Objective To analyze the changes of diaphragm function
with the correlation of diaphragm function with stroke duration, swallowing
function, respiratory function, extremity motor function, balance function and
daily living ability in stroke patients with hemiplegia.
Methods This prospective study enrolled the
consecutive patients and unilateral hemiplegia after first stroke. The
following data were recorded, including general demographic information, water
swallow test (WST) score, subjective respiratory dysfunction scale, Fugl-Meyer
motor function assessment (FMA) scale, Berg balance scale (BBS), modified
Barthel index (mBI). Diaphragmatic function was measured by ultrasound,
including diaphragmatic mobility and during quiet and deep breathing and
diaphragm thickening fraction (DTF). The diaphragm function of the hemiplegia
and healthy sides among the total patients and different unilateral hemiplegia
patients, and between right and left hemiplegia patients were compared. The
correlation of diaphragm function of the hemiplegia side with stroke duration,
WST score, subjective respiratory dysfunction scale, FMA, BBS, and mBI were
analyzed.
Results A total of 45 stroke patients were included
in the study, with 27 (60.00%) left hemiplegia and 18 (40.00%) right hemiplegia
patients. Under deep breathing, for the total patients, the diaphragm mobility
(31.69±15.18 mm vs. 40.24±14.66 mm, P<0.001) and DTF (34.99%±23.70% vs.
48.13%±21.98%, P<0.001) of the hemiplegia side were lower than those of the
healthy side; for unilateral hemiplegia patients, the diaphragm mobility
(30.13±12.64 mm vs. 44.10±12.95 mm, P<0.001) and the DTF (41.20%±23.42% vs.
54.63%±21.08%, P=0.004) of the hemiplegia side were lower than those of the
healthy side in left hemiplegia patients, the DTF of the hemiplegia side
(25.67%±21.47% vs. 38.37%±20.07%, P=0.005) was lower than that of the healthy
side in right hemiplegia patients. Under deep breathing, the DTF of the
hemiplegic side in right hemiplegia patients was lower than that in left
hemiplegia patients (P=0.029), the diaphragmatic activity (P=0.028) and DTF
(P=0.012) in right hemiplegia patients were lower than those in left hemiplegia
patients. Under quiet breathing, the diaphragm mobility of the hemiplegia side
was positively correlated with the FMA (r=0.362, P=0.015); under deep
breathing, the diaphragm mobility of the hemiplegia side was positively
correlated with the WST score (r=0.298, P=0.047), subjective respiratory
dysfunction scale score (r=0.437, P=0.003), FMA (r=0.330, P=0.027), BBS
(r=0.370, P=0.012), mBI (r=0.321, P=0.031), and the DTF of the hemiplegia side
was negatively correlated with stroke duration (r=-0.298, P=0.047).
Conclusions The diaphragm function of the hemiplegia side
after stroke was lower than that of the healthy side. The bilateral diaphragm
function in right hemiplegia patients were worse than that in left hemiplegia
patients. Diaphragmatic function in stroke patients was negatively correlated
with stroke duration, and positively correlated with swallowing function,
respiratory function, extremity motor function, balance function and daily
living ability.
