Diaphragmatic Function in Stroke Patients.

Study Overview
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Brief Summary
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This study attempts to elucidate whether stroke patients with dysphagia have reduced diaphragm movement during voluntary coughing, and also during deep inspiration and expiration than stroke patients without dysphagia. This study will also compare various spirometric measurements with the diaphragmatic motions.

Detailed Description
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Stroke is a debilitating condition that can impair multiple functions, including swallowing. Stroke patients with dysphagia, are known to have reduced cough due to multiple mechanisms and this can impair their expectorate function. This can lead to accumulation of sputum and mucoid, ultimately resulting in aspiration pneumonia. Stroke patients, especially those with dysphagia, are also known to have expiratory muscle weakness and weak cough than healthy controls. Stroke patients are also known to have reduced diaphragm movement than healthy subjects. Sonography is a useful tool that can easily and reliability measure diaphragm movement. Whether stroke patients with dysphagia have reduced diaphragm movement than those without dysphagia and whether this affects voluntary cough have not been reported yet. This study attempts to evaluate diaphragm movements during voluntary cough in stroke patients with dysphagia and determine whether this reduced diaphragm movement correlates to their peak flow meters during voluntary cough.

Official Title
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Diaphragm Function Evaluation in Stroke Patients During Voluntary Cough Using Sonography

Conditions
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Paralytic Stroke, Cough

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stroke patients with confirmed unilateral brain lesion Gross aspiration confirmed via FEES or VFSS that would require non oral feeding for group 1. No gross evidence of dysphagia that would require non oral feeding for group 2. No prior episode of stroke or dysphagia for the healthy control group. Exclusion Criteria: Episode of acute pneumonia or pulmonary embolism at time of enrollment Previous history of chronic respiratory disorders or other systemic disorders that may affect respiratory function ( ex, rheumatoid arthritis, chronic renal disease, spinal cord injury) Stroke patients with multiple brain lesions Episode of Diaphragm weakness due to peripheral polyneuropathy or unilateral phrenic nerve palsy Previous episode of abdominal or thoracic surgery within one year of enrollment Concomitant diagnosis of myopathy, muscular dystrophy or other disorders that may affect respiratory muscles. Episode of rib fracture within one year of enrollment Chronic alcoholism Patient with previous diagnosis of dementia or with impaired cognitive function that may limit full participation at the evaluation.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Stroke patients with dysphagia<br>Stroke patients with confirmed evidence of aspiration and severe dysphagia tha would require modified diet or nasogastric tube feeding | |
| Stroke patients without dysphagia<br>Stroke patients but with no gross evidence of dysphagia or with mild dysphagia with a Penetration aspiration scale of less than 4 | |
| healthy volunteer group<br>healthy volunteers with no prior history of dysphagia or stroke and who are not included in the exclusion criteria | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diaphragm movement during coughing | Diaphragm movement during voluntary coughing will be recorded by musculoskeletal sonogrpahy | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal inspiratory and expiratory pressure | respiratory pressure meter would be used to measure inspiratory and expiratory strength | 1 day | 
| Pulmonary Function test | FVC, FEV1, FEF 25-75%, FVC/FEV1 ( % ), Peak cough flow | 1 day | 
| Motricity index |  | Baseline | 
| Canadian Neurological Stroke Scale |  | Baseline | 
| Diaphragm movement during inspiration | Diaphragm movement will be recorded after deep inspiration | 1 day | 
| Diaphragm movement during expiration | Diaphragm movement during expiration will be recorded | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dysphagia,diaphragm, ultrasonography, inspiration, expiration,