratory pressure (MIP) (C - r = 0.34, p < 0.05) and
the Functional Independence Measure (FIM) (D - r = 0.77, p < 0.05).
FVC (ml) FEV1 (ml)
MIP (cm H
4020 140120100806040
Santos RS et al. Trunk control in patients with stroke
strength26. Previous studies evaluating the latter in hemipa-
retic patients have demonstrated that respiratory muscle
strength may compromise trunk control and directly inter-
fere with respiratory biomechanics.
Yoon et al.22 found reduced spirometric values in stroke
patients and a correlation between these values and activi-
ties of daily living. is resulted from weakened intercostal
muscles and increased chest wall rigidity, which decreased
movements of the rib and lowered the distending pressure
that expands the lungs, ultimately leading to reduced pul-
monary capacity22. ese changes could be explained by
impairments in total pulmonary capacity and vital capacity,
indicating that respiratory biomechanics were decient in
these patients, as well as chest and lung compliance23. is
deciency eventually limited pulmonary ventilation and
conrmed that ventilatory disorders could occur in neuro-
logical diseases aecting the neuromuscular path or the rib
cage even if there was no specic pulmonary involvement
or lesion7.
e functionality evaluated by the Functional
Independence Measure showed that the patients had reduced
capacity to perform activities of daily living with complete
independence. A systematic review aiming to assess the dis-
ease severity and functional capacity using the Functional
Independence Measure in stroke patients revealed that,
based on the studies included in the review, this condition
aected patient’s lives by causing limitations and disability,
both in acute and chronic phases, often leading to moderate
or severe dependence and increasing the complexity of the
rehabilitation process27.
Additionally, we observed an association between trunk
control and functional independence, as patients with
greater postural control gained the stability required to
reproduce functional movements. is was because axial
muscles supported anti-gravitational postures and stabi-
lized the body for limb mobilization28. A study conducted
by Karatas et al.29 found a correlation of muscle weakness
in trunk exion and extension with locomotion and transfer
domains of the Functional Independence Measure, showing
the importance of axial stability movements for the develop-
ment of limb functionality29.Other studies have observed that
trunk control is important for balance, gait, and functional
independence as assessed by the Functional Independence
Measure30,31,32.Future studies should prospectively evaluate
patients to assess trunk control and functionality and further
establish the causal relationship between the variables.
In conclusion, stroke patients showed reduced pulmo-
nary function, respiratory muscle strength, and functional
independence, and there was a strong correlation between
trunk control and physical functioning.
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sênior em pacientes hemiparéticos pós-AVE. Conscientiae saúde
... The neural damage can lead to medical complications in many different bodily systems, affecting cardiac, circulatory, urinary, and respiratory function. For instance, stroke patients often exhibit postural abnormalities that interfere with the coordinated action of peripheral and respiratory muscles [8]. Pneumonia and ventilatory dysfunction are common in stroke patients [9], who may also show alterations in cortico-respiratory pathways associated with degree of disability, site of infarction, and respiratory dysfunction [10]. ...
... The relationship between central nervous system damage and respiration is complex. Stroke patients show impairments in the cortico-respiratory tract, posture, and balance, all of which can affect respiratory function [8,10,19,20]. Indeed, patients in the present studies had mean baseline FVC and FEV1 values ranging from 65% to 80% of predicted. By treating limb spasticity, onabotA may alter the dynamic between posture and breathing; FVC and FEV1 provide only a limited window into respiratory function and changes may be observed in some of the parameters not evaluated here (e.g., effort). ...
