Sonographic measurement of diaphragm movement in patients with tetraplegia

Study design: This was an observational, descriptive case-series study. The magnitude and direction of diaphragm movement during tidal and maximal inspiratory breaths in tetraplegic subjects were measured using B-mode sonography on a single occasion. Data were tabulated for descriptive analysis. Objective: There is a paucity of literature reporting dynamic movements of the paralyzed diaphragm. The aim of this pilot study was to investigate and record diaphragm movement in subjects with a cervical spinal cord injury (C1-C5), which had resulted in tetraplegia with partial or complete diaphragm paralysis. Subjects were patients of the Royal Adelaide Hospital in South Australia. Results: Three subjects participated in the study. The magnitude of diaphragm movement was small in two subjects and approached normal in one subject. During tidal inspiratory and maximal inspiratory breaths, the diaphragm moved in a caudal direction in two subjects. In the other subject, the diaphragm moved in a cephalad direction during a maximal inspiratory breath. Conclusion: Imaging of diaphragm movement was well tolerated by three subjects with cervical spinal cord injury. The difference in magnitude of diaphragm movement was not fully explained by the level of injury and the American Spinal Injury Association classification. Spinal Cord (2009) 47, 832-834; doi: 10.1038/sc.2009.45; published online 28 April 2009