근육두께 측정의 초음파 진단장치 신뢰도에 따른 최고날숨유량과 날숨근육 두께 간의 관련성 = Correlation between Peak Expiratory Flow and Expiratory Muscle Thickness in Reliability of the Muscle Thickness Measurements using Ultrasonography

다국어 초록 (Multilingual Abstract)

The purpose of the study was performed to investigate reliability of the measurements of expiratory muscles during respiratory conditions of resting and forced expiratory using ultrasonography. Additionally, this study to determine the correlation between peak expiratory flow(PEF) and expiratory muscle thickness. Forty-five normal subjects in their 20s participated with no special disease according to a pre-survey and questionnaire, and received “Informed consent” which state the voluntary participation of study. The expiratory muscle thicknesses under respiratory conditions of resting and forced expiration in the rectus abdominis, internal oblique, external oblique, and transverse abdominis muscles were measured by B-mode ultrasonography at the end of a expiration in the supine position. The peak expiratory flow was obtained using a spirometer that performed in the sitting position to measure total lung capacity. The rectus abdominis, internal oblique, external oblique muscles under respiratory conditions of resting and forced expiration showed a high level of reliability of the thickness measurement, but that of transverse abdominis muscle was relatively low. The mean values of peak expiratory flow was 512.64±76.40ℓ/min. There was no significant correlation between peak expiratory flow and the thickness of rectus abdominis, internal oblique and transverse abdominis muscles. There was a significant positive correlation between peak expiratory flow and the thickness of external oblique muscle, Correlation coefficient was 0.303. The thickness of the expiratory muscles is influenced by voluntary respiration, and assessment of the thickness by means of ultrasonography is adequately reliable. Therefore, Physiotherapists applying selective strengthening exercise of external oblique muscle may be considered intervention method to improve peak expiratory flow that patients with respiratory disease to facilitate airways clearance.

국문 초록 (Abstract)

본 연구의 목적은 초음파 진단장치를 이용해 휴식 시와 강제날숨 호흡 상태에서 날숨 근육두께 측정의 초음파 진단장치의 신뢰도를 조사하는 것이다. 또한, 일반 대상자의 최고날숨유량과 날숨근육 두께의 관련성을 알아보기 위해서 실시하였다. 사전 설문조사와 문진을 통해 특별한 질환이 없는 20대의 건강한 성인 45명을 연구 대상자로 선정한 후 자발적인 의사로 본 연구에 참여한다는 동의서를 받았다. 휴식 시와 강제날숨 호흡 상태에서 날숨근육 두께는 대상자가 바로누운 상태에서 초음파 영상장치 B—mode를 이용해 날숨의 끝에 배곧은근, 배속빗근과 배바깥빗근, 그리고 배가로근을 측정하였다. 최고날숨유량은 폐활량계 장비를 사용해 의자에 앉은 대상자의 강제폐활량 측정을 통해 획득하였다. 휴식 시와 강제날숨 호흡 상태의 날숨근육 두께 측정은 배곧은근, 배속빗근, 배바깥빗근은 높은 신뢰도를 보였지만 배가로근은 상대적으로 낮게 나타났다. 일반 대상자의 최고날숨유량 평균값은 512.64±76.40ℓ/min 이었고, 최고날숨유량과 배곧은근, 배속빗근, 배가로근 근육 두께는 상관관계가 없었다. 최고날숨유량과 배바깥빗근 근육 두께는 유의한 양의 상관관계가 나타났고(p<.05), 상관계수는 0.303 이었다. 날숨근육의 두께는 자발적인 호흡에 영향을 주며 초음파 진단장치에 의한 근육두께의 측정은 높은 신뢰도를 가진다. 그러므로 물리치료사는 호흡기 질환 환자의 기도 청결을 촉진하는 최고날숨유량을 향상시키기 위한 중재방법으로 배바깥빗근의 선택적인 근력강화운동의 적용을 고려할 수 있다.

