Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke.
BACKGROUND
The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls.


METHODS
Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry.


RESULTS
Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P < .001). Compared with healthy control subjects, the tidal volume (VT) of the subjects with stroke was 24.7, 18.0, and 14.7% lower during QB, incentive spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14).


CONCLUSIONS
Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation.
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Illia Ndf
IN
Lima
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Guilherme Af
GA
Fregonezi
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Rodrigo
R
Melo
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Elis Ea
EE
Cabral
Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano Polytechnic University of Milan, Milan, Italy.
Andrea
A
Aliverti
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Tânia F
TF
Campos
Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil.
Gardênia Mh
GM
Ferreira
D000328:Adult; D000368:Aged; D001945:Breathing Exercises; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D009038:Motion; D010991:Plethysmography; D015656:Respiratory Mechanics / Q000502:physiology*; D012132:Respiratory Muscles / Q000503:physiopathology; D013147:Spirometry; D020521:Stroke / Q000503:physiopathology*; D035441:Thoracic Wall / Q000503:physiopathology*; D013990:Tidal Volume / Q000502:physiology
breathing exercises; paresis; physical therapy modalities; plethysmography; respiratory muscles; stroke