Thoracic Excursion Research Articles

Manual Therapy Interventions in Patients With Chronic Obstructive Pulmonary Disease: A Comprehensive Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a breathing problem with ongoing airflow issues and changes in how the chest moves. Different manual therapy methods, like releasing the diaphragm, manipulating the spine and joints, and treating soft tissues, have been used for people with COPD. This review looks into how these manual therapy approaches affect COPD patients. Articles were searched in Google Scholar, PubMed, and Elsevier using keywords such as COPD, manual therapy, thoracic excursion, and pulmonary function. Only studies conducted between 2015 and 2023, employing randomized controlled trials (RCTs), crossover RCTs, or comparative studies with COPD subjects, thoracic excursion, chest expansion, or pulmonary function tests (PFTs) as outcome measures, and involving physiotherapy interventions were included. Out of 82 articles searched, 10 met the inclusion criteria, comprising six RCTs, three crossover RCTs, and one comparative study. Data extraction was performed by one reviewer, encompassing intervention descriptions, inclusion/exclusion criteria, baseline data, and outcome values. The findings suggest that conventional physiotherapy combined with manual therapy techniques such as stretching, osteopathic manual therapy, manual diaphragmatic release, soft tissue therapy, and spinal manipulation have improved thoracic excursion and pulmonary function in COPD patients. Therefore, these manual therapy techniques are recommended for enhancing thoracic excursion and pulmonary function in COPD patients.

Musculoskeletal aspects of respiratory function in cystic fibrosis: a cross-sectional comparative study

ABSTRACT Background Respiration is an intricate interaction between visceral and musculoskeletal structures. In cystic fibrosis (CF), the airways and lungs are subject to progressive obstruction and destruction. However, knowledge about the musculoskeletal aspects of respiratory function and symptoms is still limited in this patient group. Methods In a cross-sectional comparative study, 21 adults with CF enrolled at the Gothenburg CF Centre were matched with 42 healthy controls. The two groups were examined and compared in terms of thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain in accordance with a predefined protocol. Results Significant differences were observed between the groups in the number of tender points, thoracic excursion, forced vital capacity (FVC), and forced expiratory volume (FEV). The CF group also demonstrated a tendency toward reduced function in other measurements, although these were not statistically significant. Conclusion This cross-sectional study revealed that people with CF have reduced thoracic mobility and an increased prevalence of muscular tender points, alongside decreased lung function, compared to healthy controls. These findings stress the need for greater emphasis on the often-overlooked musculoskeletal aspects of CF care, especially as people with CF are living longer and may require more musculoskeletal health support.

Effect of diaphragmatic stretch technique on thoracic excursion and pulmonary function in COPD patients: Study protocol for randomized controlled trial.

Limited airflow is a defining feature of COPD, a respiratory disease that frequently results in reduced thoracic movement and compromised lung function. The diaphragm, which is the main breathing muscle, is essential for healthy lung expansion and ventilation. The diaphragm muscle’s flexibility and mobility are intended to be enhanced via diaphragmatic stretching. This method can enhance respiratory health and assist in returning the diaphragm to its original state. Patients with COPD may benefit from improved lung expansion and ventilation because of this. The usefulness of integrating the diaphragmatic stretch approach with traditional chest physical therapy is not well-established. Thus, research is needed to ascertain how the diaphragmatic stretch technique affects lung function and thoracic excursion in COPD patients. This study aims to ascertain how the diaphragmatic stretch technique affects thoracic excursion and pulmonary function (FEV1, FVC, FEV1/FVC, FEF25%-75%, PEFR) in individuals with COPD. There will be 58 COPD patients enrolled in total for this trial; 29 will receive traditional chest physiotherapy along with the diaphragmatic stretch technique, and 29 will receive traditional chest physiotherapy exclusively. Two weeks will pass throughout the intervention. Prior to the intervention, pre-outcome measures will be evaluated, and two weeks later, post-outcome measures will be evaluated once more. The anticipated outcome of this study is that the diaphragmatic stretch technique can enhance thoracic excursion and improve pulmonary function just as well as traditional chest physiotherapy when used in conjunction with it.