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Two randomized, placebo-controlled studies evaluated the pulmonary function safety of onabotulinumtoxinA (onabotA) for treatment of upper and/or lower limb spasticity. Patients with stable baseline respiratory status received one or two treatments with placebo, 240 U, or 360 U of onabotA. Pulmonary function tests, adverse events, and efficacy were measured at least every 6 weeks for 18 weeks (Study 1) or 30 weeks (Study 2). Study 1 enrolled 109 patients (n = 36–37/group) and Study 2 enrolled 155 patients (n = 48–54/group). Mean baseline forced vital capacity (FVC) was 76–78% of predicted per group in Study 1 and 71% of predicted per group in Study 2. In Study 1, change from baseline FVC values were significantly (p < 0.05) decreased vs. placebo at weeks 3 (240 U −57 mL vs. placebo +110 mL) and 12 (360 U −6 mL vs. +167 mL placebo). In Study 2, change from baseline FVC values were significantly decreased in the 360 U group vs. placebo at weeks 6 (−78 mL vs. +49 mL placebo), 13 (−60 mL vs. +119 mL placebo), 18 (−128 mL vs. +80 mL placebo), and 24 (−82 mL vs. +149 mL placebo). Individual pulmonary function-related adverse events were not correlated with PFT decreases. The most frequent pulmonary-related adverse events were nasopharyngitis (Study 1) and upper respiratory tract infection (Study 2). Ashworth scores were significantly improved at multiple time points in both studies. Injection of onabotA for spasticity in patients with decreased pulmonary function, at single and repeated doses of up to 360 U, was associated with small but statistically significant decreases in FVC or forced expiratory volume 1 s (FEV1) (>12% and 200 mL) that were subclinical and not correlated with any adverse clinical pulmonary events.
... Along with improvement in respiratory functions, CERE resulted in an improvement in both balance and trunk control far more significantly in the experimental group as compared to control. This improvement could be attributed to positive influence of respiratory functions on trunk control as has been proven in previous studies [34]. Also, improvement in strength of abdominals and internal intercostals as seen by increase in MEP values post-CERE intervention could have been responsible for better trunk stabilization [31]. ...
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Background Motor impairments caused by stroke result in impaired diaphragmatic and respiratory muscle function, changes in thoracic biomechanics on the hemiparetic side ultimately resulting in decreased efficiency of lung ventilation. This study aimed to examine the efficacy of chest expansion resistance exercise (CERE) on respiratory function, trunk control ability, and balance in patients with chronic stoke. Following a purposive sampling, thirty-five patients with chronic stroke were randomly allocated into two groups, i.e., the experimental group receiving CERE with conventional therapy and the control group receiving conventional therapy alone. Both the groups received therapy four times per week for a period of four weeks (total 16 sessions). Following assessments were done before and after treatment in both the groups: chest expansion ( axillary, nipple, xiphisternal levels) using measure tape, respiratory muscle strength using micro-respiratory pressure meter, trunk control using the Trunk Impairment Scale, and balance using mini-Balance Evaluation Systems Test. Results Both groups had 17 participants each ( n = 34, drop-outs = 1) consisting of 12 males and 5 females having a mean age of 56.5 ± 12.98 years and 59.7 ± 10.2 years, respectively. Intra-group analysis showed a statistically significant increase in mean values of chest expansion, respiratory muscle strength, trunk control ability, and balance in the experimental group whereas the control group showed improvement only in trunk control ability and balance. Inter-group comparison revealed a better improvement in all the outcome variables in experimental group compared to the control group. Conclusions Based on these results, this study proved that CERE was more effective in improving respiratory function, trunk control, and balance in patients with chronic stroke.
... The diaphragm is the inspiratory muscle responsible for most of the total ventilation of an individual in the sitting and lying positions, and its paralysis causes dysfunction in 51.7% of stroke patients as it leads to a marked decrease in respiratory function [3]. At the same time, a secondary problem caused by muscle paralysis is that the lungs and chest cage fail to achieve sufficient inflation, which leads to asymmetric respiration due to the following: decreased lung compliance, abnormal chest expansion, increased sensitivity to carbon dioxide, and decreased voluntary respiration [4,5]. It was determined that muscle paralysis in stroke patients leads to weakened respiratory function, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiration ratio (FEV1/FVC), and peak cough flow (PCF), which is accompanied by impaired daily living activities, social restrictions, and respiratory complications [6,7]. ...
