Medical Journal of the Islamic Republic Of Iran

en Effect of Pulmonary Rehabilitation Therapy on Diaphragmatic Motion in Chronic Stroke Patients: A Randomized Controlled Study Physical Medecine& Rehabilitaion Physical Medecine& Rehabilitaion Original Research Original Research Background: Respiratory muscle dysfunction, particularly of the diaphragm, is common after stroke and limits physical performance. Targeted diaphragmatic exercises may enhance respiratory efficiency and recovery. To evaluate the effect of diaphragmatic breathing exercises on diaphragmatic motion and functional performance in patients with chronic hemiplegia.    Methods: In this single-blind randomized controlled trial, 70 chronic hemiplegic patients were randomly assigned to two equal groups (n=35 each): a control group (traditional exercise) and an intervention group (traditional plus diaphragmatic breathing exercises). Over eight weeks, outcomes including diaphragmatic excursion (DE) (assessed via M-mode ultrasonography), six-minute walk distance (6MWD), modified Medical Research Council (mMRC) dyspnea scale, and Berg Balance Scale (BBS) were evaluated. Data were analyzed using SPSS version 25.0. Statistical methods included descriptive statistics, independent samples t-tests, paired samples t-tests, Chi-square tests, and analysis of covariance (ANCOVA) to compare post-intervention outcomes while adjusting for baseline values. A p-value < 0.05 was considered statistically significant.    Results: There were no statistically significant differences between the two groups in baseline characteristics (age, sex, BMI, smoking history) or in baseline assessments of 6MWD, BBS, or mMRC scores (P>0.05). After eight weeks, the intervention group showed significantly greater improvements in functional capacity, balance, dyspnea, and diaphragmatic function (6MWD, BBS, and mMRC scores) compared to the control group (P<0.05). DE improved significantly in the intervention group during tidal (P=0.005), deep (P=0.009), and sniff breathing (P<0.001), while the control group showed a significant change only in tidal excursion (P=0.027). ANCOVA confirmed these findings after baseline adjustment (P<0.05), with moderate to large effect sizes.    Conclusion: Diaphragmatic breathing exercises significantly enhance diaphragmatic movement, physical performance, and quality of life in chronic hemiplegic patients. These findings support incorporating targeted pulmonary rehabilitation in stroke management, with ultrasonography as a valuable non-invasive bedside monitoring tool.   Stroke, Hemiplegia, Diaphragm, Ultrasonography, Pulmonary Rehabilitation 691 699 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-9233-1&slc_lang=en&sid=1 Hoda A. Eid Hodasaaad1231@yahoo.com 200319475328460092090 200319475328460092090 No Department of Chest Diseases, Faculty of Medicine , Al-Azhar University, Cairo, Egypt Ahmed E Kabil a_ka_81@hotmail.com 200319475328460092091 200319475328460092091 Yes Department of Chest Diseases, Faculty of Medicine , Al-Azhar University, Cairo, Egypt Rasha Elattar drrashaelattar@gmail.com 200319475328460092092 200319475328460092092 No Department of Neurology, Faculty of Medicine Al-Azhar University, Cairo, Egypt Hala M. Elzomor Hala.elzomor@azhar.edu.eg 200319475328460092093 200319475328460092093 No Department of Rheumatology and Rehabilitation, Faculty of Medicine Al-Azhar University, Cairo, Egypt Hanaa Abou-Elhassan hanaaabouelyazid@azhar.edu.eg 200319475328460092094 200319475328460092094 No Department of Community Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt Ahmed Abd El-Hakim Ahmed.abdelmanam@pt.bsu.edu.eg 200319475328460092095 200319475328460092095 No Department of Basic Sciences, Faculty of physical Therapy, Beni-Suef University, Egypt Mohamed H Rashad Dr.mohamedhamed29@yahoo.com 200319475328460092096 200319475328460092096 No Department of Neurology, Faculty of Medicine Al-Azhar University, Cairo, Egypt Ahmed Attia Dr_a.attia@yahoo.com 200319475328460092097 0009-0004-4498-3245 No Department of Chest Diseases, Faculty of Medicine , Al-Azhar University, Cairo, Egypt Magdy Taha noshamagdy48@gmail.com 200319475328460092098 0009-0007-0262-2881 No Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt Omar Abd Elkhalek dr.omar.abdelkhalek@gmail.com 200319475328460092099 0009-0007-0500-9257 No Department of Chest Diseases, Faculty of Medicine , Al-Azhar University, Cairo, Egypt Tamer l. Abo Elyazed Tamer.i.aboelyazed@gmail.com 200319475328460092100 200319475328460092100 No Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Beni-Suef University, Egypt Moaz Atef Moazatef1985@gmail.com 200319475328460092101 0123-0004-0002-0012 No Department of Chest Diseases, Faculty of Medicine , Al-Azhar University, Cairo, Egypt