{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:02:56Z","timestamp":1788382976682,"version":"build-2803163510"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> In normal subjects, the diaphragm plays a key functional role in postural stability, articulation, respiration, defecation, and urination.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> The aim of this study was to investigate the role of the diaphragm in postural stability and visceral function in patients with Parkinson\u2019s disease (PD) and to compare the diaphragm function by gender, Hoehn and Yahr (H&amp;amp;Y) staging, and motor subtypes.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> In total, 79 patients were enrolled in this cross-sectional study. The severity of the disease was assessed by the Movement Disorder Society-Unified Parkinson\u2019s Disease Rating Scale III and by H&amp;amp;Y staging. Postural stability was quantitatively recorded, and respiratory function was evaluated by spirometry. Several scales were used to evaluate visceral function in patients with PD. In addition, diaphragm ultrasound was used to measure the excursion, contraction velocity, and thickness of the diaphragm during quiet breathing, deep breathing, and the sniff test. Significant features were selected by the least absolute shrinkage and selection operator (LASSO) regression and fitted in the multivariate linear regression and Pearson\u2019s correlation analysis.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Diaphragm thickness and excursion during quiet breathing were significantly different between men and women and between H&amp;amp;Y stage 1\u20132 and stage 2.5\u20133, whereas the diaphragm function was not influenced by motor subtypes. It was shown that the diaphragmatic function was significantly correlated with postural stability, voice function, respiratory function, constipation, and urological function to varying degrees in patients with PD.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The diaphragmatic function is associated with dysfunction in PD although it remains unclear as to whether the observed changes in the diaphragm are primary or secondary.<\/jats:p>","DOI":"10.3389\/fnagi.2021.785020","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T15:05:42Z","timestamp":1640271942000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["The Role of the Diaphragm in Postural Stability and Visceral Function in Parkinson\u2019s Disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-ying","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-xi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao-hui","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-dan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-ping","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-ning","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo-yan","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.116625","article-title":"Extended release levodopa at bedtime as a treatment for nocturiain Parkinson\u2019s disease: an open label study.","volume":"410","author":"Brusa","year":"2020","journal-title":"J. Neurol. Sci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1185\/03007995.2012.657301","article-title":"The bowel function index: a new validated scale for assessing opioid-induced constipation.","volume":"28","author":"Ducrott\u00e9","year":"2012","journal-title":"Curr. Med. Res. Opin."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1002\/mds.27195","article-title":"Falls in parkinson\u2019s disease: a complex and evolving picture.","volume":"32","author":"Fasano","year":"2017","journal-title":"Mov. Disord."},{"key":"B4","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S1474-4422(15)00007-1","article-title":"Gastrointestinal dysfunction in Parkinson\u2019s disease.","volume":"14","author":"Fasano","year":"2015","journal-title":"Lancet Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1002\/cphy.c180012","article-title":"Evolution and functional differentiation of the diaphragm muscle of mammals.","volume":"9","author":"Fogarty","year":"2019","journal-title":"Compr. Physiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1080\/17476348.2020.1732822","article-title":"Spinal cord injury and diaphragm neuromotor control.","volume":"14","author":"Fogarty","year":"2020","journal-title":"Expert Rev. Respir. Med."},{"key":"B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization paths for generalized linear models via coordinate descent.","volume":"33","author":"Friedman","year":"2010","journal-title":"J. Stat. Softw."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1002\/mds.20213","article-title":"Movement disorder society task force report on the hoehn and yahr staging scale: status and recommendations.","volume":"19","author":"Goetz","year":"2004","journal-title":"Mov. Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of spirometry 2019 update. an official american thoracic society and european respiratory society technical statement.","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B10","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s00192-019-04157-8","article-title":"Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women.","volume":"31","author":"Hagovska","year":"2020","journal-title":"Int. Urogynecol. J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3233\/JPD-130180","article-title":"Aerodynamic assessment of phonatory onset in Parkinson\u2019s disease: evidence of decreased scaling of laryngeal and respiratory control.","volume":"3","author":"Hammer","year":"2013","journal-title":"J. Parkinsons Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1152\/jappl.2000.89.3.967","article-title":"Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm.","volume":"89","author":"Hodges","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1212\/wnl.17.5.427","article-title":"Parkinsonism: onset, progression and mortality.","volume":"17","author":"Hoehn","year":"1967","journal-title":"Neurology"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000024158","article-title":"Effect of pelvic floor electrical stimulation on diaphragm excursion and rib cage movement during tidal and forceful breathing and coughing in women with stress urinary incontinence: a randomized controlled trial.","volume":"100","author":"Hwang","year":"2021","journal-title":"Medicine"},{"key":"B15","doi-asserted-by":"publisher","first-page":"993","DOI":"10.3233\/JPD-191806","article-title":"Assessment and management of urinary dysfunction in 187 patients with parkinson\u2019s disease.","volume":"10","author":"Jia","year":"2020","journal-title":"J. Parkinsons Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s00702-012-0914-8","article-title":"Urological problems in Parkinson\u2019s disease: clinical aspects.","volume":"120","author":"Jost","year":"2012","journal-title":"J. Neural Transm."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208697","article-title":"Impact of diaphragm function parameters on balance maintenance.","volume":"13","author":"Kocjan","year":"2018","journal-title":"PLoS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/j.jvoice.2011.01.002","article-title":"Study on the simplified chinese version of the voice handicap index.","volume":"26","author":"Li","year":"2012","journal-title":"J. Voice"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jocn.2019.12.029","article-title":"Voice changes in Parkinson\u2019s disease: what are they telling us?","volume":"72","author":"Ma","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1007\/s00415-015-7823-3","article-title":"Efficacy and safety profile of prolonged release oxycodone in combination with naloxone (OXN PR) in Parkinson\u2019s disease patients with chronic pain.","volume":"262","author":"Madeo","year":"2015","journal-title":"J. Neurol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1080\/00365520510012208","article-title":"Development and validation of the patient assessment of constipation quality of life questionnaire.","volume":"40","author":"Marquis","year":"2005","journal-title":"Scand. J. Gastroenterol."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9041211","article-title":"Urinary Incontinence in Women: modern methods of physiotherapy as a support for surgical treatment or independent therapy.","volume":"9","author":"Mazur-Bialy","year":"2020","journal-title":"J. Clin. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e1427","DOI":"10.1212\/WNL.0000000000008931","article-title":"Bladder training for urinary tract symptoms in Parkinson disease.","volume":"94","author":"McDonald","year":"2020","journal-title":"Neurology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1177\/1545968320971739","article-title":"Prolonged standing task affects adaptability of postural control in people with parkinson\u2019s disease.","volume":"35","author":"Moretto","year":"2021","journal-title":"Neurorehabil. Neural Repair"},{"key":"B25","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jvoice.2020.09.021","article-title":"The cutoff point and diagnostic accuracy of the voice handicap index in cantonese-speaking population.","volume":"35","author":"Ng","year":"2020","journal-title":"J. Voice"},{"key":"B26","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1093\/ageing\/afz079","article-title":"Assessment of core and lower limb muscles for static\/dynamic balance in the older people: an ultrasonographic study.","volume":"48","author":"\u00d6zkal","year":"2019","journal-title":"Age Ageing"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.resp.2010.01.004","article-title":"The evolutionary origin of the mammalian diaphragm.","volume":"171","author":"Perry","year":"2010","journal-title":"Respir. Physiol. Neurobiol."},{"key":"B28","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1007\/s13311-020-00897-4","article-title":"Autonomic dysfunction in parkinson\u2019s disease.","volume":"17","author":"Pfeiffer","year":"2020","journal-title":"Neurotherapeutics"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson\u2019s disease.","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov. Disord."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.601225","article-title":"Comparison of three motor subtype classifications in de novo parkinson\u2019s disease patients.","volume":"11","author":"Ren","year":"2020","journal-title":"Front. Neurol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/0022-510x(96)00003-2","article-title":"Obstructive and restrictive pulmonary dysfunctions in Parkinson\u2019s disease.","volume":"138","author":"Sabat\u00e9","year":"1996","journal-title":"J. Neurol. Sci."