Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Original Research

Can diaphragmatic mobility be measured by chest wall volumes?

Tarcila Dal Pont, Jéssica Canizelli Gonçalez, Carolina Luana Mello, Davi de Souza Francisco, Catherine Corrêa Peruzzolo, Dayane Montemezzo, Danielle Soares Rocha Vieira, Elaine Paulin

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Background: The evaluation of the diaphragm muscle is important in clinical practice as a way to investigate its relationship with lung volumes. This allows the knowledge of pulmonary variations via different equipment, enabling the accessibility of the ventilatory evaluation. Objective: To investigate the relationship between chest wall volumes and diaphragmatic mobility in the sitting position and dorsal decubitus at 30° of trunk inclination. Methods: 40 participants of both sexes, aged between 20 and 50 years, were submitted to measurements of volume changes in three chest wall compartments by optoelectronic plethysmography. Diaphragmatic mobility (DM) was assessed by ultrasonography. Statistical analysis: univariate analysis was performed using Spearman´s rank correlation, followed by linear regression to determine the influence of lung volume changes in each compartment on DM. Significance was set at ≤5%. Results: DM was correlated with the volume of the abdominal rib cage (Vrca) at 30° (r=0.33, p=0.03) and with abdominal volume (Vab) in both sitting position and at 30° inclination, respectively (r=0.62, p<0.001; r=0.61, p<0.001). However, in multivariate analysis, Vab contributed to 68% and 50% of DM variance while sitting and at 30º, respectively. Conclusion: Abdominal volume (Vab) can be used as an indirect measure of DM in men and women in the sitting position and at 30º of trunk inclination in dorsal decubitus .


Diaphragm; Chest Wall; Respiratory Mechanics


1. Anraku M, Shargall Y. Surgical conditions of the diaphragm: anatomy and physiology. Thorac Surg Clin. 2009;19(4):419-29, v. PMid:20112625.

2. Yamaguti WPS, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge JM, et al. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(4):571-7. PMid:22464088.

3. Agostoni E, Fenn W. Velocity of muscle shortening as a limiting factor in respiratory airflow. J Appl Physiol. 1960;15(3):349-53. PMid:13792046.

4. Agostini E, Rahn H. Abdominal and thoracic pressures at different lung volumes. J Appl Physiol. 1960;15(6):1087-92. PMid:13681667.

5. Layton AM, Moran SL, Garber CE, Armstrong HF, Basner RC, Thomashow BM, et al. Optoelectronic plethysmography compared to spirometry during maximal exercise. Respir Physiol Neurobiol. 2013;185(2):362-8. PMid:23022440.

6. Vogiatzis I, Aliverti A, Golemati S, Georgiadou O, Lomauro A, Kosmas E, et al. Respiratory kinematics by optoelectronic plethysmography during exercise in men and women. Eur J Appl Physiol. 2005;93(5-6):581-7. PMid:15578206.

7. Vieira DS, Hoffman M, Pereira DA, Britto RR, Parreira VF. Optoelectronic plethysmography: intra-rater and inter-rater reliability in healthy subjects. Respir Physiol Neurobiol. 2013 Dec 1;189(3):473-6. PMid:24036178.

8. Aliverti A, Pedotti A. Opto-electronic plethysmography. Monaldi Arch Chest Dis. 2003;59(1):12-6. PMid:14533277.

9. Ferrigno G, Carnevali P, Aliverti A, Molteni F, Beulcke G, Pedotti A. Three-dimensional optical analysis of chest wall motion. J Appl Physiol. 1994;77(3):1224-31. PMid:7836125.

10. Iandelli I, Aliverti A, Kayser B, Dellacà R, Cala SJ, Duranti R, et al. Determinants of exercise performance in normal men with externally imposed expiratory flow limitation. J Appl Physiol. 2002;92(5):1943-52. PMid:11960944.

11. Gottesman E, McCool DF. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Care Med. 1997;155(5):1570-4. PMid:9154859.

12. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest. 2009;135(2):391-400. PMid:19017880.

13. Toledo NS, Kodaira SK, Massarollo PC, Pereira OI, Mies S. Right hemidiafragmatic mobility: assessment with US measurement of craniocaudal displacement of left branches of portal vein. Radiology. 2003;228(2):389-94. PMid:12819344.

14. Grams ST, Von Saltiél R, Mayer AF, Schivinski CI, Nobre LFS, Nóbrega IS, et al. Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility. Clin Physiol Funct Imaging. 2014;34(1):18-25. PMid:23730805.

15. Aliverti A, Ghidoli G, Dellacà RL, Pedotti A, Macklem PT. Chest wall kinematic determinants of diaphragm length by optoelectronic plethysmography and ultrasonography. J Appl Physiol. 2003;94(2):621-30. PMid:12391129.