MediYoga compared to physiotherapy treatment as usual for patients with stress-related symptoms in primary care rehabilitation: A randomized controlled trial.

The purpose of this study was to compare the effect of MediYoga as a group treatment to conventional treatment provided by a physiotherapist for people with perceived stress-related symptoms. Randomized controlled trial. Primary care rehabilitation, Gothenburg Sweden. Fifty-five patients with stress-related symptoms were invited to participate. Nine patients declined, and a total of 46 patients aged 26-70 years (mean 47), 44 women and two men were randomized, 23 to the MediYoga group and 23 to the physiotherapy treatment as usual group. The MediYoga group performed MediYoga for one hour a week during an 8-week period. The control group received physiotherapy treatment as usual. Data were mainly collected by self-reported questionnaires. For primary outcome the Swedish version of the Perceived Stress Scale (PSS) was used. Secondary outcomes were the Hospital Anxiety and Depression Scale (HADS), EuroQol-5D (EQ-5D) and EuroQol-Visual Analog Scale (EQ-VAS). Thoracic excursion was the only physical measurement. Mixed effect model was used for analyse. For the primary outcome PSS, there was a close to statistically significant group effect over time advantaging MediYoga over physiotherapy (P = 0.06). For secondary outcomes, the group effect over time was statistically significant in HADS anxiety (P = 0.01) and EQ-VAS (P = 0.03). There was a group trend over time advantaging MediYoga in HADS depression (P = 0.08). Despite a large dropout in both groups, MediYoga can be recommended as a treatment option for people suffering from stress-related symptoms. Registered in: ClinicalTrials.gov NCT02907138.

Measuring thoracic excursion using a wearable patch antenna

Measuring thoracic excursion using a wearable patch antenna

Effect of chest wall mobilization on respiratory muscle function in patients with severe chronic obstructive pulmonary disease (COPD): A randomized controlled trial

BackgroundClinical trials have demonstrated positive correlation between pulmonary function and chest wall expansion in COPD. Decrease in chest wall expansion in patients with COPD compromises rib cage mobility and functional length of respiratory muscles that ultimately jeopardize the efficacy and function of respiratory system. MethodThirty male adults (mean age: 74.97 ± 6.29) suffered with severe COPD were randomly allocated to either experimental group (chest wall mobilizations) or control group. Both groups received standardized education and walking exercise (twice/week) for 6 weeks. Patients in experimental group received additional chest wall mobilizations that include stretching and joints mobilization. Pulmonary function, respiratory muscle strength, thoracic excursion, cervical and thoracic range of movement were evaluated at baseline, post-program and at 3-month follow-up. ResultsThere were significantly greater improvements in respiratory muscle strength, thoracic excursion and thoracic range of movement (p < 0.01) except thoracic flexion. Lower thoracic excursion is strongly associated with increase in maximum inspiratory pressure (β = 13.64, p < 0.001) and maximum expiratory pressure (β = 16.23, p < 0.001). Thoracic range of movement especially extension (p < 0.001) and bilateral rotation (p < 0.01) exhibit a strong relationship with increase in lower thoracic excursion (adjusted R2 = 0.876) as shown in multiple regression analysis. ConclusionAdditional chest wall mobilization in the rehabilitation of patients with COPD is likely to enhance thoracic extension and rotation which increase lower thoracic excursion. This significant improvement in chest expansion capacity allows respiratory muscles to work at an optimal functional length which result in greater respiratory muscle strength in patients with severe COPD.

