Ultrasound Assessment of Diaphragmatic Function in Children With Cerebral Palsy: A Cross-Sectional Observational Case-Control Study

Abstract

Background and Aims: Children with cerebral palsy (CP) are vulnerable to respiratory infections and chronic airway inflammation, which leads to diminished respiratory function. This decline is exacerbated by muscle tone abnormalities and reduced strength, worsening as CP progresses. Traditional lung function tests are often impractical for those with severe cognitive and motor impairments. Diaphragm evaluation through ultrasound imaging emerges as a non-invasive, easy-to-apply technique for assessing respiratory function in CP children. This study aimed to evaluate diaphragm function in CP and typically developing (TD) children using ultrasound, focusing on diaphragm thickness and excursion parameters. The study also explored factors influencing respiratory function, particularly the number of lower respiratory tract infections (LRTI). Methods: The study included 10 CP (11.2; range 4–17 years) and 12 TD children (8.9 years; range 4–13 years). M-mode ultrasound assessed diaphragm thickness, thickening fraction (TF), and inspiratory slope (IS). Additionally, data on demographics, anthropometrics, medical history, and physical examination were collected. Results: The intra-operator reliability for diaphragm ultrasound measurements showed good to excellent consistency (over 0.86). Significant differences were found between CP and TD children; CP children exhibited lower excursion and IS, with a non-significant trend towards reduced diaphragm thickness. LTRI were associated to decreased excursion and IS, and increased TF in CP children. Conclusions: Diaphragmatic ultrasound is a non-invasive, reproducible tool for assessing respiratory function in both CP and TD children, even in cases of severe cognitive and motor impairment. It effectively identifies diaphragm dysfunction associated with LRTI