Abstract
BACKGROUND: Respiratory muscle dysfunction, particularly of the diaphragm, is common after stroke and limits physical performance. Targeted diaphragmatic exercises may enhance respiratory efficiency and recovery. To evaluate the effect of diaphragmatic breathing exercises on diaphragmatic motion and functional performance in patients with chronic hemiplegia. METHODS: In this single-blind randomized controlled trial, 70 chronic hemiplegic patients were randomly assigned to two equal groups (n=35 each): a control group (traditional exercise) and an intervention group (traditional plus diaphragmatic breathing exercises). Over eight weeks, outcomes including diaphragmatic excursion (DE) (assessed via M-mode ultrasonography), six-minute walk distance (6MWD), modified Medical Research Council (mMRC) dyspnea scale, and Berg Balance Scale (BBS) were evaluated. Data were analyzed using SPSS version 25.0. Statistical methods included descriptive statistics, independent samples t-tests, paired samples t-tests, Chi-square tests, and analysis of covariance (ANCOVA) to compare post-intervention outcomes while adjusting for baseline values. A p-value < 0.05 was considered statistically significant. RESULTS: There were no statistically significant differences between the two groups in baseline characteristics (age, sex, BMI, smoking history) or in baseline assessments of 6MWD, BBS, or mMRC scores (P>0.05). After eight weeks, the intervention group showed significantly greater improvements in functional capacity, balance, dyspnea, and diaphragmatic function (6MWD, BBS, and mMRC scores) compared to the control group (P<0.05). DE improved significantly in the intervention group during tidal (P=0.005), deep (P=0.009), and sniff breathing (P<0.001), while the control group showed a significant change only in tidal excursion (P=0.027). ANCOVA confirmed these findings after baseline adjustment (P<0.05), with moderate to large effect sizes. CONCLUSION: Diaphragmatic breathing exercises significantly enhance diaphragmatic movement, physical performance, and quality of life in chronic hemiplegic patients. These findings support incorporating targeted pulmonary rehabilitation in stroke management, with ultrasonography as a valuable non-invasive bedside monitoring tool.