Effects of Abdominal Stimulation during Inspiratory Muscle Training on Respiratory Function of Chronic Stroke Patients

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke

OBJECTIVE

To investigate the impact of inspiratory muscle training on lung function and swallowing function in patients with dysphagia-induced aspiration following ischemic stroke and to evaluate the effectiveness of inspiratory muscle training on aspiration symptoms.

METHODS

Fifty-eight inpatients with dysphagia-induced aspiration following ischemic stroke were selected and randomly divided into a control group (n = 29, conventional swallowing therapy) and a treatment group (n = 29, conventional swallowing therapy plus inspiratory muscle training). Both groups received conventional swallowing function training, including oral sensory training, oral motor training, airway safety protection training, and neuromuscular electrical stimulation therapy for 10-20 min per session, twice daily for 2 weeks. The treatment group additionally received inspiratory muscle resistance training using the POWERbreathe device for 20 min per session, twice daily for 2 weeks. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Functional Oral Intake Scale (FOIS) based on the videofluoroscopic swallowing study (VFSS) before and after treatment. Lung function, including maximal peak expiratory flow rate (PEF) and forced vital capacity (FVC), was evaluated using the Miraclink X-SCRIBE cardiac stress testing system.

RESULTS

Before treatment, there were no significant differences in FOIS, FDS, and PAS scores between the two groups (P > 0.05), while post-treatment, both groups showed significant improvements in these indicators (P < 0.05), with the treatment group showing more significant improvements than the control group (P < 0.05). Further, before treatment, there were no significant differences in FVC and PEF scores between the two groups (P > 0.05), whereas post-treatment, the treatment group showed significant improvements in these indicators (P < 0.05) and the control group showed no significant changes (P > 0.05). The treatment group also showed more significant improvements than the control group (P < 0.05). Finally, a correlation analysis revealed a significant linear relationship between FVC and PEF in the post-treatment PAS in the treatment group (P < 0.05).

CONCLUSION

Inspiratory muscle training can improve lung function in patients with dysphagia following ischemic stroke, as it develops swallowing function more effectively than conventional swallowing function training alone. Moreover, inspiratory muscle training is effective in treating aspiration caused by dysphagia, with enhancements in aspiration related to improved lung function.

The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes: A randomized controlled trial

Objectives

The purpose of the study was to validate the effectiveness of inspiratory muscle training (IMT) in preventing poststroke sarcopenia and to examine the impact of IMT on the prognosis for stroke recovery.

Patients and methods

In the randomized controlled trial, 367 patients with a first stroke event between December 2021 and May 2023 were randomly allocated to an experimental group and a control group. Of the patients, 329 (179 males, 150 females; mean age: 61.0±8.7 years; range, 35 to 78 years) completed the experiment and were included in the analyses (experimental group, n=164; control group, n=165). Both groups received conventional neurological rehabilitation treatment, and the experimental group also received IMT. The incidence of poststroke sarcopenia and pneumonia during four weeks of treatment were examined and compared. Additionally, an analysis was conducted on the variations between the two groups in maximal inspiratory pressure (MIP), modified Rankin scale (mRS), trunk impact scale (TIS), and modified Barthel index (MBI).

Results

Following four weeks of therapy, the experimental group experienced a reduced incidence of poststroke sarcopenia (p=0.004) and pneumonia (p=0.017) than the control group. The trial group performed better than the control group in MBI (p=0.002), TIS (p<0.001), MIP (p<0.001), and mRS (p=0.011) scores after intervention.

Conclusion

In conclusion, the findings demonstrate that early IMT can significantly lower the risk of poststroke sarcopenia and pneumonia while also improving the prognosis for stroke patients' recovery.

The optimal treatment duration for inspiratory muscle strengthening exercises in stroke patients: a double-blinded randomized controlled trial

BACKGROUND

Little is known about the ideal duration of inspiratory muscle training in stroke patients.

OBJECTIVE

The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients.

METHODS

This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks.

RESULTS

Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period.

CONCLUSION

For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.

Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial

BACKGROUND

The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known.

