title: Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial.
abstract: OBJECTIVE
  No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia.
  
  
  METHODS
  Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15  minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1  second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity.
  
  
  RESULTS
  Our results showed that changes between the pre- and post-test values of FVC (F = 12.50, P = 0.02) and FEV1 (F = 12.81, P = 0.01) (P < 0.05) in the ITG were significantly (P < 0.05) greater. Changes in EMG activation of the diaphragm (F = 13.75, P = 0.003) and external intercostal (F = 14.33, P = 0.002) (P < 0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P < 0.05) greater than those in patients of the RMTG and the CG at post-test.
  
  
  CONCLUSIONS
  Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.
authors.forename: Chang-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Lee
authors.forename: Hyeong-Dong
authors.initials: HD
authors.lastname: Kim
authors.forename: In-Seob
authors.initials: IS
authors.lastname: Kim
mesh_terms: D000368:Aged; D001945:Breathing Exercises / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012132:Respiratory Muscles / Q000503:physiopathology*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Abdominal drawing-in maneuver,; Incentive respiratory spirometer,; Pulmonary function,; Respiratory muscle training,; Surface electromyography