PTRCTJournal of physical therapy science2017

The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients' respiratory muscle activation.

KyoChul Seo, Park Seung Hwan, KwangYong Park

PMID 28356632

WHAT IT FOUND

In chronic stroke patients, adding therapist-guided diaphragm and pursed-lip breathing to routine physical therapy increased paretic-side respiratory muscle activity over four weeks.

Key findings

01The group that added inspiratory diaphragm and expiratory pursed-lip breathing to joint mobilization, muscular strengthening, and extension exercise showed significant post-test increases in all measured paretic-side respiratory muscle activity levels, while the control group that added non-breathing auto-med exercise to the same physical therapy showed none.

02Between-group post-test differences were significant for paretic-side upper trapezius, latissimus dorsi, rectus abdominis, and internal abdominal oblique, but not external abdominal oblique.

03Experimental group post-test paretic-side upper trapezius activity was 143.1 ± 3.6% of the normalized pre-test mean, while control group activity was 104.2 ± 13.1%.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

The study was small, with 30 participants, and was done at one hospital. The participants had to be independent walkers, free of pulmonary disease or orthopedic thoracic deformity, not receiving stiffness drug therapy, and able to follow instructions with a mini mental state examination-Korean version score of 24 or higher, so the result may not apply to more severe stroke or cognitive impairment. The main outcome was electrical activity of paretic-side respiratory muscles, not measured breathing capacity, endurance, walking, or daily function. The normalized values set the pre-exercise mean at 100%, so the percentage figures describe relative EMG change, not absolute muscle activity. The breathing block combined inspiratory diaphragm and expiratory pursed-lip breathing, so the contribution of either breathing component alone cannot be separated. The paper does not report how randomisation was done or whether blinding was used, and it does not report follow-up beyond the four-week intervention.

The easy way to misread this

Do not conclude that this exercise improves breathing capacity, walking, or daily function. The measured outcome was paretic-side respiratory muscle electrical activity, and the paper reports no functional respiratory or daily activity outcomes.

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