OBJECTIVE

To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke.

METHODS

A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography.

RESULTS

Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025).

CONCLUSIONS

The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.

Effects of robotic-assisted gait training on physical capacity, and quality of life among chronic stroke patients: A randomized controlled study

BACKGROUND

Even though robotic therapy is becoming more commonly used in research protocols for lower limb stroke rehabilitation, there still is a significant gap between research evidence and its use in clinical practice. Therefore, the present study was designed assuming that the wearable mobile gait device training for chronic stroke patients might have different effects on functional independence when compared to training with a stationary gait device. The present study aims to examine the effects of gait training with ExoAthlet exoskeleton and Lokomat Free-D on functional independence, functional capacity, and quality of life in chronic stroke patients.

METHODS

The present study included 32 chronic stroke patients. Participants were randomly divided into two groups. Functional independence of patients was evaluated by using Functional Independence Measure (FIM), physical function was assessed by using the 30-second chair stand test (30-CST), functional capacity was measured by using the 6-Minute Walk Test (6MWT), and quality of life was assessed by using Short Form 36 (SF36). All participants underwent a conventional physiotherapy program for eight weeks, three sessions per week, and each session lasted 60 min. After the physiotherapy program, one group received gait training by using ExoAthlet exoskeleton (ExoAtlet 1 model/2019, Russia), while the other group received training by using Lokomat Free-D (Hocoma, Lokomat Pro Free-D model/2015, Switzerland). Participants were assessed at baseline and post-intervention.

RESULTS

Results achieved in this study revealed that there was a statistically significant difference between FIM, 30-CST, 6MWT, and SF36 scores before and after the treatment in both groups (p < 0.05).There was no difference in FIM, 30-CST, and 6MWT results between Exoskeleton ExoAthlet and Lokomat Free-D groups (p > 0.05). However, there was a statistically significant difference between Exoskeleton ExoAthlet and Lokomat Free-D groups in terms of SF-36 sub-parameters "vitality", "mental health", "bodily pain", and "general health perception" (p < 0.05).

CONCLUSIONS

This study demonstrated that the use of ExoAthlet exoskeleton and Lokomat Free-D in addition to conventional physiotherapy, was effective in improving functional independence, physical function, functional capacity, and quality of life among chronic stroke patients. Incorporation of robotic gait aids into rehabilitation for chronic stroke patients might offer significant advantages.

Effect of pulmonary training for community‐dwelling frail older adults with chronic stroke: A randomized controlled pilot trial

Background

Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community‐dwelling, frail elderly people with chronic stroke.

Method

This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group (n = 15) and control (n = 15). All participants (65–94 years) attended twelve 20‐min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8･PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6‐min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions.

Results

The intervention group showed significant improvement in %MIP (95% CI, 2.9–31.6; p < 0.01), DRACE (95% CI, −4.1–0.1; p < 0.01), and SF8･PCS (95% CI, 2.5–7.2; p < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction.

Conclusions

These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.

Yoga in Burn: Role of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full-thickness circumferential burns of the chest

BACKGROUND

Circumferential burn of chest (CBC) is a significant type of burn and considers as a major cause of restrictive lung disease (RLD). Patient who has CBC with RLD leads to respiratory symptoms such as breathing difficulty, airway obstruction, reduced exercise capacity and altered pulmonary functions. However, studies examining the role of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full thickness circumferential burn of chest are lacking.

OBJECTIVE

To find the short term effects of pranayama breathing exercise on pulmonary function, respiratory muscle activity and exercise tolerance in full thickness circumferential burns of chest.

METHODS

Through simple random sampling method thirty subjects (N = 30) with RLD following CBC were allocated to pranayama breathing exercise group (PBE-G; n = 15) and conventional breathing exercise group (CBE-G; n = 15). They received pranayama breathing exercise and conventional breathing exercise for 4 weeks respectively. All the subjects received chest mobility exercise as common treatment. Primary (Numeric Pain Rating Scale - NPRS, forced expiratory volume (FEV1), forced vital capacity (FVC) and maximum voluntary ventilation (MVV) and secondary (Electromyogram of sternocleidomastoid, scalene, external intercostal and diaphragm muscle, 6 min walk test & Global Rating of Change - GRC) outcome measures were measured at baseline, after four weeks and after three months follow up.

