The diaphragm is known to assume an either cephalic or caudal position, depending on thoracic and abdominal conditions. This may explain why the paralyzed hemidiaphragm

has greater downward freedom during maximum inspiration. In a hemiplegic individual with right side impairment, the right dome of the diaphragm is even more elevated than the left dome. Moreover, there are kinetic disturbances in the thoracic cage caused by a deficit in the ability to generate force and oblique abdominal muscles (compromising lower rib stability), parasternal intercostal muscles, outer intercostals muscles (compromising thoracic expansibility) and scalene muscles (hindering elevation and forward expansion of the rib cage) (Teixeira-Salmela et al., 1999). Additionally, there are also reports of the participation of the more caudal intercostal parasternal muscles in posture maintenance Staurosporine order (Gandevia et al., 2006). Houston et al., 1995a and Houston et al., 1995b report that paralysis and paresis interfere with movement of the hemidiaphragm with a possible reduction or absence of paradoxical movement in the affected cupulae affected. However, this paradoxical movement was observed in fluoroscopic

examinations in only 6% of normal individuals (Alexander, 1966). This may explain the increased mobility in the impaired cupulae of subjects with right NVP-BEZ235 molecular weight hemiplegia, interpreted as a paradoxical motion. Moreover, Cohen et al., 1994a and Cohen et al., 1994b, in their study on the relationship between volume and displacement of the right diaphragm, described best observation of the hemidiaphragm due to the acoustic window created by the liver, while the left cupulae contrast with the air found in the stomach, possibly limiting observation of diaphragmatic motion. In another study, Cohen et al., 1994a and Cohen et al., 1994b, reported that 50% of their sample shows a reduced diaphragmatic motion on the paretic side, while the other half remained unchanged. The projections of these fibers are contralateral, but there is evidence

of other ipsilateral projections of corticospinal fibers, which could explain the non-difference in cupula mobility Carbachol in individuals with left hemiplegia. Thus, altered mobility cannot be attributed only to damaged fibers on the stroke side, since there is evidence of other pathways. It is important to emphasize that the supine position eliminates postural control exercised by the portion of the crural diaphragm, allowing greater freedom of movement and best viewed with the ultrasound technique chosen. PImax was lower in the hemiplegic individuals, but this difference was only statistically significant in the controls with right-side hemiplegia. In a study carried out on dogs with unilateral diaphragmatic paralysis, Scillia et al.