16. Wang HK, Lu TW, Liing RJ, Shih TT, Chen SC, Lin KH. Relationship between chest wall motion and diaphragmatic excursion in healthy adults in supine position. J Formos Med Assoc. 2009;108(7):577-86. PMid:19586832.

17. Pereira CAC, Sato T, Rodrigues SC. New reference values for forced spirometry in adult white adults. J Bras Pneumol. 2007;33(4):397-406. PMid:17982531.

18. WHO Consultation on Obesity (1999: Geneva, Switzerland) & World Health Organization. (2000). Obesity : preventing and managing the global epidemic: report of a WHO consultation. World Health Organization.

19. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38. PMid:16055882.

20. Aliverti A. Opto-eletronic pletismography: new findings in chronic obstructive pulmonary disease. IJRC. 2008;4(2):45-50.

21. Parreira VF, Vieira DS, Myrrha MA, Pessoa IM, Lage SM, Britto RR. Optoelectronic plethysmography: a review of the literature. Rev Bras Fisioter. 2012;16(6):439-53. PMid:23184278.

22. Aliverti A, Rodger K, Dellacà RL, Stevenson N, Lo Mauro A, Pedotti A, et al. Effect of sabultamol on lung function and chest wall volumes at rest and during exercise in COPD. Thorax. 2005;60(11):916-24. PMid:15994253.

23. Cala SJ, Kenyon CM, Ferrigno G, Carnevali P, Aliverti A, Pedotti A, et al. Chest wall and lung volume estimation by optical reflectance motion analysis. J Appl Physiol. 1996;81(6):2680-9. PMid:9018522.

24. Borghese NA, Ferrigno G. An algorithm for 3-D automatic movement detection by means of standard TV cameras. IEEE Trans Biomed Eng. 1990;37(12):1221-5. PMid:2289795.

25. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol. 2011;37(1):44-52. PMid:21144957.

26. Munro BH. Statistical methods for health care research. 5. ed. New York: Lippincott Williams & Wilkins; 2005. Chapter 11, Regression; p. 259-86.

27. Portney LG, Watkins MP. Foundations of clinical research applications to practice. New Jersey: Pearson Prentice Hall; 2008.

28. Mead J, Loring SH. Analysis of volume displacement and length chances of the diaphragm during breathing. J Appl Physiol. 1982;53(3):750-5. PMid:6215387.

29. Aliverti A, Cala SJ, Duranti R, Ferrigno G, Kenyon CM, Pedotti A, et al. Human respiratory muscle actions and control during exercise. J Appl Physiol. 1997;83(4):1256-69. PMid:9338435.

30. Chen R, Kayser B, Yan S, Macklem PT. Twitch transdiaphragmatic pressure depends critically on thoracoabdominal configuration. J Appl Physiol. 2000;88(1):54-60. PMid:10642362.

31. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F, et al. Normal diaphragmatic motion and the effects of body composition: determination with m-mode sonography. J Ultrasound Med. 2004;23(2):255-60. PMid:14992363.

32. KaneKo H, Horie J. Breathing movements of the chest and abdominal wall in healthy subjects. Respir Care. 2012 Sep;57(9):1442-51. PMid:22348414.

33. Romei M, Mauro AL, D’Angelo MG, Turconi AC, Bresolin N, Pedotti A, et al. Effects of gender and posture on thoraco-abdominal kinematics during quiet breathing in healthy adults. Respir Physiol Neurobiol. 2010;172(3):184-91. PMid:20510388.

34. Hamid Q, Shannon J, Martin J. Physiologic basis of respiratory disease. Hamilton: B.C. Decker. 2005.

35. Binazzi B, Lanini B, Bianchi R, Romagnoli I, Nerini M, Gigliotti F, et al. Breathing pattern and kinematics in normal subjects during speech, singing and loud whispering. Acta Physiol. 2006;186(3):233-46. PMid:16497202.

36. Leal BE, Gonçalves MA, Lisboa LG, Linné LMS, Tavares MGS, Yamaguti WP, et al. Validity and reliability of fluoroscopy for digital radiography: a new way to evaluate diaphragmatic mobility. BMC Pulm Med. 2017;17(1):62. PMid:28415987.

37. Saltiel RV, Grams ST, Pedrini A, Paulin E. High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals. Braz J Phys Ther. 2013 Mar-Apr;17(2):128-36. PMid:23778774.

38. Cohen E, Mier A, Heywood P, Murphy K, Boultbee J, Guz A. Excursion-volume relation of the right hemidiaphragm measured by ultrasonography and respiratory airflow measurements. Thorax. 1994;49(9):885-9. PMid:7940428.

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