Pulmonary Rehabilitation after Stroke

Abstract

Respiratory dysfunction is a common complication following a stroke; however, the pulmonary rehabilitation of stroke patients has not been heavily emphasized until recently. PUBMED databases were searched systematically (since inception to December 2016) using the following search terms: “stroke” in Title/Abstract and “pulmonary rehabilitation” in all field. Articles published in a language other than English excluded. The original search yielded 404 articles, of which 57 articles were included in this systematic review. After a stroke, the respiratory center and related motor pathways can directly decrease respiratory muscle strength and subsequently induce a change in breathing patterns. As a result, pneumonia, pulmonary ventilation disorders, lung injury, lung ischemia reperfusion injury, decreased pulmonary compliance, abnormal posture, and obstructive sleep apnea can occur following a stroke. Thus, pulmonary rehabilitation is critical to reducing these complications. The main forms of pulmonary rehabilitation include exercise training, respiratory muscle training, oxygen therapy, noninvasive ventilation, nutrition support, social psychological support, and health education.Although pulmonary rehabilitation has become a definitive therapy of chronic respiratory diseases, the mechanisms of pulmonary rehabilitation, including the specific methods used for stroke patients requires further investigation. To provide some useful information for clinicians on treating respiratory dysfunction, we reviewed the type of stroke-related respiratory dysfunction and pulmonary rehabilitation methods in our manuscript.

The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: a meta-analysis

“…Moreover, IMT + EMT and IMT also improved MIP and MEP. Early stroke patients may have decreased respiratory muscle strength due to respiratory centre injury and central diaphragm dysfunction [ 12 , 29 , 53 , 54 ], while RMT may improve the integration and regulation of respiratory-related sensory input by promoting the recovery of cerebral cortex respiratory centre [ 9 , 53 ] and activating cortical spinal cord pathway [ 12 , 55 ], thereby improving diaphragm function and respiratory muscle strength. Furthermore, RMT is more likely to change the adaptive structure of respiratory muscle [ 56 ] in patients with early stroke, thereby improving the strength of respiratory muscle.…”

“…However, people usually give priority to the recovery of limb dysfunction in patients with early stroke and pay less attention to respiratory dysfunction after early stroke [ 8 ]. Although there is no precise report on the incidence of respiratory dysfunction in early stroke patients, previous studies have found that 18–88% of stroke patients have respiratory dysfunction [ 6 , 9 ]. Research shows that stroke recovery usually occurs within three months of stroke onset, while 15–30% of stroke patients may have permanent dysfunction after 3 months of onset [ 6 , 10 , 11 ].…”

“…Respiratory dysfunction in patients with early stroke may be related to respiratory centre damage after stroke [ 9 , 12 ]. Stroke lesions can induce a series of pathophysiological reactions like inflammation, oxidative stress, metabolic abnormalities, excitatory toxicity and apoptosis, which can affect the respiratory centre, destroy the nerve conduction pathways related to respiration, and further damage the integration and regulation ability of respiratory-related sensory input, thereby reducing the activity function of respiratory muscle and eventually leading to respiratory dysfunction [ 13 ].…”

“…Stroke lesions can induce a series of pathophysiological reactions like inflammation, oxidative stress, metabolic abnormalities, excitatory toxicity and apoptosis, which can affect the respiratory centre, destroy the nerve conduction pathways related to respiration, and further damage the integration and regulation ability of respiratory-related sensory input, thereby reducing the activity function of respiratory muscle and eventually leading to respiratory dysfunction [ 13 ]. Besides, patients may suffer from malnutrition, secondary pain, reduced hemiplegic side activity, abnormal muscle tension, chest contracture, and even immobilization after early stroke, which may cause secondary dysfunction such as respiratory pattern disorder, insufficient pulmonary ventilation and gas exchange, decreased respiratory muscle contraction coordination, abnormal thoracic activity, and ultimately further lead to respiratory dysfunction [ 9 , 14 – 16 ]. Respiratory dysfunction can increase the mortality rate of early stroke patients by 2–6 times, prolong the average hospitalization time, aggravate neurological dysfunction and lose their self-care ability [ 17 , 18 ].…”

Medizinische Rehabilitation aus Patientensicht: Depression, Erschöpfungssyndrom und Return-to-work

“…Liu et al [5] entzündlichen oder degenerativen rheumatischen Erkrankungen und Fibromyalgiesyndrom erhoben. Die meisten Patienten erwiesen sich als leicht bis deutlich belastet, ohne klinisch relevante Beeinträchtigungen zu haben, wobei diese Beschwerden über die Zeit recht stabil blieben.…”