Ultrasonographic evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2019.1669955 · Published: January 1, 2021

Spinal Cord Injury Medical Imaging Rehabilitation

Simple Explanation

This study uses ultrasound to examine the diaphragm in patients with cervical spinal cord injuries (SCI). It aims to understand how the diaphragm's thickness and movement differ from those of healthy individuals. The study also assesses how reliable ultrasound is for measuring diaphragm function in SCI patients. The researchers measured the diaphragm's thickness and how much it moves during breathing in both SCI patients and a control group. They also checked how consistent the ultrasound measurements were when taken by different operators and at different times. The results showed that the diaphragm is thicker in SCI patients compared to healthy individuals. Also, the diaphragm moves more during normal breathing in SCI patients. The ultrasound measurements were found to be very reliable.

Study Duration

March 2017 and October 2017

Participants

60 participants with cervical spinal cord injury and 60 control participants

Evidence Level

Pilot Case–Control Study

Key Findings

1
Diaphragm thickness was significantly higher in patients with cervical spinal cord injury than the control group.
2
Diaphragmatic excursion of the right hemidiaphragm was significantly greater in patients with cervical spinal cord injury than the control group at the end of quiet tidal breathing.
3
Intraclass correlation coefficients of inter-and intra-ultrasonography operators for the thickness and excursions of the diaphragm were greater than 0.93.

Research Summary

This study evaluated diaphragm thickness and excursion in patients with cervical spinal cord injury (SCI) using ultrasonography, comparing them to able-bodied participants and assessing the reliability of the ultrasound measurements. The study found that the diaphragm was significantly thicker in SCI patients compared to the control group, and the diaphragmatic excursion was greater during quiet tidal breathing. However, there was no significant difference in diaphragmatic excursion during maximal inspiration. The study concluded that the diaphragm in patients with cervical SCI is hypertrophied and the diaphragm excursion is greater. Ultrasound is a highly reliable tool for the evaluation of diaphragm thickness and excursion in patients with cervical spinal cord injury.

Practical Implications

Clinical Significance

Ultrasound is a reliable instrument for measuring diaphragm movement in patients with cervical SCI, aiding in the evaluation of respiratory function.

Long-Term Respiratory Recovery

Diaphragm function is an important determinant of long-term respiratory recovery in patients with cervical SCI.

Further Research

Further research is needed to clarify the relationship between pulmonary function test results and thickening of the diaphragm in patients with cervical SCI.

Study Limitations

1
This study only assessed the right hemidiaphragm excursions.
2
This study did not correlate diaphragm thickening ratio and baseline diaphragm thickness with pulmonary function.
3
This study involved a small number of participants; this study selected patients according to a strict criterion.

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