참고문헌 (Reference)

1 Hides JA, "Use of real-time ultrasound imaging for feedback in rehabilitiaon" 3 (3): 125-131, 1998

2 Teyhen DS, "Ultrasound Characteristics of the Deep Abdominal Muscles During the Active Straight Leg Raise Test." 90 (90): 761-767, 2009

3 Kisner C, "Therapeutic Exercise - Foundations and Techniques" FA Davis 2006

4 McMeeken JM, "The relationship between EMG and change in thickness of transversus abdominis" 19 (19): 337-342, 2004

5 Cohen J., "Statistical power analysis for the behavioral sciences" Lawrence Erlbaum Assoicates 1988

6 Cresswell AG., "Responses of intra-abdominal pressure and abdominal muscle activity during dynamic trunk loading in man" 66 (66): 315-320, 1993

7 Weiner P, "Respiratory muscle training in chronic obstructive pulmonary disease:inspiratory, expiratory, or both?" 11 (11): 140-144, 2005

8 Sapienza CM, "Respiratory muscle strength training: functional outcomes versus plasticity" 27 (27): 236-244, 2006

9 DePalo VA, "Respiratory muscle strength training with nonrespiratory maneuvers" 96 (96): 731-734, 2004

10 Summerhill EM, "Respiratory muscle strength in the physically active elderly" 185 (185): 315-320, 2007

11 Otani Y, "Reliability of the deep abdominal muscle thickness measurements using ultrasonography in normal subjects" 23 (23): 357-359, 2011

12 Springer BA, "Relationships among lateral abdominal muscles, gender, body mass index, and hand dominance" 36 (36): 289-297, 2006

13 Hasani A, "Regional mucus transport following unproductive cough and forced expiration technique in patients with airways obstruction" 105 (105): 1420-1425, 1994

14 Kim YS, "Peak expiratory flow in normal healthy korean subjects measured by Mini-Wright Peak Flow Meter" 50 (50): 320-333, 2001

15 Cresswell AG, "Observations on intraabdominal pressure and patterns of abdominal intra-muscular activity in man" 144 (144): 409-418, 1992

16 Snijders CJ, "Oblique abdominal muscle activity in standing and in sitting on hard and soft seats" 10 : 73-78, 1995

17 Hodges PW, "Measurement of muscle contraction with ultrasound imaging" 27 (27): 682-692, 2003

18 Ishida H, "Maximum expiration activates the abdominal muscles during side bridge exercise" 28 (28): 81-84, 2015

19 McCool FD, "Maximal inspiratory pressures and dimensions of the diaphragm" 155 (155): 1329-1334, 1997

20 Axler CT, "Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge" 29 (29): 804-811, 1997

21 Kaneko H, "Influence of posture on lateral abdominal muscles’s thicknes" 21 : 255-259, 2006

22 Misuri G, "In vivo ultrasound assessment of respiratory function of abdominal muscles in normal subjects" 10 (10): 2861-2867, 1997

23 Kim J, "Implications of expiratory muscle strength training for rehabilitation of the elderly:tutorial" 42 (42): 211-224, 2005

24 National heart, Lung, and Blood Institute, "Guide lines for the Diagnosis and Management of Asthma"

25 De Troyer A, "Functional anatomy of the respiratory muscles" 9 (9): 175-193, 1988

26 Fink JB., "Forced expiratory technique, directed cough, and autogenic drainage" 52 (52): 1210-1221, 2007

27 Ramírez-Sarmiento A, "Expiratory muscle endurance in chronic obstructive pulmonary disease" 57 (57): 132-136, 2002

28 Yamaguti W. P, "Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial" 93 (93): 571-577, 2012

29 Fontana G. A, "Cough motor mechanisms" 152 (152): 266-281, 2006

30 Ishida H, "Correlation between Peak Expiratory Flow and Abdominal Muscle Thickness" 26 (26): 1791-1793, 2014

31 Cresswell AG, "Changes in intra-abdominal pressure, trunk muscle activation and force during isokinetic lifting and lowering" 68 (68): 315-321, 1994

32 Hides J, "An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall" 31 (31): 175-178, 2006

33 Ota M, "Age-related changes in the thickness of the deep and superficial abdominal muscles in women" 55 (55): e26-e30, 2012

34 Mier A, "Action of abdominal muscles on rib cage in humans" 58 (58): 1438-1443, 1985

35 Mier A, "Action of abdominal muscles on rib cage in humans" 58 (58): 1438-1443, 1985

36 Critchley DJ, "Abdominal muscle function in chronic low back pain patients. Measurement with real-time ultrasound scanning" 88 (88): 322-332, 2002

37 Waller DA, "A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks" 54 (54): 442-443, 1999