RESULTS

Baseline demographic and clinical variables show homogenous distribution between the groups (p > 0.05). Four weeks following different breathing exercises, PBE-G group shows more significant changes in pain intensity, pulmonary function, respiratory muscle activity, exercise tolerance and global rating of change than CBE-G group (p ≤ 0.05) at four weeks and three months follow up.

CONCLUSION

Both groups showed improvement over time. However, differences between the groups were noticed small. Still physiotherapy management, which included pranayama breathing exercises with chest mobilization program, had an effective strategy in the treatment of restrictive lung disease following circumferential burn of chest.

Can inspiratory muscle training benefit patients after stroke? A systematic review and meta-analysis of randomized controlled trials

Objectives:

The aim of this study was to investigate the effects of inspiratory muscle training in post-stroke patients and to explore the effective training protocol.

Data sources:

PubMed/Medline, Web of Science, Scopus, Embase, Cochrane database, China National Knowledge Infrastructure, and China Science Periodical Database were searched through April 2020.

Review methods:

Trials examining effects of inspiratory muscle training on pulmonary function, cardiopulmonary endurance, pulmonary infection incidence, and quality of life in post-stroke patients were included. Subgroup analysis was performed to compare different training programs. Mean differences and risk ratios with 95% confidence intervals were presented. Risk of bias was assessed with the Cochrane tool.

Results:

Thirteen randomized controlled trials involving a total of 373 participants were identified. Meta-analysis conducted in 8 out of 13 trials revealed evidence for beneficial effects of inspiratory muscle training on forced vital capacity (MD: 0.47, 95% CI: 0.28–0.66), forced expired volume in 1 second (MD: 0.26, 95% CI: 0.18–0.35), 6-minute walk test (MD: 52.61, 95% CI: 25.22–80.01), maximum inspiratory pressure (MD: 18.18, 95% CI: 5.58–30.78), inspiratory muscle endurance (MD: 19.99, 95% CI: 13.58–26.40), and pulmonary infection incidence (RR: 0.11, 95% CI: 0.03–0.40). Omitting individual trials from the meta-analysis did not significantly change the results. The effective inspiratory muscle training protocol was suggested by subgroup analysis with three repetitions per week and more than 20 minutes per day for three weeks.

Conclusion:

Inspiratory muscle training can be considered as an effective intervention for improving pulmonary function and cardiopulmonary endurance, and reducing pulmonary infection incidence in patients after stroke.

Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke

The aim of this study was to investigate the effects of diaphragm and deep abdominal muscle exercise (DDAME) on walking ability (WA) and balance ability (BA) in subjects with hemiplegia due to stroke. Study subjects consisted of twenty patients diagnosed with hemiplegia due to stroke. They were randomized into a control group (CG) (n=10) that performed traditional exercise and an experimental group (EG) (n=10) that performed DDAME. The WA was measured using the 10-m walking test (10MWT) and 6-min walk test (6MWT). The BA was measured using the Timed Up and Go test (TUG) and Berg’s balance scale (BBS). Paired t-test was performed to compare differences within the groups before and after intervention. The analysis of covariance was performed to compare the differences between the EG and CG. The level of significance was set at α=0.05. Within-group changes in 10MWT and 6MWT were significantly different in both the EG (P<0.05) and CG (P<0.05). There was significantly more improvement in the 10MWT and 6MWT in the EG than in the CG (P<0.05). Within-group changes in TUG and BBS were significantly different in both the EG (P<0.05) and the CG (P<0.05). There was significantly more improvement in TUG and BBS in the EG than in the CG (P<0.05). DDAME program, with diaphragm and inspiratory muscle strengthening exercises, is needed for patients experiencing difficulty in WA, BA, trunk asymmetry, abnormal alignment, mobility of trunk muscles, power, or endurance decline.

