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Vol. 21. Num. 6.
Pages 389-480 (01 November 2017)
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Vol. 21. Num. 6.
Pages 389-480 (01 November 2017)
Original Research
DOI: 10.1016/j.bjpt.2017.06.006
Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case–control study
Elis E.A. Cabrala, Vanessa R. Resquetia, Illia N.D.F. Limaa,b, Lucien P. Gualdia,b, Andrea Alivertic, Guilherme A.F. Fregonezia,
Corresponding author

Corresponding author at: Laboratório PneumoCardioVascular, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte – Campus Universitário Lagoa Nova, Caixa Postal 1524, CEP 59072-970 Natal, RN, Brazil.
a Universidade Federal do Rio Grande do Norte (UFRN), Hospital Universitário Onofre Lopes -Empresa Brasileira de Serviços Hospitalares (EBSERH), Departamento de Fisioterapia, Natal, RN, Brazil
b Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brazil
c Politecnico Di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Laboratorio di Tecnologie Biomediche, Milan, Italy

  • The PEP device at 10cmH2O may be a potential home treatment for stroke group.

  • The intensities above 10cmH2O may lead to lung hyperinflation in stroke group.

  • Stroke group reduced shortening velocity index for expiratory muscles during use PEP.

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Table 1. Anthropometric, spirometric, and global respiratory muscle strength data.

Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients;

however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear.


To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls.


16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes,

and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities.


During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; p<0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage.


Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.

Respiratory system
Respiratory therapy
Positive-pressure respiration


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