Using entropy of snoring, respiratory effort and electrocardiography signals during sleep for OSA detection and severity classification

Study objectivesObstructive sleep apnea (OSA) is a very prevalent disease and its diagnosis is based on polysomnography (PSG). We investigated whether snoring-sound-, very low frequency electrocardiogram (ECG-VLF)- and thoraco-abdominal effort- PSG signal entropy values could be used as surrogate markers for detection of OSA and OSA severity classification. MethodsThe raw data of the snoring-, ECG- and abdominal and thoracic excursion signal recordings of two consecutive full-night PSGs of 86 consecutive patients (22 female, 53.74 ± 12.4 years) were analyzed retrospectively. Four epochs (30 s each, manually scored according to the American Academy of Sleep Medicine standard) of each sleep stage (N1, N2, N3, REM, awake) were used as the ground truth. Sampling entropy (SampEn) of all the above signals was calculated and group comparisons between the OSA severity groups were performed. In total, (86x4x5 = )1720 epochs/group/night were included in the training set as an input for a support vector machine (SVM) algorithm to classify the OSA severity classes. Analyses were performed for first- and second-night PSG recordings separately. ResultsTwenty-seven patients had mild (RDI = ≥ 5/h but <15/h), 21 patients moderate (RDI ≥15/h but <30/h) and 23 patients severe OSA (RDI ≥30/h). Fifteen patients had an RDI <5/h and were therefore considered non-OSA. Using SE on the above three PSG signal data and using a SVM pipeline, it was possible to distinguish between the four OSA severity classes. The best metric was snoring signal-SE. The area-under-the-curve (AUC) calculations showed reproducible significant results for both nights of PSG. The second night data were even more significant, with non-OSA (R) vs. light OSA (L) 0.61, R vs. moderate (M) 0.68, R vs. heavy OSA (H) 0.84, L vs. M 0.63, M vs. H 0.65 and L vs. H 0.82. The results were not confounded by age or gender. ConclusionsSampEn of either snoring-, very low ECG-frequencies- or thoraco-abdominal effort signals alone may be used as a surrogate marker to diagnose OSA and even predict OSA severity. More specifically, in this exploratory study snoring signal SampEn showed the greatest predictive accuracy for OSA among the three signals. Second night data showed even more accurate results for all three parameters than first-night recordings. Therefore, technologies using only parts of the PSG signal, e.g. sound-recording devices, may be used for OSA screening and OSA severity group classification.

Endotracheal tube obstruction due to cuff overinflation or cuff herniation in small equids: A case series

SummaryAdequate inflation of the endotracheal tube (ETT) cuff is important to avoid leakage of anaesthetic gases or aspiration of gastric contents and to allow positive pressure ventilation. However, overinflation or herniation of the cuff can cause tracheal mucosal damage and in rare cases even obstruction of the ETT. ETT obstruction due to the cuff itself may be an underrecognised phenomenon in equine practice and we aim to create awareness with this retrospective case series (n = 3). Cases identified between 2014 and 2021 with (partial) ETT obstruction due to cuff overinflation or cuff herniation at the Utrecht University Equine Clinic were selected. Anaesthesia records were examined and presented. Two cases occurred in foals and one in a pony. In each case, high airway pressure was encountered and no or minimal thoracic excursions were visible. In all three cases, cuff deflation led to immediate normalisation of ventilation parameters. When presented with an intubated patient that is difficult to ventilate and high airway pressures exist, ETT cuff overinflation or herniation should be considered as a possible cause; rapid cuff deflation should be included in algorithms for management of ventilation failure due to suspected airway obstruction.

Changes in pulmonary function following thoracic spine manipulation in a healthy inactive older adult population-a pilot study.

