We compared the kinematic evaluation of the thorax with a structured light device( SLP) and the diaphragm muscle excursion of an ALS patient using sonography.

1. +“Diaphragmatic Sonography vs Structured Light Plethysmography in
ALS patient after NIMV and Cough Machine treatments“
A. Longoni Respiratory Therapist, D. Mangiacasale MD, P. Pozzi MD, A.D. Marco MD, L. Cattaneo MD,
M. Vago Respiratory Therapist, A. Paddeu MD.
Asst Lariana - U.O. of Specialistic Cardio-Respiratory Rehabilitation 2, “Paola Giancola Foundation” Cantù, Italy
angelo.longoni@asst-lariana.it
A 56 year-old male patient, former smoker and truck
driver that practised activity as bicyclist for 6 years
started suffering from right emiparesis in 2013; in
2014 the diagnosis of motoneuron disease (ALS)
was set; ALS went on and on 2016 the patient
devoleped chest wall muscles deficit and ipovalid
cough. In 2017 he was hospitalized to start non
invasive mechanical ventilation (NIMV) and assisted
cough with a Cough Machine (CM) in order to
prevent respiratory insufficiency as well as
pneumonia.
Clinical case n. 1580
Case history
The rehabilitative treatments
Conclusion:
The difference in US diaphragmatic excursion was 0,4 cm to 1,5 cm with forced breath and 1,5 cm to 4 cm under Caugh Machine. The
Pneumacare values in forced breath were: upper left 61%, upper right 78%, lower left 90%, lower right 70% to upper left 22%, upper
right 23%, lower left 24%, lower right 30%. Our study suggests that the Ultrasonography and the Structured Light Plethysmography are
a safe, reliable, useful and complementary modality that provides clinicians with a non-invasive way, when the patient is no longer able
to perform pulmonary function testings, of observing active, real-time regional and selective respiratory function like the movement of
the chest wall and the diaphragm escursion.They can be used to set the NIMV and the Cough-assist machine at the bedside, in conscious
or unconscious patient and they can help clinicians and respiratory therapists in offering patients a tailored therapy.
The patient has performed cycles of nighttime and
diurnal NIMV in S/T mode with oronasal mask,
single circuit with leak and esternal hot humidifier
and three daily treatments of diurnal cough machine
with Pressure I/E=+- 35cmH2O, (Time ins=2,5s,
Time exp=1,5s, Pause=1s) =1 cycle, for three/four
repetitions of five cycles. Once a day it performed
motor exercises with assisted minibike. Respiratory
evaluation with Ultrasound and Structured Light
Plethysmography were performed at the admission
and at the discharge in sitting position.
The patient underwent a nighttime pulsoximetry. Pulmonary
function testings were not possible and we evaluated the
patient through the study of the diaphragm muscle
excursion and chest movements with a ultrasound (US) and
the Pneumacare Thora 3-D System. The US machine, a
portable one with a 1-5 MHz Convex probe, was set in B
and M-Mode modality and the valutation was performed in
an anterior subcostal approach on semi-recumbent position.
PneumaCare (called Structured Light Plethysmography -
SLP) consisted of a visible white light that projected a grid
pattern onto the patient’s chest. Two cameras filmed the
movement at high speed (30 frames per second) and the
software generated a 3D view of the chest wall movement
over the time and it calculated the volume of air moved.
The examination was performed in sitting or lying position in
order to measure the tidal volume in different settings.
Investigations