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Background and Objectives: This study aimed to assess the effect of neck stabilization exercise on respiratory function in stroke patients through longitudinal observation and determine whether there is a difference in its effect based on the side of paralysis in the patients. It is difficult to observe the amount of change observed in individuals and groups as most intergroup comparison studies only use mean values. To address these shortcomings, this study adopted a hierarchical linear model (HLM) in our trajectory analysis. Materials and Methods: We conducted neck stabilization training three times a week for four weeks in a single group of 21 stroke patients. To evaluate respiratory function, their forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), forced expiration ratio (FEV1/FVC), and peak cough flow (PCF) were measured. Data analysis was performed using HLM 8.0. Results: A significant increase was found in the respiratory function after neck stabilization training (p < 0.05). While neck stabilization training overall was longitudinally effective, the growth rate of respiratory function in left-sided paralytic patients was less than the whole group value. Conversely, the growth rate of respiratory function in right-sided paralytic patients was greater than the whole group value. Conclusions: This study demonstrated that neck stabilization training is longitudinally effective in improving respiratory function in stroke patients. Additionally, the growth rate of respiratory function was greater in patients with right side paralysis than in patients with left side paralysis.
... Common stroke has a negative impact on patients' voluntary respiration [1]. Muscle weakness is the most evident respiratory problem in stroke patients [2] and is associated with a reduction in pulmonary function, functional outcome, and postural control [3]. ...
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The forward head posture (FHP) of stroke patients has a negative impact on respiratory function. Cervical spine mobilization is a manual therapy technique that used to prevent and treat FHP and respiratory function. This pilot study investigated whether cervical spine mobilization can effectively improve outcomes following FHP and respiratory function of stroke patients. Twenty-four patients participated in our assessor-blinded randomized controlled trial. All the participants received neurodevelopmental treatments (gait training and trunk rehabilitation). The experimental group additionally received 15-min sessions of cervical spine mobilization three times per week for 4 weeks. The control group received cervical spine sham mobilization during the same period. For the cervical angles, the cranial vertebral angle (CVA) and cranial rotation angle (CRA) were measured. A respiratory function test was performed to measure the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and chest circumferences (upper and lower chest sizes). Except for MIP, there was no significant difference between the experimental group and the control group. The CVA and CRA were significantly increased in the experimental group only. Cervical spine mobilization improved cervical angles and inspiratory function of the stroke patients in this study. However, a comparative study with a larger number of patients is needed to confirm this finding from our pilot study, which had a small sample size.
Background: Clinical changes after stroke can contribute to reduced mobility and negatively affect the survival of these individuals. The objective of this study was to verify factors associated with functional mobility in stroke individuals. Methods: Crosssectional study carried out with stroke individuals in an outpatient clinic. Demographic and clinical data were collected and the following measures were applied: National Institute of Health Stroke Scale (NIHSS), modified Barthel Index, Trunk Impairment Scale, Functional Reach Test, Timed Up and Go Test, and the International Physical Activity Questionnaire. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP).Variables with p < .05 in univariate logistic regression analysis were included in the multivariate logistic regression model, using the backward stepwise method. Results: 53 individuals were enrolled with a mean age of 55 years (±13.43). 51% were male and the median NIHSS score was 2.25 (0-13). The final multivariate model included NIHSS (OR = 1.872; 95% CI 1.167-3.006; p = 0.009), physical therapy treatment (OR = 15.467; 95% CI 1.838-130.178; p = 0.012) and MIP (OR = 1.078; 95% CI 1.024-1.135; p = 0.004). Conclusion: Stroke severity and inspiratory muscle strength were factros associated with functional mobility in individuals after stroke, regardless stroke time.