[Purpose] Pulmonary function pathology is primarily treated pharmacologically, with a range of medication side effects. Few studies have systematically examined non-pharmacologic approaches such as joint manipulation effects on pulmonary function. This study examined the immediate and short-term effects of thoracic manipulation on pulmonary function. [Participants and Methods] Twenty-one physically inactive otherwise healthy participants aged 50 years or older were randomly assigned to either receive three sessions of thoracic manipulation (n=10) or three sessions of "sham intercostal training" (n=11). Outcome measures included forced vital capacity, maximal voluntary ventilation and thoracic excursion during maximal inhalation and exhalation. [Results] There was a statistically significant difference in maximal voluntary ventilation in the manipulation group, when measured within a week of the third intervention session and immediate effects in thoracic excursion during exhalation in the sham group following a single intervention session. There were no significant changes in other measures. [Conclusion] Spinal manipulation had no immediate effect on pulmonary function, however, affected an improvement in maximal voluntary ventilation within 7 days following a third session. The sham intervention showed a change in thoracic excursion during exhalation after the first session. Future research is necessary to further explore the relationship between thoracic manipulation and pulmonary function.

Перспективы использования дыхательных тренажёров у больных с травматическими повреждениями

Chest injuries sustained during armed conflict have a high mortality rate and are accompanied by pulmonary dysfunction. Pulmonary contusion is manifested by rupture of pulmonary parenchyma, atelectasis, and hemorrhages in pulmonary parenchyma. The treatment strategy for such patients includes anesthesia, management of acute respiratory failure, treatment of infectious complications, sanation of airways, and rehabilitation measures. One of the goals of such interventions is the elimination of respiratory biomechanics disorders. It is recommended to use respiratory exercisers with a threshold level of resistance for the process of inhalation and exhalation to train respiratory muscles. At the Main Military Clinical Hospital named after N.N. Burdenko the possibility of application of the respiratory simulator "Universal-2011" as a therapeutic physical training tool in the hospital phase of treatment of patients with thoracic trauma was studied. The efficacy of the carried activities was evaluated by functional tests of tolerance to hyper- and hypocapnia of Stange and Gench and the assessment of thoracic cage excursion. The experience of using a respiratory exerciser was observed to be positive. All 25 patients fulfilled the planned program with the achievement of improvement of external respiratory function and exercise tolerance.

THORACIC ULTRASOUND IN COVID-19: USE OF LUNG AND DIAPHRAGM ULTRASOUND IN EVALUATING DYSPNEA IN SURVIVORS OF CRITICAL ILLNESS FROM COVID-19 PNEUMONIA IN A POST-ICU CLINIC

THORACIC ULTRASOUND IN COVID-19: USE OF LUNG AND DIAPHRAGM ULTRASOUND IN EVALUATING DYSPNEA IN SURVIVORS OF CRITICAL ILLNESS FROM COVID-19 PNEUMONIA IN A POST-ICU CLINIC

Effect of Chest Resistance and Expansion Exercises on Respiratory Muscle Strength, Lung Function, and Thoracic Excursion in Children with a Post-Operative Congenital Diaphragmatic Hernia.

Background. Congenital diaphragmatic hernia (CDH) is a life-threatening condition with long-term complications including respiratory tract infections, respiratory muscle weakness, and abnormal lung functions. This study was designed to ascertain the effects of chest resistance and chest expansion exercises on respiratory muscle strength, lung function, and chest mobility in children with post-operative CDH. Methods. This randomized controlled clinical study was conducted in the outpatient physiotherapy clinic at Prince Sattam bin Abdulaziz University. Thirty-two children with CDH aged 10–14 years between May 2020 and February 2021 were randomly allocated to the study group (n = 16) and the control group (n = 16). The control group underwent a usual chest physiotherapy program; however, the study group underwent a 12-week chest resistance exercise combined with chest expansion exercise in addition to usual chest physiotherapy, with three sessions per week. Respiratory muscle strength, lung function, and thoracic excursion were assessed pre- and post-treatment. Results. Using the 2 × 2 repeated ANOVA, significant time × group interactions were detected in favor of the study group, FVC (F = 4.82, 95% CI = −15.6 to −0.97, p = 0.005, and η2 = 0.16), FEV1 (F = 4.54, 95% CI = −11.99 to −2.8, p ˂ 0.001, and η2 = 0.14), PImax (F = 5.12, 95% CI = −15.71 to −5.3, p ˂ 0.001, and η2 = 0.15), and thoracic excursion (F = 4.41, 95% CI = −2.04 to −0.16, p = 0.036, and η2 = 0.17). Conclusions. Concurrent chest resistance and expansion exercises may improve respiratory muscle strength, lung function, and thoracic excursion in children with post-operative CDH. The study findings suggest that concurrent chest and chest expansion exercises be part of an appropriate pulmonary rehabilitation program in children with a history of CDH.

