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Title: Respiratory impairment in stroke patients : lung function, respiratory muscles, voluntary and reflex cough
Author: Ward, Katie
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2012
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Stroke is a major public health problem and stroke patients suffer much mortality and morbidity due to chest infections, especially in the acute period. Chest infections are associated with respiratory muscle weakness and poor cough. We studied ischaemic hemispheric stroke patients within two weeks of their first-ever stroke to investigate their respiratory physiology, volitional and non-volitional respiratory muscle strength and voluntary and reflex cough function. -- Patients were weak on voluntary but not involuntary tests of expiratory muscle function. They were also impaired on tests of both voluntary and reflex cough. The data we collected suggests that impairment may be due in part to ineffective coordination of the complex cough manoeuvre, following cerebral ischaemia. -- To further investigate the underlying reasons for impaired cough flow we studied functional residual capacity (FRC) in a group of stroke patients with mild impairments. In the semi-recumbent position patients’ FRC was significantly lowered, compared with healthy controls even in these acute patients little residual disability. The low FRC was strongly associated with low cough inspired volume and low cough inspired volume was associated with poor cough flow. -- Transcranial magnetic stimulation was used to investigate the corticomotor projection to the abdominal muscles. We also designed a cough training protocol to be tried initially in the lab, to see if there is an effect of cough training on corticomotor excitability. This was a feasibility study in two patients; we make recommendations to increase the training duration to ten minutes and suggest how TMS could be used to assess the effect of training on corticomotor excitability. If an effect is shown in the lab across a number of patients, the training regimen could then be tried over longer periods in a clinical trial.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available