Effect of breathing exercises combined with dynamic upper extremity exercises on the pulmonary function of young adults

BACKGROUND

The abdominal muscles, upper extremities, and diaphragm work in synergy to maintain trunk stability during breathing.

OBJECTIVE

This study aimed to investigate the effects of a breathing technique combined with dynamic upper extremity exercise on the pulmonary function of healthy adults.

METHOD

Forty male participants in their 20s were recruited and randomly divided into two groups of 20 participants each: the experimental group performed a dynamic upper extremity exercise with breathing, and the control group only performed the breathing exercise. The experimental duration was 4 weeks, and both groups performed each training three times per a week. We performed pulmonary function test.

RESULTS

Forced vital capacity increased significantly in both groups after the training period, but it was not significantly different between the two groups. Similarly, the forced expiratory volume at one second was not significantly different after training, but was significantly different between the two groups. In contrast, the peak expiratory flow did not show any significant within-group or between-group difference.

CONCLUSION

Consequently, we came up with result that breathing exercise with dynamic upper extremity exercise improves pulmonary function. Our findings indicate that the breathing and dynamic upper extremity exercise described here should be considered in patients who require breathing therapy, since it seems to have beneficial effects on pulmonary function.

Optimal electrode position for abdominal functional electrical stimulation

Abdominal functional electrical stimulation (abdominal FES) improves respiratory function. Despite this, clinical use remains low, possibly due to lack of agreement on the optimal electrode position. This study aimed to ascertain the optimal electrode position for abdominal FES, assessed by expiratory twitch pressure. Ten able-bodied participants received abdominal FES using electrodes placed: 1) on the posterolateral abdominal wall and at the motor points of 2) the external oblique muscles plus rectus abdominis muscles, and 3) the external obliques alone. Gastric (P_ga) and esophageal (P_es) twitch pressures were measured using a gastroesophageal catheter. Single-stimulation pulses were applied at functional residual capacity during step increments in stimulation current to maximal tolerance or until P_ga plateaued. Stimulation applied on the posterolateral abdominal wall led to a 71% and 53% increase in P_ga and P_es, respectively, compared with stimulation of the external oblique and rectus abdominis muscles ( P < 0.001) and a 95% and 56% increase in P_ga and P_es, respectively, compared with stimulation of the external oblique muscles alone ( P < 0.001). Stimulation of both the external oblique and rectus abdominis muscles led to an 18.3% decrease in P_ga compared with stimulation of only the external oblique muscles ( P = 0.040), with inclusion of the rectus abdominis having no effect on P_es ( P = 0.809). Abdominal FES applied on the posterolateral abdominal wall generated the highest expiratory twitch pressures. As expiratory pressure is a good indicator of expiratory muscle strength and, thus, cough efficacy, we recommend this electrode position for all therapeutic applications of abdominal FES. NEW & NOTEWORTHY While abdominal functional electrical stimulation (abdominal FES) can improve respiratory function, clinical use remains low. This is at least partly due to lack of agreement on the optimal electrode position. Therefore, this study aimed to ascertain the optimal electrode position for abdominal FES. We show that electrodes placed on the posterolateral abdominal wall generated the highest expiratory twitch pressures. As such, we recommend this electrode position for all therapeutic applications of abdominal FES.

The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke

[Purpose] This study aimed to investigate the correlation between the diaphragm thickness and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed using ultrasonography, and the diaphragm thickening ratio was standardized using a formula. To analyze pulmonary function, we measured the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Results] A statistically significant correlation was found between the diaphragm thickness, thickness ratio, and diaphragm excursion; and the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a relationship between respiratory function and diaphragm thickness and diaphragm excursion, especially in the paretic side of the diaphragm. Therefore, the role of the respiratory muscles of the paretic side is important in rehabilitation programs to improve the respiratory function of stroke patients.

