CLINICAL EXPERTISE AIDED BY TECHNOLOGY: HINTS FROM THE PAST TO BET ON THE FUTURE

N°P2
Treviso 21-23 Marzo 2019

!“DIAPHRAGMATIC MUSCLE SONOGRAPHY IN THE PHYSIOTHERAPIST

CLINICAL PRACTICE AS FUNCTIONAL ASSESSMENT OF THE CARDIO-
RESPIRATORY PATIENT SUBJECT TO REHABILITATION TREATMENT”
Angelo Longoni1 RT, Mariele Vago1 RT, Dionigi Mangiacasale1 MD, Paolo Pozzi1 MD, Albino De Marco1 MD,
Laura Cattaneo1 MD, Francesca Perin2 FT, Antonio Paddeu1 MD.
1. Cardio-Respiratory Rehabilitation “P. Giancola Foundation”, ASST Lariana S. Antony Abate Cantu’ Hospital , Como (Italy),
2. Physiotherapist, Varese
Mail: angelo.longoni@asst-lariana.it

Aim: B mode
The aim of this work is to describe how the Ultrasound of
the diaphragm muscle can be useful in the clinical practice
of the physiotherapist as a support to the classical clinical
tests such as wt 6 minutes and MIP/MEP pressures, after
a rehabilitation program in COPD patients.

Methods:
For the study of the diaphragm muscle we a portable
ultrasound with a Convex probe (1-5 MHz). The patient
was positioned in semi-supine position (40°). The B mode
modality scan, in anterior subcostal view, was used in
order to indentify the diaphragm muscle whereas the M-
mode one was used to appreciate the diaphragmatic
kinetics, following the oscillation of the pleural/liver profile
generated during the respiratory acts. WT6 'and MIP/MEP
WT 6’ MIP-MEP
MIP-MEP
pressure were performed according to standard ATS. All
procedures were performed at the entrance and discharge
of COPD patients.

Results:
A total of 116 patients aged 51 to 91, 78 men and 38 women
were included in the study. The standard unit of measurement Portable sonography
is centimeter. The data was examined with SmallTalk, an
programming language. This analysis shows a positive
response of at least one ultrasound parameter despite the
values ​ ​ of MIP/MEP have not improved. This exception could
probably underline a greater precision of the ultrasound in the
specific analysis of the diaphragmatic dynamics. From the
analysis of the data relative to the comparison between
Convex probe 5 MHz Supine position at 40°
distance walked in 6MWT and amplitude of the diaphragmatic
excursion measured in cm, the following results are obtained:
considering 100 patients who improved walking test
performance (75.9% of the total), 80% also optimized
diaphragmatic motility (72.29% with reference to 75.9%) while
the remaining 20% ​ ​ (3, 61%) did not improve the excursion
parameter. As far as patients with unchanged distance in
6MWT are concerned (24.1% of total patients), 95.24% Data collection
(22.85% on the graph) has an increase in diaphragmatic
excursion.

Conclusions:
The US of the diaphragm offers a valid, practical, rapid and
sensitive approach that could be overlapped with the
classical evaluation methods used by the physiotherapist in
the daily practice to monitor treatment’s efficacy.
Improvements in ultrasound parameters correlate with
those of 6MWT and MIP/ MEP and we could claim that
ultrasound is an excellent support in the functional
evaluation of the outcomes after rehabilitation of COPD
patients if gold-standard methods are not applicable in
case of temporary disability of the patient (severe
symptomatology, acute pain, clinical instability). Despite the
positive results found, these data are not sufficient and
statistically significant in order to draw up a protocol. Future
research work is required on the basis of the proposed
outcomes.