title: Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography.
abstract: OBJECTIVE
  To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  University rehabilitation hospital.
  
  
  METHODS
  Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured.
  
  
  RESULTS
  The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (P<.001); 23.8±7.1, 32.7±10.6, and 44.7±10.3 (P<.001); and 16.8±4.8, 28.5±4.9, and 36.0±8.2 (P<.001), respectively. The differences were statistically significant. Differences were observed in the maximum inspiratory (P<.001) and expiratory (P<.001) pressures and peak cough flow (P=.027) among the 3 groups. Forward selection stepwise regression analysis, which was performed to determine variables that help predict diaphragm excursion during voluntary coughing, showed that the presence of dysphagia explained up to 60% (P<.001) of the hemiplegic diaphragm movement during voluntary coughing in patients with stroke.
  
  
  CONCLUSIONS
  M-mode ultrasonography showed that stroke patients with dysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing.
authors.affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Geun-Young
authors.initials: GY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Seong-Rim
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Kwang Wook
authors.initials: KW
authors.lastname: Jo
authors.affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Eu Jeen
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea.
authors.forename: Young Moon
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Republic of Korea. Electronic address: lafoliamd@gmail.com.
authors.forename: Sun
authors.initials: S
authors.lastname: Im
mesh_terms: D000368:Aged; D003371:Cough / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D014463:Ultrasonography
keywords: Cough; Deglutition disorders; Diaphragm; Rehabilitation; Stroke; Ultrasonography