Introduction
stroke patients show an exercise capacity that is reduced by about 40% when compared with the control group of the same age and sex, and it may be more severe in the case of underlying pulmonary disease. We report a case of a stroke patient with chronic obstructive pulmonary disease (COPD) who underwent 3 weeks of pulmonary rehabilitation (PR) along with conventional stroke rehabilitation program.
Case
A 71-year-old man with COPD visited the emergency room due to dysarthria and aphasia without motor and sensory change. Brain MRI showed infarction of left middle cerebral artery territory, and he was admitted to the Department of Neurology. He was transferred to the Department of Rehabilitation for rehabilitation treatment focused on aphasia. His baseline characteristics including Modified Medical Research Council scale (mMRC), pulmonary function test (PFT), hand grip power, Korean Modified Barthel Index (K-MBI), and Berg balance scale are showen in Table 1. He also underwent surface electromyography (sEMG) in upper trapezius, sternocleidomastoid, external oblique, and diaphragm muscles. (Figure 1) To measure the activity of the respiratory muscles, muscle activation intensity (%) was calculated: [mean root mean squre (RMS) of each muscle/ mean RMS of the maximal voluntary contraction] x 100. Since he has COPD, he underwent 3 weeks of PR along with conventional stroke rehabilitation program. The PR program consisted of 60 minutes of aerobic exercise, respiratory muscle strengthening, and stretching exercise. Aerobic exercise is carried out using an ergometer and treadmill. Respiratory muscle strengthening was performed using threshold inspiratory muscle training (IMT) and threshold positive expiratory pressure (PEP) devices. After 3 weeks of the rehabilitation, follow up examinations were performed, and showed mild improvements in forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), values in sEMG, hand grip power, and K-MBI (Table 1).
Discussion
After 3 weeks of PR, the results of FEV1 and FEV1/FVC were improved, which suggests an improvement of airway obstruction in a patient with obstructive lung disease. Furthermore, the results of sEMG showed that PR could increase the use of the primary respiratory muscles (diaphragm, external oblique muscle), and reduce the use of accessory respiratory muscles (upper trapezius muscle, sternocleidomastoid muscle) during breathing. In addition, there was an improvement in hand grip power and K-MBI, but it was considered to be more related to the effect of conventional rehabilitation than that of PR.
Conclusion
This case shows the effect of 3 weeks of PR on pulmonary function in a stroke patient with COPD. To generalize the result, further evaluation is required in larger, prospective studies. |