Thoracic Excursion Is a Biomarker for Evaluating Respiratory Function in Amyotrophic Lateral Sclerosis.

ObjectiveTo evaluate the usefulness of thoracic excursion as a biomarker in patients with amyotrophic lateral sclerosis (ALS).MethodsWe measured the forced the vital capacity (FVC), thoracic excursion, baseline-to-peak diaphragmatic compound muscle action potential (DCMAP) amplitude, diaphragm thickness at full inspiration (DTfi), Medical Research Council (MRC) sum score for muscle strength, and arterial partial pressures of oxygen and carbon dioxide and administered the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) and modified Medical Research Council (mMRC) Dyspnea Scale. The test–retest reliability of thoracic excursion was determined.Results and ConclusionsThirty-four patients with ALS and 26 age- and sex-matched healthy participants were enrolled. Thoracic excursion measurement had excellent test–retest reliability (intraclass coefficient: 0.974). Thoracic excursion was more strongly correlated with FVC (r = 0.678, p < 0.001) than DCMAP amplitude (r = 0.501, p = 0.003) and DTfi (r = 0.597, p < 0.001). It was also correlated with ALSFRS-R score (r = 0.610, p < 0.001), MRC sum score (r = 0.470, p = 0.005), and mMRC Dyspnea Scale score (r = −0.446, p = 0.008) and was the most sensitive parameter for assessing dyspnea and FVC. Thoracic excursion decreased as FVC declined in the early and late stages, there were no differences in DCMAP amplitude and DTfi between the early and late stages, and ALSFRS-R score and MRC sum score decreased only in the late stage. Thoracic excursion was well correlated with respiratory function and is useful for predicting respiratory and general dysfunction in patients with ALS regardless of stage.

Development of a 3D Individualized Mask for Neonatal Non-Invasive Ventilation.

Non-invasive masks are designed based on generic facial models; therefore, difficulties in fitting patients’ unique characteristics are common. A poor fit of the mask may have consequences such as air leaks or pressure ulcers. It is possible to optimize the fit of interfaces by adapting them to a patient’s face. Our objective is to design an individualized silicone mask for non-invasive ventilation for a premature phantom using a three-dimensional (3D) scanner and bioprinter. The facial surface of the manikin was scanned with a 3D scanner in a supine position, in an incubator with a sliding mattress and in <2 min. We printed the tailor-made mask in 3 h with biocompatible and hypoallergenic silicone. When applied under a simulated clinical scenario, the mask possessed good structural reliability after post-processing and optimal mechanical features. We observed adequate thoracic excursion and 14% reduction in air leaks when the manikin was ventilated with the customized mask with a neonatal ventilator. We ink the edges of personalized and standard masks. After fitting them to phantoms, personalized mask showed better pressure distribution. Our subsequent research direction is to test the viability of personalizing non-invasive ventilation masks for very preterm infants of our department.

P-MN004. Multiple neurophysiologic biomarkers evaluated the pulmonary function of ALS

