Pulmonary Physiotherapy for Ischemic Stroke
Pulmonary Physiotherapy for Ischemic Stroke
This study evaluates the predictors of intensive care unit admission and mortality among
 stroke patients and the effects of pulmonary physiotherapy on these stroke patients.
 One-hundred patients participated in the pulmonary rehabilitation program and 81 patients
 served as a control group.
Predicting early mortality and disability after a stroke depends on many factors, such as
 age, the type of stroke, lesional location, level of consciousness, severity of neurological
 impairment, medical risk factors (hypertension and diabetes), premorbid conditions, fever and
 history of stroke. Stroke patients may experience a reduction of up to 50% in respiratory
 function when compared to age- and gender-matched norms. The reduction in respiratory
 function can lead to decreased endurance, dyspnoea and increased sedentary behaviour, as well
 as an elevated risk of stroke. The reduction in respiratory function may also cause
 aspiration, leading to pneumonia.

 The aim of pulmonary rehabilitation program is to enhance respiratory muscle resistance
 during breathing, thereby improving respiratory function. Pulmonary rehabilitation programs
 are considered to be capable of inducing positive effects on stroke patients' respiratory
 muscles through diaphragm breathing exercise and lip puckering breathing exercise. Pulmonary
 physiotherapy (PPT) improves the quality of life of stroke patients.

 The PPT program was conducted by physical therapists at our hospital for 30 min, three
 days/week. As part of the PPT, a physiotherapist monitored this group for 12 weeks. The same
 physiotherapist supervised all the exercises. During the exercise program, all patients were
 clinically stable and all were receiving optimal medical therapy. Rehabilitation started with
 inspiratory diaphragm breathing exercises. The physiotherapist placed his hands on the
 superior rectus abdominis immediately below the anterior costal cartilage and induced
 inspiratory diaphragm breathing by instructing the patient to slowly and deeply inhale the
 air through the nose. Then the patient was instructed to perform expiratory pursed-lip
 breathing exercise by continuously exhale the air. During pursed-lip breathing exercise, the
 patient was instructed in sequence, to breathe in gently through the nose, purse his/ her
 lips as though whistling and then breathe out through the long pursed lips by not exerting
 power until she/ he is short of breath. The expiration time was set to be at least twice
 times longer than inspiration time. The patients took a rest when they complained about
 fatigue or dizziness during breathing exercise and conducted breathing exercise again. The
 exercise intensity was based on the maximal heart rate and maximal effort of the patients.
 Each patient's performance during the exercise sessions was recorded and reported regularly
 to the patient's physician. National Institute of Health Stroke Scale scores, modified Rankin
 scale scores, pneumonia onset, admission to the intensive care unit and mortality were
 recorded at the end of the first and third month.
Inclusion Criteria:

 -  acute ischemic stroke confirmed by computed tomography or a diffusion-weighed magnetic
 resonance imaging scan,

 -  aged > 40 years,

 -  ability to understand and follow simple verbal instructions,

 -  modified Rankin scale score > 2,

 -  National Institute of Health Stroke Scale score > 0,

 -  no unrestricted movement of the lips,

 -  no receptive aphasia and no history of thoracic or abdominal surgery.

 Exclusion Criteria:

 -  blood pressure >180/100 mm Hg more than twice in 24 h;

 -  significant pulmonary disease, angina, myocardial infarction or acute heart failure
 within three months;

 -  neurological conditions other than stroke;

 -  presence of a severe visual disability and visual field defects;

 -  receiving medications that would influence the metabolic or cardiorespiratory
 responses to exercise;

 -  inability to perform the tests.