Introdução. Hemiparéticos por Acidente Vascular Cerebral (AVC) apresentam diversas disfunções motoras e respiratórias, as quais estão relacionadas com prejuízos funcionais, levando a piora da qualidade de vida. Objetivo. Avaliar a função respiratória e motora de pacientes hemiparéticos por AVC e a correlação existente entre estas variáveis importantes para a capacidade funcional. Método. Trata-se de um estudo descritivo transversal, envolvendo 25 pacientes hemiparéticos pós-AVC. Foram avaliados: independência funcional (índice de Barthel modificado), força de preensão manual (dinamometria), velocidade de marcha, mobilidade funcional (Timed Up and Go Test), pico de fluxo expiratório (PFE - Peak Flow) e as pressões inspiratórias e expiratórias máximas (manovacuometria). Resultados. Foram constatados déficits nas variáveis motoras e respiratórias. Os valores de pressão respiratória foram inferiores quando comparados aos valores preditos para saudáveis, estando a pressão inspiratória máxima em 58,74% e a pressão expiratória máxima em 62,92% do valor predito (p<0,001). Houve correlações entre PFE e todas as variáveis motoras apenas em pacientes agudos. Conclusão. Pacientes hemiparéticos apresentam importantes comprometimentos motores e respiratórios. A avaliação da musculatura respiratória pós-AVC, por vezes não realizada, é necessária na prática clínica pois fornece importantes informações sobre a função pulmonar, contribuindo para prevenção de complicações respiratórias nestes pacientes.
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To determine the effectiveness of trunk training after stroke in comparison to no therapy or to control therapy, either dose-matched or not. The review will assign the outcome measures to the levels defined in the ICF model and the review will evaluate the effect of different types of trunk training. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Os objetivos deste estudo foram obter valores para o teste de argolas de seis minutos (TA6) em uma amostra de indivíduos com disfunção neurológica, comparar estes valores com os valores de referência de adultos saudáveis e verificar a associação do TA6 com o controle de tronco. Estudo transversal realizado com 31 indivíduos com disfunção neurológica de ambos os sexos atendidos em clínica de reabilitação neurofuncional vinculada à universidade federal. Os indivíduos realizaram o TA6 e foram avaliados através da Escala de Deficiências de Tronco (EDT). Os valores obtidos no TA6 pelos indivíduos com disfunção neurológica foram inferiores aos de adultos saudáveis em todas as faixas etárias estudadas (p < 0,05). Houve comprometimento moderado do tronco. Não houve correlação entre o TA6 e a EDT (r = 0,269; p = 0,144). De acordo com os valores preditos para a população saudável, os pacientes com disfunção neurológica possuem um desempenho funcional e endurance de membros superiores inferiores ao esperado para sua faixa etária. O TA6 é um teste simples, rápido e barato, útil para reabilitação neurofuncional, pois mimetiza as atividades de vida diária, entretanto não se correlacionou com a EDT.
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Introdução. O Acidente Vascular Encefálico (AVE) repercute com prejuízos motores e funcionais e o acesso à reabilitação pode promover melhora na funcionalidade e incapacidade. Objetivo. Analisar a severidade neurológica e as repercussões funcionais de sujeitos pós – AVE mediante o acesso à reabilitação. Métodos. Buscas sistemáticas nas bases de dados eletrônicas: SciELO, LILACS e PUBMED, no período de julho a agosto de 2014 e seleção de artigos de forma independente e cega, por dois pesquisadores. Resultados. Dos 708 artigos identificados, 15 preencheram os critérios de inclusão e foram selecionados para a revisão de texto completo. Os estudos apontam para uma maioria de indivíduos que após o AVE apresentam níveis moderado a grave de comprometimento funcional, gerando impactos para a execução de suas atividades cotidianas e sobrecarga dos serviços de reabilitação. Conclusão. A gravidade e as limitações do AVE apresentam relação direta com a maior necessidade de uso dos serviços de reabilitação.