Introduction . Declining respiratory-muscle function is the primary cause of death in patients with amyotrophic lateral sclerosis (ALS). Spirometry is the most frequently used to predict hypoventilation and survival in ALS, but their cut off value cannot indicate disease prognosis. Multiple neurophysiological evaluations, which performed using diaphragmatic compound motor-action potential (DCMAP) by phrenic nerve conduction study, diaphragm thickness (DDT) by ultrasonography and new measurement system of thoracic excursion are proposed as new variable biomarkers. Methods . A total of 14 ALS patients diagnosed by El Escorial criteria were enrolled (4 females and 10 males, mean age 71.0 years, mean disease duration 29.2 months, mean body mass index ( BMI ) 19.5 kg/m 2 ). We prospectively evaluated the spirometry, arterial partial pressure of oxgen and carbon dioxide (PaO2 and PaCO2), baseline-to-peak amplitude of DCMAP, and the differences in DDT and thoracic excursion between timed maximal inspiration and maximal expiration (UMIN:000042222). We then analyzed the relationships between neurophysiological biomarkers, the respiratory-function test, and the other quantitative evaluations. Results . All patients completed the examinations with the exception of the respiratory-function test of two patients. The test–retest analysis of neurophysiologic biomarkers showed a high level of reliability. Decrease of DCMAP and DDT was detected in patients who reported no subjective dyspnea. DCMAP and DDT were found to correlate strongly with both PaCO2 and forced vital capacity (FVC); in contrast, thoracic excursion was strongly correlated to PaCO2 but not to FVC. Except for one female patient with high BMI (> 25), correlation with thoracic excursion and FVC was observed. Conclusion . Multiple neurophysiologic evaluations are reliable and reflects respiratory function. DCMAP and DDT are useful for the objective evaluations of respiratory function before the awareness of subjective dyspnea in patients with ALS.

Development and Commercialization of Thoracic Excursion Measurement System with Biofeedback

Development and Commercialization of Thoracic Excursion Measurement System with Biofeedback

Improving Clinical Outcomes and Quality of Life with Massage Therapy in Youth and Young Adults with Cystic Fibrosis: a Pilot Study

Cystic Fibrosis (CF) is an autosomal recessive disorder of exocrine glands characterized by abnormal production of thick mucus, primarily in bronchi of the lungs. Individuals experience recurrent respiratory infections, increased work of breathing, cough and musculoskeletal changes with pain. Previous research found that massage therapy (MT) decreased pain, muscle tightness, and anxiety in individuals with CF, but did not use valid/reliable measurements of quality of life (QOL). To evaluate the effects of MT on QOL and clinical outcomes in individuals 8 to 21 years old with CF. A 622-bed nonprofit pediatric hospital in Ohio in the United States. Convenience sample of 24 patients with CF; 12 randomly assigned to treatment and control groups, respectively. Prospective two-group controlled pre/post pilot study using deep tissue myofascial trigger point massage over 10 to 12 weeks. Pediatric Quality of Life Inventory (Peds QL 4.0); Cystic Fibrosis Questionnaire-Revised (CFQ-R); numeric rating scales (NRS) for pain, muscle tightness, ease of breathing, relaxation; pulmonary function (PFT); single breath count; thoracic excursion (TE). All participants were Caucasian; mean age 15.7 (SD = 3.5) years; 16 (66.6%) female. No significant differences were found in terms of age, gender, baseline pain between MT and control groups. At the final visit, compared to the control group, the children in MT group showed statistically significantly reduced muscle tightness (p = .048) with a large effect size (ω2 =0.163) and marginally statistically significantly higher levels of relaxation (p = .052), less pain (p = .076), and improved upper TE (p = .078) and lower TE (p = .056) scores with large and moderate effect sizes (ω2 = 0.156, ω2 = 0.095, ω2 = 0.083, and ω2 = 0.073). No statistically significant differences in children's and caregivers' QOL scores between the two groups were found. Massage therapy was found to significantly reduce muscle tightness, marginally significantly help pain, relaxation, and thoracic excursion in participants with CF.