The effect of lumbar stabilization exercise on the pulmonary function of stroke patients

[Purpose] This study was aimed at assessing the effect of lumbar stabilization exercise on the pulmonary function of stroke patients. [Subjects and Methods] The subjects were randomly allocated into lumbar stabilization exercise group and a general physical therapy group. The program consisted of 30-min sessions conducted 3 days a week for 8 weeks. Pulmonary function was assessed based on lung performance parameters, including forced vital capacity, forced expiratory volume at 1 second, ratio of forced expiratory volume at 1 second to forced vital capacity, and peak expiratory flow. [Results] In the assessment of pulmonary function, the values of all the lung performance parameters were significantly increased in the lumbar stabilization exercise group but were significantly decreased in the general physical therapy group. [Conclusion] These results indicate that lumbar stabilization exercise had a more positive effect on pulmonary function than general physical therapy.

Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis

OBJECTIVE

To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke.

DATA SOURCES

We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials.

STUDY SELECTION

Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently.

DATA EXTRACTION

Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated.

DATA SYNTHESIS

Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported.

CONCLUSIONS

Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.

Abdominal functional electrical stimulation to improve respiratory function after spinal cord injury: a systematic review and meta-analysis

OBJECTIVES

Abdominal functional electrical stimulation (abdominal FES) is the application of a train of electrical pulses to the abdominal muscles, causing them to contract. Abdominal FES has been used as a neuroprosthesis to acutely augment respiratory function and as a rehabilitation tool to achieve a chronic increase in respiratory function after abdominal FES training, primarily focusing on patients with spinal cord injury (SCI). This study aimed to review the evidence surrounding the use of abdominal FES to improve respiratory function in both an acute and chronic manner after SCI.

SETTINGS

A systematic search was performed on PubMed, with studies included if they applied abdominal FES to improve respiratory function in patients with SCI.

METHODS

Fourteen studies met the inclusion criteria (10 acute and 4 chronic). Low participant numbers and heterogeneity across studies reduced the power of the meta-analysis. Despite this, abdominal FES was found to cause a significant acute improvement in cough peak flow, whereas forced exhaled volume in 1 s approached significance. A significant chronic increase in unassisted vital capacity, forced vital capacity and peak expiratory flow was found after abdominal FES training compared with baseline.

CONCLUSIONS

This systematic review suggests that abdominal FES is an effective technique for improving respiratory function in both an acute and chronic manner after SCI. However, further randomised controlled trials, with larger participant numbers and standardised protocols, are needed to fully establish the clinical efficacy of this technique.

Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people

[Purpose] This study aimed to determine the effects of different intensities of inspiratory muscle training on the relative respiratory muscle activity in healthy adults. [Subjects and Methods] Thirteen healthy male volunteers were instructed to perform inspiratory muscle training (0%, 40%, 60%, and 80% maximal inspiratory pressure) on the basis of their individual intensities. The inspiratory muscle training was performed in random order of intensities. Surface electromyography data were collected from the right-side diaphragm, external intercostal, and sternocleidomastoid, and pulmonary functions (forced expiratory volume in 1 s, forced vital capacity, and their ratio; peak expiratory flow; and maximal inspiratory pressure) were measured. [Results] Comparison of the relative activity of the diaphragm showed significant differences between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. Furthermore, significant differences were found in sternocleidomastoid relative activity between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. [Conclusion] During inspiratory muscle training in the clinic, the patients were assisted (verbally or through feedback) by therapists to avoid overactivation of their accessory muscles (sternocleidomastoid). This study recommends that inspiratory muscle training be performed at an accurate and appropriate intensity through the practice of proper deep breathing.

