title: Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series.
abstract: BACKGROUND
  The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown.
  
  
  OBJECTIVE
  1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV).
  
  
  METHODS
  Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test.
  
  
  RESULTS
  Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (p<0.01), and abdominal muscles, mean=0.09 (SD=0.02)L/s versus 0.14 (SD=0.06)L/s (p<0.01), increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02).
  
  
  CONCLUSIONS
  NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.
authors.affiliation: Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Magalhães
authors.affiliation: Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil.|PneumoCardioVascular Lab, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), UFRN, Natal, RN, Brazil.
authors.forename: Guilherme A
authors.initials: GA
authors.lastname: Fregonezi
authors.affiliation: Programa Vent-Lar - Ventilação Mecânica Domiciliar para Pessoas com Doenças Neuromusculares do Estado de Minas Gerais, Serviço de Pneumologia, Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Belo Horizonte, MG, Brazil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Vidigal-Lopes
authors.affiliation: Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Bruna S P P
authors.initials: BS
authors.lastname: Vieira
authors.affiliation: Curso de Fisioterapia, Universidade Federal de Santa Catarina (UFSC), Araranguá, SC, Brazil.
authors.forename: Danielle S R
authors.initials: DS
authors.lastname: Vieira
authors.affiliation: Departamento de Fisioterapia, UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Verônica F
authors.initials: VF
authors.lastname: Parreira
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D006801:Humans; D063087:Noninvasive Ventilation; D010991:Plethysmography; D011187:Posture / Q000502:physiology*; D015656:Respiratory Mechanics / Q000502:physiology*; D035441:Thoracic Wall / Q000502:physiology*