Comparative Analysis of the Discriminative Capacity of EEG, Two ECG-Derived and Respiratory Signals in Automatic Sleep Staging

Highly accurate classification of sleep stages is possible based on EEG signals alone. However, reliable and high quality acquisition of these signals in the home environment is difficult. Instead, electrocardiogram (ECG) and Respiratory (Res) signals are easier to record and may offer a practical alternative for home monitoring of sleep. Therefore, automatic sleep staging was performed using ECG, Res (thoracic excursion) and EEG signals from 31 nocturnal recordings of the Sleep Heart Health Study (SHHS) polysomnography Database. Feature vectors were extracted from 0.5 min (standard) epochs of sleep data by time-domain, frequency domain, time-frequency and nonlinear methods and optimized by using the Support Vector Machine-Recursive Feature Elimination (SVM-RFE) method. These features were then classified by using a SVM. Classification based upon EEG features produced a Correct Classification Ratio CCR=0.92. In comparison, features derived from ECG signals alone, that is the combination of Heart Rate Variability (HRV), and ECG-Derived Respiration (EDR) signals produced a CCR=0.54, while those features based on the combination of HRV and (thoracic) Res signals resulted in a CCR=0.57. Overall comparison of the results based on standard epochs of EEG signals with those obtained from 5-minute (long) epochs of cardiorespiratory signals, revealed that acceptable CCR=0.81 and discriminative capacity (Accuracy=89.32%, Specificity=92.88% and Sensitivity=78.64%) were also achievable when using optimal feature sets derived from long epochs of the latter signals in sleep staging. In addition, it was observed that the presence of some artifacts (like bigeminy) in the cardiorespiratory signals reduced the accuracy of automatic sleep staging more than the artifacts that contaminated the EEG signals.

Optoelectronic Plethysmography Characterises Thoracic Excursion In The Evaluation Of Dysfunctional Breathing (DB)

PURPOSE: Ventilatory pattern and thoracic excursion, can vary during exercise and impact on ventilatory performance. A deviation away from an optimal trunk lumbo-pelvic recruitment pattern may affect lung volumes, work of breathing and may be relevant in the development of exertional dyspnoea. The aim of the study was to investigate the effect of different postural positions on the ventilatory excursion using optoelectronic plethysmography (OEP) and a spirometer. METHODS: Fifteen healthy male athletes (Mean ± SD age: 30.3±6.5 yrs.) completed the study. Ninety reflective markers were placed on the chest, abdomen and back (Figure 1). Participants underwent simultaneous OEP and spirometry data collection in two conditions, in a randomised order: (C1) with normal shoulder position or (C2) with hunched shoulders. Forced vital capacity (FVC) was assessed by the spirometer and data was gathered on the chest wall volume (CW) and the compartmental volumes of the rib cage (RC) and the abdomen (AB) by OEP. RESULTS: The correlation between the two instruments in measuring FVC was good in both normal (R2=0.89) and hunched (R2=0.84) positions. FVC was significantly lower in hunched position during both spirometry (5.22±0.69 L vs. 5.35±0.69 L; p=0.03) and OEP measurements (5.22±0.62 L vs. 5.42±0.69 L; p=0.01). When volume contributions in the two conditions were compared the RC/AB ratio was significantly lower in hunched position (1.84±0.74 vs. 2.12±0.79; p=0.01). CONCLUSIONS: These findings suggest that respiratory excursion and lung volume compartmentalisation are affected by the position of the shoulders. Specifically, a hunched should position leads to increased abdominal motion to vital capacity and decreased lung volumes. OEP may be a useful tool to detect altered parameters associated with developement of exertional dyspnoea.Figure

Posture and mobility of the upper body quadrant and pulmonary function in COPD: an exploratory study.

ABSTRACTBackgroundThere is limited evidence regarding interactions between pulmonary (dys)function, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD).ObjectivesThis exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals.MethodFifteen patients with COPD (67.93±9.71yrs) and 15 healthy controls (66.80±7.47yrs) participated. Pulmonary function (FEV1, FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM) length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function.ResultsPatients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02) and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02) and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01) than controls. Patients’ non-dominant PmM length and maximal head protraction were predictors of FEV1 (r2 adjusted=0.34). These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r2 adjusted=0.68).ConclusionOur findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.