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Tytuł: Respiratory muscle strength and their coordination in patients with hemiparesis after stroke
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Introduction Stroke in Poland is the second leading cause of death and the third leading cause of disability. Each year, about 15 million people worldwide experience a stroke, of which 5 million die and another 5 million remain permanently disabled, requiring long-term rehabilitation. With serious economic and social consequences, as well as an impact on quality of life due to disability and premature death, stroke is a global public health problem and one of the most important challenges for preventive health care. The clinical manifestation of a stroke patient depends on many factors, including comorbidities, type of stroke, the time from the onset of symptoms to the implementation of post-stroke therapy and neurological rehabilitation. A common presentation is dominant hemiparesis on one side of the body, contralateral to the injured hemi-sphere of the brain, which is associated with muscle weakness and limited motor control. A consequence of stroke is also a weakness of the trunk muscles, including the diaphragm and other respiratory muscles, which is a serious cause of impaired breathing. The diaphragm is the main respiratory muscle and one of the four central stabilisation muscles, which translates into its dualistic function, respiratory and postural. Im-paired postural function can affect respirator)' function and vice versa. Proper breathing is characterised by the coo ; rdinated work of all involved respiratory muscles, which we can divide into main and accessory respiratory muscles. Accessory respiratory muscles are especially needed in situations of increased ventilation demand, such as during exertion or in situations of illness when the main respiratory muscles (diaphragm and external intercostal muscles) are inefficient. The latter group includes the sternocleidomastoid muscle, the scalene muscles, the pectoralis major and minor pectoralis muscle, the anterior alveolar muscle and the levatores costarum muscles, the in-ternal intercostal muscles, the external and internal oblique abdominal muscles, the rectus abdominis muscle and the transverse abdominal muscle. It is not clear how the activity of these muscles changes after stroke and whether coordination between agonists and antagonists is also affected. Despite preservation of lung function and the ability to breathe at rest, motor weakness can affect maximum respiratory effort, which translates into impaired coughing power and increasing the incidence of pneumonia in this group of patients. Respiratory complications are one of the leading causes of death not directly related to the vascular system in post-stroke patients. Objective The main objective of this study was to evaluate the strength of the respiratory muscles and electromyographic activity of the accessory respiratory muscles ; , as well as their coordination during different phases of breathing on the contralateral and ipsilateral sides, in post-stroke patients with hemiparesis compared to healthy subjects. Material and methods Seventy participants were recruited for the study, including 36 post-stroke patients and 34 healthy subjects. Based on inclusion and exclusion criteria, 2 stroke patients and 1 healthy person were excluded from the study. Finally, 67 subjects were qualified, including 34 post-stroke and 33 healthy subjects. Study participants were divided into two groups. The experimental group included subjects after stroke, and healthy sub-jects were included in the control group. After inclusion in the group, two poststroke and two healthy subjects dropped out due to illness. In the end, 62 people participated in the study, 32 of them in the experimental group and 30 in the control group. The study used surface electromyography (sEMG) to assess the electromyographic activity of the sternocleidomastoid muscles (MOS), scalene muscles (P), and external oblique abdominal muscles (SBZ) during respiratory maneuvers in a respiratory drive study, which measured maximum inspiratory pressure (Plmax), maximal expiratory pressure (PEmax) and occlusion pressure (P0.1). The values obtained by the subjects were expressed as a percentage of the due value calculated for each subject by the computer system o ; n the basis of the entered data on gender, race, age, weight and body height. Functional capacity of post-stroke patients was assessed using the Fugl-Meyer assessment (FMA) and the Timed Up and Go (TUG) test. A Care Fusion Jeager Masters COPE SIN 756057 spirometer, equipped with a respiratory drive assessment attachment, was used to test respiratory muscle strength, according to the recommendations of the American Thoracic Society/European Respiratory Society (ATS / ERS) for testing respiratory muscles. Superficial electromyography (sEMG) signals were acquired using a six-channel system based on components that meet the requirements of the SENIAM