The assessment of changes of respiratory parameters and bioelectrical activity of accessory respiratory muscles depending on applied breathing stimulation in patients after ischemic stroke

INTERVENTION: The main goal of this project is to perform an objective evaluation of the influence of selected interventions on respiratory function in stroke patients. A single intervention stimulating respiratory system will be performed in each person depending on the assigned group. All stimulations will concentrate on intensifying the work of diaphragm and intercostal muscles and will be performed with patients lying on their back with their lower and upper limbs slightly flexed and resting on special rollers and wedges. Due to that, the diaphragm does not have to work directly against gravity. Additionally, lower limb flexion leads to relaxation of the abdominal wall and improvement of inspiration effectiveness. The target group will be divided into a study group (Group A – stimulation of breathing using a proprioceptive neuromuscular facilitation method, PNF) and a control group (Group B ‐ patient positioning). Each intervention will be administered to participants once by the same person ‐ a physiotherapist who is also a certified PNF therapist. Group A will be subjected to breathing stimulation according to the proprioceptive neuromuscular facilitation method. Proprioceptive neuromuscular facilitation (PNF) is a neuromuscular treatment method for restoring movement and mobility using sensory inputs to direct motions. During the PNF breathing stimulation, physiotherapist places his hands on the epigastric region, below the costal margins. Therapist instructs the exercising person with regard to the moment of deep expiration phase, at the end of which he applies optimal pressure (stretch) directed toward the diaphragm, simultaneously commanding the patient to inhale. Slight resistance, however not preventing inspiration, is applied when taking a breath. This action is repeated thrice, in two series, at time intervals (1 minute interval), which prevents hyperventilation [3 stimulated breaths in – 1 minute interval – 3 stimulated breaths in]. Subsequently, the therapist moves his hands to the region of inferior costal arches of the chest and repeats the stimulation [and again: 3 stimulated breaths in – 1 minute interval – 3 stimulated breaths in]. Intervention in Group B will involve lying free in a supine position, with lower and upper limbs slightly bent placing a special roller under the lower limbs. This will allow to investigate exclusively the influence of diaphragm position, which in this case is placed at optimal height, gaining greater inspiratory dimension. Patients stay in this position for 15 minutes. CONDITION: Patients after ischemic stroke PRIMARY OUTCOME: The electromyographic examination of accessory respiratory muscles by means of surface EMG. SECONDARY OUTCOME: Evaluation of pulse oximetry by pulse oximeter. The spirometric evaluation of ventilation parameters by spirometer. INCLUSION CRITERIA: 1. Ischemic stroke (at least 6 months before the examination) 2. Subject's consent to participate in the study, 3. Attending physician's consent