Real-time ultrasound imaging biofeedback training is diaphragmatic function in nontraumatic cervical spinal cord injury: a single-subject experimental study

This study aimed to describe, and report the results from a detailed procedure of a diaphragmatic breathing exercise using real-time ultrasound imaging biofeedback (RUIB) training. The subject was a 16-year-old man with an incomplete cervical spinal cord injury (CSCI) caused by spinal intramedullary arteriovenous malformations at the level of his C4–C5 spinal cord. Although he could walk independently, decreased respiratory function was one of the major factors reducing his ability to perform daily activities, such as walking. Outcome measures included a 10-meter walk test (10MWT) results, balance ability in eyes open and closed, diaphragm movement distance on sniffing, and forced vital capacity. All parameters except the 10MWT results appeared to significantly improve during the intervention phase. Data points during both the intervention and follow-up phases showed improved trends in comparison to those in the baseline phase, indicating that intervention might be beneficial in improving respiratory function and performance and that these gains can be maintained after the intervention. Our findings suggest that the use of RUIB during breathing exercise may be valuable in managing respiratory and physical function of patients with cervical cord injuries.