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O acidente vascular encefálico (AVE) tem grande impacto sobre a saúde da população. A hemiparesia é um dos sinais clínicos mais óbvios da doença e os indivíduos acometidos apresentam tendência em manter-se em uma posição de assimetria postural, com função respiratória prejudicada. O objetivo deste estudo foi avaliar os efeitos de um Programa de Reabilitação na independência funcional, qualidade de vida, força muscular respiratória e mobilidade torácica em pacientes hemiparéticos, após AVE. Participaram do estudo quatro indivíduos hemiparéticos, com idades entre 53 e 78 anos. Para a mensuração das variáveis, foram utilizadas as Escalas PASS e IBm, o questionário SF-36, e testes específicos de manovacuometria e cirtometria. Após a avaliação inicial, foi aplicado um Programa de Reabilitação do Tronco, com duração de 50 minutos. Ao término de 20 sessões, todos os indivíduos foram reavaliados, utilizando-se os mesmos instrumentos. Não foram encontrados resultados estatisticamente significantes (p > 0,05), porém se observou melhora nos índices de independência funcional, qualidade de vida, força muscular respiratória e mobilidade torácica. Sugere-se que a aplicação de exercícios, direcionados ao restabelecimento da função do tronco, em um programa de reabilitação para o indivíduo hemiparético é satisfatória. Faz-se necessária a realização de novos estudos com uma amostra maior. Stroke has a major impact on public health. Hemiplegia is one of the most obvious clinical signs of the disease, and individuals tend to keep themselves in an asymmetric postural position, with impaired respiratory function. The purpose of this study was to evaluate the effects of a rehabilitation project on functional independence, quality of life, respiratory muscle strength and mobility chest in hemiplegic patients. The study was based on four hemiplegic subjects, aged between 53 and 78 years. Outcomes chest tests. After the initial assessment, the Trunk Rehabilitation Program was used for 50 minutes. At the end of 20 sessions, all subjects were reassessed, using the same instruments. There were no statistically significant results (p > 0,05), however, an improvement was observed in levels of functional independence, quality of life, respiratory muscle strength and mobility chest. It is suggested that the implementation of exercises, aimed at restoring the function of the trunk, in a rehabilitation program for the hemiplegic subject, is satisfactory. Further studies with a larger sample is recommended.
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Introduction: Dance can improve the quality of life (QOL) of people who have some psychomotor impairment; however, nothing has been found about dance for seniors in neurological patients. Objective: To assess the quality of life (QOL) in patients with hemiparesis resulting from a stroke, before and after dance therapy for seniors. Methodology: Eight hemiparetic patients answered two QOL questionnaires: SF-36 and SS-QOL. One-hour dance therapy sessions were then held twice a week at the physiotherapy clinic of Uninove, totaling 24 sessions. At the end of the sessions, the questionnaires were reapplied. Descriptive statistics were used to characterize the sample; afterwards, the data were tested for normality with the Kolmogorov-Smirnov and Wilcoxon tests. The significance level was set at 5%. Results: There was a statistically significant difference in QOL: SF-36 (p = 0.05) and SS-QOL (p = 0.01). Conclusion: The study showed positive results, because there was a significant improvement in the quality of life of patients who participated in the dance therapy.
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Trunk control - which is a basic motor ability to perform many functional tasks -is disrupted in most patients who have suffered a stroke. There are few foreign references and none in Portuguese dealing with the quantitative assessment of trunk control. The aim of this study was to translate, verify intra- and inter-examiner reliability, validity and internal consistency of the Brazilian version of the Trunk Impairment Scale (TIS). Eighteen hemiparetic, post-stroke volunteers were evaluated by means of the Fugl-Meyer Assessment Scale, Functional Independence Measure, Berg Balance Scale (BBS), and Functional Ambulation Classification; TIS was apllied by three experienced physical therapists; retest was carried out 48 hours later. Data analysis showed moderate intra-rater and an excellent inter-rater reliability (p<0.05), though low internal consistency (0.45). The only scale found to correlate with TIS was BBS (r=0.491, p=0.038), comparison to the others having shown no statistical significance. The TIS Brazilian version thus proved a valid and effective measure of trunk deficits, having fulfilled reliability criteria; it is easy to apply, and may be said to be reproducible by neurology physical therapists.
Individuals diagnosed with Stroke impairment of voluntary movements, spasticity and loss of selective activity of the muscles responsible for trunk control. In these patients is found difficulty in aligning body with consequent reduction in the balance, compensation and loss of functional independence. The trunk is also associated with respiratory function, since the expansion and diaphragmatic excursion depend on the action of axial muscles. Objective. To determine whether deficits in trunk control is correlated with functional performance, balance and respiratory impairment in patients after stroke. Method. This is a cross-sectional study conducted at Promove São Camilo; 15 patients with stroke were evaluated using the scales of the Trunk Impairment (ECT), Functional Independence Measure (FIM), Berg Balance (BSE) and measures of respiratory muscle strength. Results. There was a statistically significant relation between the Berg and ECT scales (r=0.57, p=0.02), Berg and FIM (r=0.64, p=0.0098), MIF and ECT (r=0.58, p=0.02). However, there was no correlation between measures of respiratory strength rate scales. Conclusion. There was a correlation between trunk control, balance and functional performance in patients with stroke, but these individuals may use compensatory strategies to maintain respiratory function despite the proximal stability.
