The selection of hemiplegic volunteers was based on the same criteria and included the presence of hemiplegia secondary to cerebrovascular disease, with impairment of one of the cerebral hemispheres (determined by computed tomography), with muscle hypertonia on the affected side and sufficient cognitive level to understand verbal commands and perform the voluntary respiratory movements requested. Volunteers unable to perform the required movements, those with muscle hypotonia or in the acute stroke phase, subjects with

emotional liability that would affect movement performance and individuals with facial paralysis were excluded from the study. Patients with hemiplegia were distributed into two groups: patients with right-side hemiplegia and patients

with left-side hemiplegia. All patients were at more than 24 months post-stroke. Lung function tests, diaphragmatic excursion, volumetric measurement, maximal find more check details inspiratory pressure and quantification of motor function were evaluated in this order. Spirometry (Vitalograph 2010 spirometer) was performed in compliance with ATS/ERS (2005). The following parameters were assessed during the test: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), mean forced expiratory flow between 25 and 75% of the FVC maneuver (FEF25–75%), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV). The first two parameters are expressed in liters per second (l/s) and the last three in liters per minute (l/min). A previously calibrated spirometer

was used in the evaluations. Assessment of spirometry was performed with patients in the sitting position. Assessment of diaphragmatic excursion on the cranial-caudal Flavopiridol (Alvocidib) axis was performed using ultrasound in M mode (format that views the movement in a window of time) using the LOGIQTM 100 Pro (Siemens) model C36 and convex transducer (FOV: 68X, ROC: 50 mm), with variable frequency between 3.5 and 5.0 MHz depending on the depth of the structure for best image visualization. For this assessment, the volunteer remained in the supine position, with a ten-degree inclination of the upper part of the body. The movement of each hemidiaphragm was measured in centimeters on the cranial-caudal axis, starting with the condition of functional residual capacity until reaching total lung capacity. Inspiratory capacity was measured simultaneously on an analog ventilometer (Wright–Ferraris), using a mouthpiece and nose clip. To obtain the image, the transducer was positioned on the abdominal wall just below the ribs between the mid axillary line and the mammillary line, forming a 45-degree angle between the transducer and the surface of the abdominal wall in the cephalic direction (Cohen et al., 1994a and Houston et al., 1994), as shown in Fig.