This study aims to investigate the differences in muscle recruitment of the diaphragm (assessed using ultrasound), the sternocleidomastoid (SCM) and trunk muscles (both measured via surface electromyography (sEMG)), during loaded breathing training performed on both stable and unstable surfaces. The goal is to understand the interaction between the inspiratory and trunk muscles during Inspiratory muscle training (IMT) across these two surface conditions.
Age ≥ 40 years and < 80 years
Breathing spontaneously
Clinically diagnosed with ischemic and/or hemorrhagic stroke
Stroke duration from onset between 1 and 12 months
Acute myocardial infarction or acute heart failure
Acute pain in any part of the body
History of chronic respiratory illness or positive clinical signs of impaired respiratory function (such as shortness of breath, hypoxemia, chronic cough, and sputum retention)
Presence of a nasal feeding tube, tracheal tube, or any condition that prevents the measurement or implementation of the study procedures
People diagnosed with stroke who meet the criteria will be invited to participate in the study
Cohort
Cross-sectional
Loaded breathing on stable and unstable surfaces
Other interventionParticipants will be instructed to perform 10 loaded breaths via a threshold inspiratory load device on both a stable surface (sitting on a chair, Protocol 1) and an unstable surface (sitting on a soft pad, Protocol 2) in random order. The inspiratory load/resistance will be set at 50% of the maximum inspiratory pressure (MIP).
Diaphragmatic thickening fraction
Diaphragmatic thickening fraction is determined by "(thickness of the diaphragm at end inspiratory - thickness at end expiratory)/thickness at end expiratory". Diaphragmatic thickness will be measured by ultrasonography.
Muscle activation of the sternocleidomastoid muscle
Surface electromyography (sEMG) will be used to measure accessory inspiratory muscle (sternocleidomastoid muscles) activity during all breathing protocol tests.
Muscle activation of the trunk muscles
Surface electromyography (sEMG) will be used to measure the muscle activity of rectus abdominis (RA), external oblique (EO), internal oblique/transversus abdominis (IO/TrA), and erector spinae (ES)- using sEMG during all breathing protocol tests.
Perceived Exertion Borg scale
This is a vertical scale quantified from 0 to 10, where 0 represents no symptoms, and 10 represents the maximum symptoms. The Borg score provides an individual measurement of the exercise intensity.
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