Patients with central nervous system disorders are not only paralyzed by the arms, legs, and trunk, but they often have decreased pulmonary function. Pulmonary function tests are often used to evaluate respiratory function, and another important thing to measure is the movement of the diaphragm. Especially, patients with cervical spinal cord injury are more likely to have diaphragmatic paralysis depending on the level of cervical involvement. Various methods such as fluoroscopy, CT, MRI, and ultrasonography can be used to measure diaphragm movements. Among these, fluoroscopy can be used to measure diaphragm motion easily and visually by using X-ray, which is a commonly used method, but it has a drawback that it is exposed to radiation and requires a machine. The method of viewing the diaphragm movement using the M-mode of ultrasonography has been tried in several papers, and it can be easily performed on the bedside and it is advantageous that it is not exposed to radiation. There is no study on the gold standard to measure diaphragm movement. A previous study of diaphragmatic movement measurement using both fluoroscopy and ultrasonography has been performed in 14 normal subjects and the two methods have been reported to be highly correlated. In this study, we will compare the diaphragmatic movement using fluoroscopy and M-mode ultrasonography in patients with central nervous system disorder, which is expected to have decreased pulmonary function. We will evaluate whether there is a more relevant method of evaluating pulmonary function among the two methods. 
From October 2017, we will enroll the patients with central nervous system disorder hospitalized for rehabilitation. Pulmonary function test including Functional vital capacity (FVC), FEV1 (Forced expiratory volime), FEV1/FVC, PCF (Peak cough flow), MIP (Maximal inspiratory pressure), MEP (Maximal expiratory pressure) is performed by initial patient evaluation at admission and diaphragm movement is measured by M-mode ultrasonography and fluoroscopy. For the measurement of the diaphragm movement with fluoroscopy, the patient rests comfortably and breathes three times. The average value of the three measurement is recorded. The measurement time is within 2 minutes. When measuring the diaphragm movement using M-mode ultrasonography, the patient lie in a relaxed state, and a curved linear probe is placed between the mid-axillary line and the mammillary line and tilted 45 ' upward. And the average value of the three measurement is recorded. The measurement time is less than 5 minutes. Correlation analysis will be performed right and left sides separately, in order to check the degree of correlation between two mothods. Correlation analysis is performed to determine the measurement methods that are more relevant to FVC, FEV1, FEV1 / FVC, PCF, MIP, and MEP. Statistical analysis was performed using SPSS 20.0 and statistically significant at p <0.05.

Cohort/Group Label

Patients with central nervous system disorder

Cohort/Group Description

We will measure the diaphragm movement using fluoroscopy and ultrasonography for patients with central nervous system disease who were hospitalized at Bundang Sacrifice Hospital. Identify the degree of association between the two methods and identify which of the two methods is more relevant to the assessment of pulmonary function.

Not collect nor Archive

Patients with central nervous system disorder who are admitted to Bundal Jesaeng Hospital for inpatient rehabilitation

consecutively enroll central nervouw system disorder patients who are admitted for inpatient rehabilitation.

Gender

Age

Description

1) Patients with central nervous system disorders ((Stroke, Traumatic brain injury, Parkinson disease, spinal cord injury, etc.)
2) Patients with intact cognitive fuction who can perform pulmonary function test 

1) Patients wigh poor congnitive functions who cannot perform pulmonary function test 

Diaphragm movement 

on admission

pulmonary function test (Forced vital capacity, Forced expiratory volume1, FEV1/FVC, Peak cough flow, Maximal inspiratory pressure, Maximal expiratory pressure)

on admission