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A physical therapy intervention to address functional deficits associated with a paralyzed hemi-diaphragm.

(1) Bowman, Matthew L.; (1) Neville, Kevin; (1) Avers, Dale. (1) Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, United States.

Purpose/Hypothesis: A paralyzed hemi-diaphragm can go undiagnosed if the patient does not have a pre-existing pulmonary condition. Common complaints include dyspnea in supine and on exertion and a decrease in functional endurance and recreation. The purpose of this case report is to describe an evidence-based physical therapy program to address the functional deficits related to a paralyzed hemi-diaphragm. Number of Subjects: 1 Materials/Methods: Mrs. S is a 59-year-old female with a body mass index (BMI) of 29.2. During the winter one year prior to evaluation, the patient reported shoveling snow when she "wrenched" her neck with a significant onset of pain. Two months later she went to her primary care physician with complaints of left lower chest pain, exacerbation of reflux disease, dyspnea on exertion and also when lying on her left side. After receiving a second opinion, she was referred to pulmonary physical therapy to address functional deficits associated with the paralyzed hemi-diaphragm. A 1-repetition maximum (1-RM) was used to assess the patient's lower extremity strength. The patient completed the St. George's Respiratory Questionnaire, a 6-minute walk test (6-MWT), 30-second chair sit to stand (30 STS). The patient was not in any pain at the time of evaluation and complained of 4/10 on the Borg Dyspnea scale when negotiating 30 steps. The patient was seen for a total of 19 visits using an evidence-based pulmonary rehabilitation protocol including endurance training protocol and a high intensity strengthening program. Results: Significant improvements were made in the St. George's Respiratory Questionnaire, the 6-MWT, 30 STS while substantial gains were achieved with lower extremity strength including a 26% increase in 1-RM leg press strength. The patient stated that she only had a 1/10 on the Borg Dyspnea scale when negotiating 30 steps. Conclusions: Standard physical therapy interventions are effective for improving the quality of life and functional status of those afflicted with a paralyzed hemi-diaphragm. Further research to analyze the significance of physical therapy interventions on this population is appropriate in the form of randomized control trials. Clinical Relevance: There is a lack of research regarding outpatient physical therapy rehabilitation for patients with a paralyzed hemi-diaphragm. This case study provides a baseline evidence-based treatment guideline for therapists to use in their treatment of these patients or provide information for a pilot RCT study.
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Publication:Cardiopulmonary Physical Therapy Journal
Date:Dec 1, 2011
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