},{"key":"B32","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1002\/mus.23671","article-title":"Neuromuscular ultrasound for evaluation of the diaphragm.","volume":"47","author":"Sarwal","year":"2013","journal-title":"Muscle Nerve"},{"key":"B33","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1159\/000479927","article-title":"Speech and communication changes reported by people with parkinson\u2019s disease.","volume":"69","author":"Schalling","year":"2017","journal-title":"Folia Phoniatr. Logop."},{"key":"B34","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1038\/nrn.2017.62","article-title":"Non-motor features of Parkinson disease.","volume":"18","author":"Schapira","year":"2017","journal-title":"Nat. Rev. Neurosci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1002\/mds.25613","article-title":"Framework for understanding balance dysfunction in Parkinson\u2019s disease.","volume":"28","author":"Schoneburg","year":"2013","journal-title":"Mov. Disord."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1164\/rccm.201912-2341OC","article-title":"Tissue doppler imaging of the diaphragm in healthy subjects and critically Ill patients.","volume":"202","author":"Soilemezi","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1159\/000506016","article-title":"Evaluation of respiratory muscle strength and diaphragm ultrasound: normative values, theoretical considerations, and practical recommendations.","volume":"99","author":"Spiesshoefer","year":"2020","journal-title":"Respiration"},{"key":"B38","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1002\/mds.25383","article-title":"How to identify tremor dominant and postural instability\/gait difficulty groups with the movement disorder society unified Parkinson\u2019s disease rating scale: comparison with the unified Parkinson\u2019s disease rating scale.","volume":"28","author":"Stebbins","year":"2013","journal-title":"Mov. Disord."},{"key":"B39","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jmpt.2017.01.005","article-title":"Effects of diaphragmatic breathing patterns on balance: a preliminary clinical trial.","volume":"40","author":"Stephens","year":"2017","journal-title":"J. Manip. Physiol. Ther."},{"key":"B40","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jns.2014.08.003","article-title":"Depression and voice handicap in Parkinson disease.","volume":"346","author":"Sunwoo","year":"2014","journal-title":"J. Neurol. Sci."},{"key":"B41","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1080\/00222895.2017.1327413","article-title":"The impact of deep muscle training on the quality of posture and breathing.","volume":"50","author":"Szczygiel","year":"2018","journal-title":"J. Mot. Behav."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0244539","article-title":"Respiratory kinematics and the regulation of subglottic pressure for phonation of pitch jumps - a dynamic MRI study.","volume":"15","author":"Traser","year":"2020","journal-title":"PLoS One"},{"key":"B43","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.resp.2016.11.007","article-title":"Respiratory dynamics in phonation and breathing\u2014a real-time MRI study.","volume":"236","author":"Traser","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005559","article-title":"Levodopa reverse stridor and prevent subsequent endotracheal intubation in Parkinson disease patients with bilateral vocal cord palsy: a case report.","volume":"95","author":"Tsai","year":"2016","journal-title":"Medicine"},{"key":"B45","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1007\/s00134-019-05892-8","article-title":"Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients-a narrative review.","volume":"46","author":"Tuinman","year":"2020","journal-title":"Intensive Care Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1038\/ajg.2010.408","article-title":"Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension.","volume":"106","author":"Villoria","year":"2011","journal-title":"Am. J. Gastroenterol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1007\/s00134-012-2547-7","article-title":"Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation.","volume":"38","author":"Vivier","year":"2012","journal-title":"Intensive Care Med."},{"key":"B48","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1164\/rccm.201701-0218PP","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary.","volume":"195","author":"Vogelmeier","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"381","DOI":"10.3233\/NRE-192983","article-title":"Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: a randomized control trial.","volume":"46","author":"Yoon","year":"2020","journal-title":"NeuroRehabilitation"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-55724-4","article-title":"Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial.","volume":"9","author":"Zachovajeviene","year":"2019","journal-title":"Sci. Rep."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00724","article-title":"Dysregulation of respiratory center drive (P0.1) and muscle strength in patients with early stage idiopathic parkinson\u2019s disease.","volume":"10","author":"Zhang","year":"2019","journal-title":"Front. Neurol."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2021.785020\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T15:05:49Z","timestamp":1640271949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2021.785020\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,23]]},"references-count":51,"alternative-id":["10.3389\/fnagi.2021.785020"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2021.785020","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,23]]},"article-number":"785020"}}