The Effect of Respiratory Muscle Training for Diaphragm Movement in Chronic Obstructive Pulmonary Disease Patients

OBJECTIVE: To determine the effect of respiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) by pulmonary function test and fluoroscopy- guided diaphragm movement. METHOD: The respiratory muscle training program included breathing retraining, self-exercise and electromyography- assisted biofeedback therapy. 22 COPD patients underwent training program for 177+/-47.8 (84~259) days and were followed up regularly. To evaluate the effect of respiratory muscle training, we tested pulmonary function test before and after training. We also evaluated difference of area at full inspiratory and full expiratory time by fluoroscopy- guided diaphragm motion. RESULTS: Parameters in pulmonary function test showed no significant differences before and after respiratory muscle training. In fluoroscopic examination, the difference in the diaphragm movement area at full inspiration and expiration time showed significant improvement after respiratory muscle training (p<0.05). CONCLUSION: Diaphragm movement increased in patients with COPD after respiratory muscle training, although pulmonary function test did not.

Clinical Findings of Swallowing Difficulties in Patients with Post-poliomyelitis Syndrome

OBJECTIVE: To evaluate the presence of swallowing difficulties in patients with post-poliomyelitis syndrome (PPS) by characterizing their swallowing patterns with videofluoroscopic swallowing study. METHOD: Eleven patients diagnosed with PPS were enrolled. All subjects answered the self assessment questionnaire for swallowing difficulty and gastric symptoms. We assessed the ability of tongue control, the oral transit time, cricopharyngeal opening time, and pharyngeal transit time. We also assessed the presence of aspiration or penetration and the amount of residue in the vallecular and pyriform sinus by four grade scales. A gastroenterologist examined esophagus, stomach and duodenum through an esophagogastroduodenoscopy. RESULTS: Six patients complained swallowing difficulty and nine patients showed symptoms of esophageal regurgitation. Although finding of penetration or aspiration was not seen, all patients showed swallowing dysfunction in the videofluoroscopic swallowing study. In the esophagogastroduodenoscopy, chronic superficial gastritis was observed in all enrolled patients (n=11) and reflux esophagitis was found in 4 patients (36%). CONCLUSION: About half patients with PPS complained of dysphagia. Routine evaluation of dysphagia with videofluoroscopic swallowing study and esophagogastroduodenoscopy is needed in all patients with PPS due to the low reliability in their subjective symptom.

Tarsal Tunnel Syndrome Combined with Diabetic Neuropathy

OBJECTIVE: To investigate the frequency of tarsal tunnel syndrome (TTS) in the diabetic neuropathy patients. METHOD: Electrodiagnostic study was performed to diagnose diabetic neuropathy and tarsal tunnel syndrome (TTS) in 56 patients (male 25, female 31) with diabetes mellitus. The frequency of combined TTS in diabetic neuropathy patients was calculated. RESULTS: Out of 56 diabetic patients, 52 patients were diagnosed as diabetic peripheral neuropathy. The frequency of concomitant TTS was 22 cases in 52 diabetic patients with diabetic neuropathy. CONCLUSION: In diabetic neuropathy group, the frequency of TTS was higher than general population.