The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease

[Purpose] Fragmentary studies on characteristics of respiratory muscles are being done to increase respiratory capacity by classifying exercises into voluntary respiratory exercise which relieves symptoms and prevents COPD and exercise using breathing exercise equipment. But this study found changes on respiratory pattern through changes on the activity pattern of agonist and synergist respiratory muscles and studied what effect they can have on body function improvement. [Subjects and Methods] Fifteen subjects in experimental group I that respiratory exercise of diaphragm and 15 subjects in experimental group II that feedback respiratory exercise were randomly selected among COPD patients to find the effective intervention method for COPD patients. And intervention program was conducted for 5 weeks, three times a week, once a day and 30 minutes a session. They were measured with BODE index using respiratory muscle activity, pulmonary function, the six-minute walking test, dyspnea criteria and BMI Then the results obtained were compared and analyzed. [Results] There was a significant difference in sternocleidomastoid muscle and scalene muscle and in 6-minute walk and BODE index for body function. Thus the group performing feedback respiratory had more effective results for mild COPD patients. [Conclusion] Therefore, the improvement was significant regarding the activity of respiratory muscles synergists when breathing before doing breathing exercise. Although, it is valuable to reduce too much mobilization of respiratory muscles synergists through the proper intervention it is necessary to study body function regarding improvement of respiratory function for patients with COPD.

Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients

[Purpose] This study evaluated the effects of inspiratory muscle training on pulmonary function, deep abdominal muscle thickness, and balance ability in stroke patients. [Subjects] Twenty-three stroke patients were randomly allocated to an experimental (n = 11) or control group (n = 12). [Methods] The experimental group received inspiratory muscle training-based abdominal muscle strengthening with conventional physical therapy; the control group received standard abdominal muscle strengthening with conventional physical therapy. Treatment was conducted 20 minutes per day, 3 times per week for 6 weeks. Pulmonary function testing was performed using an electronic spirometer. Deep abdominal muscle thickness was measured by ultrasonography. Balance was measured using the Berg balance scale. [Results] Forced vital capacity, forced expiratory volume in 1 second, deep abdominal muscle thickness, and Berg balance scale scores were significantly improved in the experimental group than in the control group. [Conclusion] Abdominal muscle strengthening accompanied by inspiratory muscle training is recommended to improve pulmonary function in stroke patients, and may also be used as a practical adjunct to conventional physical therapy.

The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients

[Purpose] This study investigated the effects of progressive load and fixed load high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. [Subjects] Twenty-one stroke patients were assigned to one of three groups: progressive load high-intensity inspiratory muscle training (n = 8), fixed load high-intensity inspiratory muscle training (n = 6), and controls (n = 7). [Methods] The progressive load and fixed load high-intensity inspiratory muscle training participants undertook an exercise program for 20 minutes, three times weekly, for 6 weeks. After each session, diaphragm thickness was measured using ultrasonography. The diaphragm asymmetry ratio and diaphragm thickening ratio were standardized using a formula. [Results] After intervention, the diaphragm asymmetry ratio significantly differed among the three groups, and the diaphragm asymmetry ratio significantly increased in the control group. A significant increase was identified in the diaphragm thickening ratio within the progressive load and fixed load high-intensity inspiratory muscle training groups. [Conclusion] Progressive load and fixed load high-intensity inspiratory muscle training decreased the asymmetry of diaphragm thickness in stroke patients; this effect, in turn, increased the diaphragm thickening ratio in stroke patients. The two interventions examined here should be selectively applied to individuals in the clinical field.

Effects of chest resistance exercise and chest expansion exercise on stroke patients' respiratory function and trunk control ability

[Purpose] The purpose of this study was to examine the efficiency of chest resistance and chest expansion exercises for improving respiratory function and trunk control ability in patients with stroke. [Subjects] Forty patients with stroke were randomly allocated into a chest resistance exercise group (CREG, n = 20) and a chest expansion exercise group (CEEG, n = 20). [Methods] CREG patients underwent chest resistance exercises, and diaphragmatic resistance exercises by way of the proprioceptive neuromuscular facilitation. CEEG patients underwent respiratory exercises with chest expansion in various positions. Both groups received 30 minutes of training per day, five times per week, for eight weeks. [Results] Both the CERG and CEEG groups showed significant changes in FVC, FEV1, and TIS after the intervention. TIS was significantly increased in the CREG compared to the CEEG after the intervention. [Conclusion] Both chest resistance and chest expansion exercises were effective for improving respiratory function and trunk control ability in stroke patients; however, chest resistance exercise is more efficient for increasing trunk control ability.