Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Outcome of Respiratory Muscle Training in Stroke Patients: A Prospective Study
Brief Summary: Stroke survivors commonly have respiratory muscle weakness, swallowing disturbance, general weakness, reduced the daily living activities and short of motivation for rehabilitation. Respiratory muscle training (RMT) has been reported to improve the pulmonary function, respiratory muscle strength, exercise capacity, sensation of dyspnea and quality of life in several diseases, but rare in stroke patients. Reviewing previous reports, the protocol, intensity and duration of respiratory muscle training is still variable.

Purpose: To investigate the feasibility and efficacy of respiratory muscle training on cardio-pulmonary function, swallowing function, cough function and reduction of incidence of pneumonia in post-stroke patients.

Methods: A prospective, single blinded, randomized study. Consecutive patients with diagnosis of stroke will be proved by magnetic resonance image or computerized tomography. Stroke patients, aged 35-80 years old, with inspiratory muscle weakness or swallowing disturbance will be enrolled and randomly divided into control group (usual rehabilitation alone) and experimental group \[inspiratory muscle training (IMT) group for patients with inspiratory muscle weakness and expiratory muscle strengthening training (EMT) for patients with swallowing disturbance\]. Each patients will receive usual rehabilitation.

The investigator expect that RMT will be practical for the restoration of respiratory muscle, swallowing function, cough function and voice quality, thereby reduction of the incidence of pneumonia.


Options:
A: Inclusion Criteria:

1. First major stroke event, a transient ischemic attack or a previous stroke with full recovery is allowed.
2. Impairment of the trunk function, with a maximum score of 19 on the trunk impairment scale .
3. Able to maintain seated position for more than 10 seconds.
4. Able to come to the rehabilitation ward as a chronic patient.
5. More than six months after a stroke event.
6. Older than 18 years.
7. With no comorbidities other than stroke affecting trunk function. Comorbidities could be musculoskeletal problems or other neurological diseases.
8. With sufficient cognitive and language capacity to perform the assessment.

Exclusion Criteria:

1. Not able to give informed consent.
2. Not approved informed consent.
3. Subject does not understand the study procedures.
4. Subject has any history of another major neurological disorder.
B: Inclusion Criteria:

* At least 19 years old
* Hemiplegia as a result of a non-traumatic cerebral stroke (ischaemic or hemorrhagic)
* Stroke occurred at least 3 months prior to study
* Ability to understand/follow directions and answer questions in English
* Ability to maintain a sitting position in a standard office chair without arm rests, independently or with minimal supervision, for 1.5 hours.
* Have the ability to perform the following movement several times with their weak arm (while seated): move their hand to their hip (on the same side as the weak arm), it's OK if they use their trunk to help themselves, and from that point of flexion moving it forward (without touching their thigh) to touch their knee (on the same side as the weak arm). They should be able to do this movement without any help from their strong hand.

Exclusion Criteria:

* Upper limb orthopaedic surgery in the past 3 months
* Shoulder subluxation or significant shoulder pain
* Trunk pain
* Other orthopaedic or neurological conditions affecting the arm or trunk
* Severe uncorrected visual impairment that could prevent participants from completing the task
C: Inclusion Criteria:

* Patients identified as stroke and capable of performing voluntary respiratory maneuvers.

Exclusion Criteria:

* Increased intracranial pressure
* Uncontrolled hypertension
* Complicated arrhythmia
* Decompensated heart failure
* Unstable angina
* Myocardial infarction in the preceding 3 months
* Pneumothorax, bullae/blebs or infection.
D: Inclusion Criteria:

* ischemic or hemorrhagic stroke in the left or right cortical or subcortical regions
* medically stable
* cannot stand independently for \>1 minute or cannot stand at all
* can sit for at least 20 minutes with or without trunk support and can sit for at least 1 minute without trunk support
* able to provide informed consent

Exclusion Criteria:

* unstable cardiovascular, respiratory, endocrine, orthopedic or neurological condition that precludes exercise of low to moderate intensity
* vestibular deficits or vertigo
* seizure activity in the previous 6 months

Answer: C