Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging

Nathan J. Hellyer, Nicholas M. Andreas, Andrew S. Bernstetter, Kathryn R. Cieslak, Gerad F. Donahue, Elizabeth A. Steiner, John H. Hollman, Andrea Boon

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Assessment of diaphragm contraction may be useful for identifying impairments in patients with movement dysfunction involving trunk stabilization, respiration, or both. Real-time ultrasound imaging is a readily available technology that can be used to quickly assess this aspect of diaphragm activity. Although previous studies have examined diaphragm contraction in the supine posture, a comparison of measurements between supine and upright postures has not been made. Objective To examine whether diaphragm thickness measurements differ among 3 different body postures in healthy subjects. Design Descriptive repeated measures. Setting Clinical laboratory. Patients (or Participants) Twenty-four healthy subjects (12 male and 12 female) aged 22-35 years old were recruited and completed the study. Method Diaphragm thickness was assessed in via B-mode ultrasound imaging in supine, seated, and standing postures. Measurements of diaphragm thickness were taken in the zone of apposition during maximal inspiration to total lung capacity (TLC) and end-tidal expiratory lung volume (EELV). A thickness ratio (inspiration thickness/expiration thickness) was calculated to compare relative diaphragm contraction during each condition. Main Outcome Measurements The primary dependent variable was diaphragm thickness (mm). Results Average diaphragm thickness at EELV and maximum TLC were more than 20% greater in the seated and standing postures than in supine (P < .05). Moreover, the diaphragm was approximately 205% thicker at TLC than at EELV (P < .05). Relative inspiratory to expiratory thickness ratios (TLC/EELV) did not differ among postures (P = .24). Conclusions The diaphragm is thicker when the body is in more upright postures (standing and sitting versus supine) perhaps due to greater vertical gravitational load on the muscle and associated change in the resting length of the muscle fibers. Thus it appears that ultrasound imaging may be a sensitive tool to examine changes in diaphragm contraction during varying postural tasks. Level of Evidence IV

Original languageEnglish (US)
Pages (from-to)21-25
Number of pages5
JournalPM and R
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2017

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Diaphragm
Posture
Ultrasonography
Total Lung Capacity
Lung
Healthy Volunteers
Muscles
Respiration
Technology

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Neurology
  • Clinical Neurology

Cite this

Hellyer, N. J., Andreas, N. M., Bernstetter, A. S., Cieslak, K. R., Donahue, G. F., Steiner, E. A., ... Boon, A. (2017). Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging. PM and R, 9(1), 21-25. https://doi.org/10.1016/j.pmrj.2016.06.001

Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging. / Hellyer, Nathan J.; Andreas, Nicholas M.; Bernstetter, Andrew S.; Cieslak, Kathryn R.; Donahue, Gerad F.; Steiner, Elizabeth A.; Hollman, John H.; Boon, Andrea.

In: PM and R, Vol. 9, No. 1, 01.01.2017, p. 21-25.

Research output: Contribution to journalArticle

Hellyer, NJ, Andreas, NM, Bernstetter, AS, Cieslak, KR, Donahue, GF, Steiner, EA, Hollman, JH & Boon, A 2017, 'Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging', PM and R, vol. 9, no. 1, pp. 21-25. https://doi.org/10.1016/j.pmrj.2016.06.001
Hellyer NJ, Andreas NM, Bernstetter AS, Cieslak KR, Donahue GF, Steiner EA et al. Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging. PM and R. 2017 Jan 1;9(1):21-25. https://doi.org/10.1016/j.pmrj.2016.06.001
Hellyer, Nathan J. ; Andreas, Nicholas M. ; Bernstetter, Andrew S. ; Cieslak, Kathryn R. ; Donahue, Gerad F. ; Steiner, Elizabeth A. ; Hollman, John H. ; Boon, Andrea. / Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging. In: PM and R. 2017 ; Vol. 9, No. 1. pp. 21-25.
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abstract = "Background Assessment of diaphragm contraction may be useful for identifying impairments in patients with movement dysfunction involving trunk stabilization, respiration, or both. Real-time ultrasound imaging is a readily available technology that can be used to quickly assess this aspect of diaphragm activity. Although previous studies have examined diaphragm contraction in the supine posture, a comparison of measurements between supine and upright postures has not been made. Objective To examine whether diaphragm thickness measurements differ among 3 different body postures in healthy subjects. Design Descriptive repeated measures. Setting Clinical laboratory. Patients (or Participants) Twenty-four healthy subjects (12 male and 12 female) aged 22-35 years old were recruited and completed the study. Method Diaphragm thickness was assessed in via B-mode ultrasound imaging in supine, seated, and standing postures. Measurements of diaphragm thickness were taken in the zone of apposition during maximal inspiration to total lung capacity (TLC) and end-tidal expiratory lung volume (EELV). A thickness ratio (inspiration thickness/expiration thickness) was calculated to compare relative diaphragm contraction during each condition. Main Outcome Measurements The primary dependent variable was diaphragm thickness (mm). Results Average diaphragm thickness at EELV and maximum TLC were more than 20{\%} greater in the seated and standing postures than in supine (P < .05). Moreover, the diaphragm was approximately 205{\%} thicker at TLC than at EELV (P < .05). Relative inspiratory to expiratory thickness ratios (TLC/EELV) did not differ among postures (P = .24). Conclusions The diaphragm is thicker when the body is in more upright postures (standing and sitting versus supine) perhaps due to greater vertical gravitational load on the muscle and associated change in the resting length of the muscle fibers. Thus it appears that ultrasound imaging may be a sensitive tool to examine changes in diaphragm contraction during varying postural tasks. Level of Evidence IV",
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