The Effects of Thoracic Joint Mobilization on Pulmonary Functions of Patients With Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke a neurological disorder leads to long term disability and decline in overall quality
      of life. Pulmonary Functions are usually impaired in individuals with stroke. The common
      findings associated with pulmonary functions in Stroke patients are Decreased lung volumes,
      decreased pulmonary perfusion and vital capacity and altered chest wall excursion. For stroke
      patients, general rehabilitation programs, only aims towards their functional recovery of the
      body. The main focus of this study was to integrate intervention and implement them in
      rehabilitation programs that are related to respiration are more effective for improving
      functional activities.in stroke patients. The study was carried out to determine the effects
      of thoracic Joint Mobilization on Pulmonary Functions of patients with stroke.
    

Detailed description: 
      INTRODUCTION Stroke is defined as sudden neurological deficit due to an abnormality in
      cerebral blood flow, with sign and symptoms lasting for more than 24 hours. Strokes can be
      grouped into two fundamental classification according to the American Stroke Association
      (ASA), first is ischemic (87%) and the second is Hemorrhagic (13%). In epidemiological and
      genetic studies a stroke subtype classification is useful indicator in our clinical practice.
      Many serious physical and cognitive deficits results due to injury to the brain tissue.
      Depending upon the region of the brain that is involved and amount of damage, a person can
      recovers from stroke.

      Stroke is associated with many primary and secondary complications. Here mentioned some
      primary complications. Sensation, Pain, Visual changes, Motor Function, Weakness, Alternation
      in Tone, Abnormal Reflexes, Altered Coordination, Altered Postural control and Balance. The
      main Indirect or secondary complications are Musculoskeletal Complications, Neurological
      Complications, Cardiovascular Complications, Pulmonary Complications, and Integumentary
      Complications.

      Pulmonary Functions are usually impaired in individuals with stroke. The common findings
      associated with pulmonary functions in Stroke patients are Decreased lung volumes, decreased
      pulmonary perfusion and vital capacity and altered chest wall excursion. Individuals with
      stroke are, associated with dysphagia which leads to dehydration and compromised nutrition.
      Dysphagia has been related with enlarged risk of pulmonary difficulties and also death.
      According to research evidence primary findings of dysphagia in patients having acute stroke
      significantly decreases complications. It also decreases the length of hospital stay and
      overall health expenditure.

      Dysphagia further leads to Aspiration. Aspiration, is penetration of food, liquid, saliva or
      gastric reflux into the airways. It usually occurs in acute phase of recovery or during
      swallowing. Aspiration is an important complication and can leads to aspiration pneumonia if
      left untreated, death can occur.

      Impaired Pulmonary functions limits physical activities as well. Because the decreased
      respiratory output is accompanied by increased oxygen demands required during altered
      movement patterns in stroke. Furthermore people with stroke usually undergo irregular
      breathing because of damage to the respiratory muscles (such as Diaphragm).

      Due to paralyzed respiratory muscles lungs and thorax cannot be sufficiently dilated. If this
      condition persists the thoracic tissues may become shortened and thoracic muscles undergo
      fibrosis to reduce the compliance of thorax. This leads to various complications like
      atelectasis, changes in muscles forces, which directly or indirectly obstruct the performance
      of daily living activities, and asymmetrical postures or movement foam, which may hamper the
      stability of motion there by.

      In stroke patients the respiratory functions are affected both directly and indirectly by the
      cardiopulmonary performance because they experience a deterioration in cardiovascular
      functioning and pulse rate. This disturbs the oxygen delivery and decline in the activity of
      the chest wall on the paralyzed side and its electrical activities. The changes in breathing
      mechanism and respiratory efficiency reflects about the extent of loss in the activity of
      chest wall, loss of symmetry and the extent of muscular paralysis of stroke patients. To
      correct above mentioned difficulties it is significant to have expansion of chest wall, to
      improve lung ventilation and to have suitable volume and capacities of lungs.

      As mentioned above stroke is accompanied by many secondary complications due to nervous
      system and musculoskeletal system insufficiencies related through brain impairments. Amongst
      many problems pulmonary disorders are further, strictly associated to life, difficulties with
      respiration and swallowing as well as language.

      Direct restrictive impairments accompanied due to non-utilization of paralyzed muscles and
      their trouble with movement elicits a secondarily decrease in cardiopulmonary functioning.
      Due to this, non-symmetric trunk encourages insufficient energy use related to gait, causing
      reduction in exercise endurance. Patients having hemiplegia due to stroke experiences
      deviated movement in posture, abnormal movement of trunk and motor control.

      Now a day's people preserve static posture for long periods due to which occurrence of
      cervical lordosis along with thoracic and lumbar kyphosis is growing day by day. Due to an
      inclination in thoracic kyphosis, restriction in expansion of chest and respiratory weakness
      of muscles occurs, thus decreasing lungs capacity and size of the thoracic cavity and
      distorting vertebral column arrangement.

      Our study focuses on the effects of thoracic joints mobilization and its effects on enhancing
      the pulmonary functions in stroke patients. Generally Rehabilitation programs target towards
      functional recovery of body. They neglect enhancement of cardiopulmonary system functioning.
      If investigator incorporate interventions related to respiration along with functional
      recovery, it possibly be additionally effective in stroke patients for enhancing functional
      doings such as gait.

      Many studies shows the effects of mobilization and its effects on pulmonary function. A study
      on The Immediate Effect of Chest Mobilization Technique on Chest Expansion in Patients of
      COPD with Restrictive Impairment. This study concluded that mobilization of rib cage joints
      improve ribcage mobility and reduced obstructive lung disease. Chest wall mobilization also
      improves the mobility of chest wall, reduces respiratory rate, increases tidal volume,
      improves ventilation, reduces dyspnea, decreases work of breathing and facilitate relaxation.

      Another study focuses on, the effect of thoracic region self-mobilization on chest expansion
      and pulmonary function. The purpose of this study was to find out the effects of thoracic
      region self-mobilization on chest expansion and pulmonary function in healthy adults. The
      outcome measures included in this study were to measure chest expansion during breathing,
      pulmonary functions, and expected pulmonary functions. There was no noteworthy change in
      pulmonary functions among intervention and control group. There was a noteworthy change in
      chest expansion between intervention and control group. Hence concluded that thoracic region
      self-mobilization is helpful for improving chest expansion in healthy adults.

      Our study focuses on the effects of thoracic joints mobilization and its effects on pulmonary
      functions in stroke patients. Generally Rehabilitation programs target towards functional
      recovery of body. They neglect enhancement of cardiopulmonary system functioning. If
      investigator incorporate interventions related to respiration along with functional recovery,
      it possibly be additionally effective in stroke patients for enhancing functional doings such
      as gait.
    

Intervention name(s): Pulmonary Function Test group; Control Group
Intervention type(s): Other; Other
Intervention description(s): The interventional group received the same conventional Chest physiotherapy Techniques for 30 minutes followed by 10 minutes rest. The patients then received additional 15 minutes protocol of thoracic joint mobilization; received conventional Chest physiotherapy Techniques for 30 minutes (including deep breathing, diaphragmatic breathing exercises, Self-stretching exercises for accessory respiratory muscles, Respiratory Resistance training by incentive spirometer) followed by 10 min rest.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Pulmonary Functions; Stroke