Objective. To evaluate respiratory muscle strength in stroke patients. Method. This is a transversal study with 22 stroke patients, 14 with left hemi paresis and 8 with right hemi paresis, both genders, age between 30 and 87 years old. The evaluation of respiratory muscle strength by the measurement of maximal inspiratory (PImax) and expiratory (PEmax) pressures was assessed with manovacuometry. Results. The strength of respiratory muscles in stroke patients was reduced when compared to predicted values described in the literature (p<0.001). Conclusion. The respiratory muscle strength in stroke patients was lower the predicted values for age.
Stroke may disrupt breathing either by (A) causing a disturbance of central rhythm generation, (B) interrupting the descending respiratory pathways leading to a reduced respiratory drive, or (C) causing bulbar weakness leading to aspiration. Neural control of respiration in man depends on a central drive to the respiratory muscles which is modulated by chemical and mechanical inputs.1 While many of the factors controlling established respiratory rhythm in mammals are understood, the neural mechanisms of rhythm generation remain obscure.2-4 It has proved difficult, in man, to attribute precise respiratory function to localised anatomical substrates because lesions are rarely localised and coexisting pulmonary, cardiovascular, or autonomic influences may complicate the clinical picture. Furthermore accurate diagnosis of respiratory insufficiency has led to earlier therapeutic intervention with controlled ventilation. Also there is probably considerable redundancy and plasticity of the neural substrate of respiratory control, thus congenital, longstanding, or slowly progressive and destructive mass lesions can have little or no functional consequence while acute discrete lesions in a similar distribution may lead to profound respiratory impairment. Finally much of the literature is flawed because the extensive experimental animal work has been applied to man without any evidence for anatomicophysiological correlates. However in individual case studies abnormalities of respiration may be associated with small, discrete lesions of the central nervous system, defined by imaging or postmortem, particularly due to stroke. Such reports have complemented experimental animal work and have greatly increased our understanding of the mechanisms that control breathing in man. Central respiratory drive is mediated by three pathways, which are largely anatomically and functionally independent above the segmental level,1 although it is increasingly clear that these systems must interact with one another to some extent.5 6 ### METABOLIC (AUTOMATIC) RESPIRATION Metabolic (automatic) respiration is the homoeostatic pathway by which ventilation may be mediated to maintain …
[Purpose] The aim of this study was to analyze and compare respiratory function and activities of daily living (ADL) of spinal cord injury (SCI) and stroke patients and normal elderly people, as well as to examine the relationship between respiration and ADL in these groups. [Subjects and Methods] This study's subjects were patients with spinal cord injury (n=30) and stroke (n=31), one year or longer after onset of their conditions, and a control group of ordinary elderly people (n=30). Measurements were made of their vital capacity (VC), forced vital capacity (FVC), forced expiratory flow (FEF), forced expiratory volume at one second (FEV1), FEV1/FVC, peak cough flow (PCF), and activities of daily living (ADL). [Results] The SCI and stroke groups had lower VC than the control group; the SCI group had the lowest value. The stroke group had the lowest FVC. There were no significant differences among the three groups in FEF, FEV1, or FEV1/FVC. The ADL of the SCI group showed significant differences according to the SCI level. Regarding the relationship between respiratory function and ADL, in the SCI group, the better their respiratory function was, the better their ADL became; there was no relationship between the two variables in the stroke group. The control group of healthy elderly was better able to climb stairs when they had better respiratory function. [Conclusion] We consider a physical therapy program accompanied by breathing execercise is necessary for SCI patients to improve ADL, and for stroke patients to prevent respiratory complications.