Effects of Inspiratory Muscles Training Plus Rib Cage Mobilization on Chest Expansion, Inspiratory Accessory Muscles Activity and Pulmonary Function in Stroke Patients

Shin Jun Park

doi:10.3390/app10155178

Abstract

After stroke, limited ribcage movement may lead to impaired respiratory function. Combining threshold inspiratory muscle training with rib cage joint mobilization has been shown to enhance the recovery of respiratory function in patients with stroke. The present study investigated whether the combination of rib cage joint mobilization and inspiratory muscle training would improve chest expansion, inspiratory muscle activity, and pulmonary function after stroke. Thirty stroke patients were recruited and randomly assigned to one of the two groups, namely 6-week rib cage joint mobilization with inspiratory muscle training (experimental group) or inspiratory muscle training alone (control group). Outcome measures included upper and lower chest expansion, activity of accessory inspiratory muscles (latissimus dorsi (LD) and upper trapezius (UT)), and pulmonary function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF)). All evaluations were conducted at baseline and after 6 weeks of inspiratory muscle training. Significant increases were observed in upper and lower chest expansion, LD and UT muscle activity, FVC, FEV1, and PEF in both the groups. Upper and lower chest expansion and muscle activity of UT and LD were significantly higher in the experimental group than in the control group. No significant differences were observed in FVC, FEV1, and PEF between the groups. Inspiratory muscle training is effective in improving chest expansion, inspiratory muscle activity, and pulmonary function after stroke. The addition of rib cage joint mobilization further increases chest expansion and inspiratory muscle activity.

Highlights

The respiratory system in stroke patients is affected due to neurological impairment [1,2].Decreased respiratory function in stroke patients may lead to an increased incidence of respiratory complications [3]
The results of the present study suggested that rib cage joint mobilization and inspiratory muscle training aimed at improving chest wall movements resulted in increased pulmonary function, increased chest expansion, and improved inspiratory muscle activity
When compared with studies regarding the effects of joint mobilization and manual therapy applied to the spine on respiratory function [18,19,28], the present study showed a wider range of therapeutic effects of rib cage joint mobilization such as improved chest expansion, inspiratory muscle activity, and pulmonary function

Summary

Introduction

The respiratory system in stroke patients is affected due to neurological impairment [1,2]. Decreased respiratory function in stroke patients may lead to an increased incidence of respiratory complications [3]. Stroke patients need respiratory physiotherapy to prevent and minimize the complications of respiratory failure [4]. Stroke patients usually exhibit a decrease in the chest wall movements on the paretic side [5], reduced respiratory muscle activity [6], and decreased pulmonary function [7]. Lower functional levels in stroke patients lead to inspiratory muscle weakness more frequently than expiratory muscle weakness [8]. Since the decrease in the inspiratory capacity in the chronic stage occurs due to rib cage contracture [9], intervention methods to address restrictive respiratory dysfunction in stroke

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Discussion

Conclusion