organisation (filtering: 10-500 Hz, 16-bit analogue-to-digital convert-er, CMRR > 100 dB, sampling frequency 7 kHz). Electromyographic (EMG) activity of selected respiratory muscles was recorded during an intense breathing manoeuvre, inhalation or exhalation during the respiratory drive test. The EMG value was ex-pressed as a percentage of the maximum voluntary contraction (MVC) value. The mean values of the obtained single muscle potentials obtained were used for calculations and the quotient values of two muscles were calculated to illustrate the intermuscular coordination of the same muscles on the right and left sides of the body. MOS vs MOS, P vs P, SBZ vs SBZ, and antagonists on the same side of the body for inspiration: MOS vs S ; BZ and P vs SBZ and for exhalation: SBZ vs MOS and SBZ vs P. Results Based on the statistical analysis of the results, there were differences in the respiratory drive values, that is, Plmax (p<0.001) and PEmax (p<0.00), between the experimental and control groups. Plmax and PEmax values were significantly higher in the healthy group compared to the post-stroke group. Subjects with right-sided hemiparesis showed higher PEmax values than those with left-sided hemiparesis (p<0.02). There was a positive correlation (p<0.01) between the FMA score and PEmax (R = 0.43), which is moderate. The PEmax value showed an increasing trend with an increasing FMA score. There was a significant (p<0.02) negative correlation between TUG and Plmax, and the resulting correlation (R= -0.40) suggests a moderate negative relationship, which means that higher TUG scores are associated with lower inspiratory muscle strength. Patients with greater difficulty during TUG (in this test, a higher score means worse functional ability) have lower maximum inspiratory pressure. Furthermore, there was a significant (p<0.04) and positively moderate correlation (R= 0.36) between the TUG test score and P0.1. There were no differences between the mean %MVC values obtained for the accessory respiratory muscles depending on the group of subjects. How-ever, there was a difference in the coordination of the electromyogra ; phic activity of the respiratory accessory muscles that work on the right and left sides of the body, and the coordination of the MOS (p<0.02) and SBZ (p<0.00) muscles was found to be worse in patients compared to healthy subjects. However, such difference was con firmed for the calculations performed for antagonistic muscles on one side o f the body. No correlation was found between% MVC values of the accessory respiratory muscles and respiratory drive in both the post-stroke and healthy groups. Conclusions Respiratory muscle strength is weakened in post-stroke patients, and respiratory pressures are significantly lower than predicted due values and values recorded in a group of healthy peers. Stroke affects not only the weakness of the muscles of the upper and lower extremities responsible for movement, but also the respiratory muscles, which is related to reduced respiratory capacity and can pose a risk of respiratory complications. Respiratory drive variables such as Plmax and PEmax can be clinically useful indica-tors of respiratory muscle strength, at various stages of patient treatment and rehabilitation. Decreased respiratory muscle strength is reflected in lower functional capacity, and, conversely, more functionally fit patients generate better respiratory strength. The coordination of identical respiratory accessory muscles is worse in post-stroke patients, as manif ; ested by a greater difference between muscle activity on the hemiparesis and contralateral side compared to more equal activity on both sides of the body in healthy individuals. The use of sEMG in the post-stroke population, as well as issues related to the determination of a reference value for electromyographic activity, requires further research to standardise procedures and minimize measurement error. Hypothetically, the lack of differences in the mean %MVC of the accessory respiratory muscles in the post-stroke and healthy groups may be due to the measurement method used, in which muscle involvement during respiratory activity represents the same value with respect to maximal arbitrary contraction regardless of whether or not muscle activity changes after stroke. The results of this study may argue for the need to implement targeted respiratory muscle training in post-stroke rehabilitation. Rehabilitation should focus on im-proving postural control, including trunk symmetry, which is important to maintain adequate muscle length, and strengthening core muscles, which can translate into im-proved respiratory function.
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Rada Dyscypliny Nauki o zdrowiu
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10 mar 2026
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10 mar 2026
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| Nazwa wydania | Data |
|---|---|
| ZB-143147 | 10 mar 2026 |
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