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Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.

Abstract：

BACKGROUND:Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. OBJECTIVE:To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. METHODS:16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. RESULTS:During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; p<0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage. CONCLUSION:Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.

journal_name

Braz J Phys Ther

journal_title

Brazilian journal of physical therapy

authors

Cabral EEA,Resqueti VR,Lima INDF,Gualdi LP,Aliverti A,Fregonezi GAF

doi

10.1016/j.bjpt.2017.06.006

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

416-424

issue

eissn

1413-3555

issn

1809-9246

pii

S1413-3555(17)30245-9

journal_volume

pub_type

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Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.