Objective: To investigate and compare the efficacy of a 6-week, supervised respiratory training program using the AiroFit PRO™ mobile respiratory trainer against traditional Pursed-Lips Breathing exercises in individuals with hemiplegia.

Study Design: A single-blind, two-arm, randomized controlled trial.

Participants: Ambulatory adults with stable hemiplegia (≥3 months post-stroke), who are medically stable and able to follow commands.

Interventions: Participants will be randomly assigned to one of two groups:

Experimental Group: Will perform Inspiratory Muscle Training using the AiroFit PRO™ device for 15 minutes/day, 5 days/week, for 6 weeks. The intensity will be progressively increased.

Active Control Group: Will perform Pursed-Lips Breathing exercises for an identical duration and frequency.

Primary Outcomes: Changes in pulmonary function tests, including Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Maximal Inspiratory Pressure (MIP).

Significance: This study will provide high-level evidence on the utility of smart, device-guided respiratory training as a novel component of neurorehabilitation, potentially offering a more effective strategy to improve respiratory health and overall recovery in hemiplegic patients compared to standard breathing exercises.

Hemiplegia, a cardinal feature of post-stroke morbidity, is characterized by unilateral motor weakness and paralysis, leading to profound physical deconditioning. While rehabilitation efforts have traditionally focused on limb function and ambulation, the critical role of respiratory muscle strength in overall functional capacity and quality of life is increasingly recognized. Individuals with hemiplegia frequently exhibit diaphragmatic weakness and impaired pulmonary function on the affected side, a condition often termed "respiratory hemiplegia." This can result in restrictive lung patterns, reduced cough efficacy, and increased susceptibility to respiratory complications, further diminishing physical performance and independence.

Inspiratory Muscle Training (IMT) has emerged as a targeted intervention to address this deficit. By providing resistance during inhalation, IMT aims to strengthen the diaphragm and accessory respiratory muscles, analogous to strength training for limb muscles. Conventional IMT has shown promise in various populations; however, its application in hemiplegia can be limited by a lack of motivation, difficulty with handling devices, and the absence of biofeedback.

The advent of smart, mobile respiratory trainers, like the AiroFit PRO™, offers a potential solution to these limitations. These devices provide real-time visual feedback and structured training programs, which may enhance patient engagement, ensure correct technique, and allow for precise progression of training intensity. While the benefits of standard IMT are being explored, the specific efficacy of this new generation of technologically assisted devices in a hemiplegic population remains insufficiently investigated.

Therefore, this study is designed to bridge this gap in clinical knowledge. We hypothesize that a structured IMT program using the mobile AiroFit PRO™ device will lead to significant improvements in respiratory muscle strength, pulmonary function parameters, and overall quality of life in individuals with hemiplegia compared to a control group.

Participants: Ambulatory adults with stable hemiplegia (≥3 months post-stroke), who are medically stable and able to follow commands.

Interventions: Participants will be randomly assigned to one of two groups:

Experimental Group: Will perform Inspiratory Muscle Training using the AiroFit PRO™ device for 15 minutes/day, 5 days/week, for 6 weeks. The intensity will be progressively increased.

Active Control Group: Will perform Pursed-Lips Breathing exercises for an identical duration and frequency.

Primary Outcomes: Changes in pulmonary function tests, including Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Maximal Inspiratory Pressure (MIP).

Inclusion Criteria:

• Clinical Diagnosis: A confirmed diagnosis of unilateral hemiplegia or hemiparesis (e.g., secondary to ischemic or hemorrhagic stroke), sustained at least 3 months prior to enrollment.
• Age: Aged between 18 and 80 years.
• Stable Medical Condition: Medically stable, as determined by the treating physician, with no changes in their primary rehabilitation regimen or medication for spasticity/neurological condition in the past 4 weeks.
• Cognitive & Communication Ability: Sufficient cognitive function and language comprehension to understand and follow simple commands and provide informed consent, as assessed by a Mini-Mental State Examination (MMSE) score of ≥ 24 (or a similar validated tool).
• Respiratory Status: Able to perform forced expiratory maneuvers for spirometry and tolerate the breathing training protocols.

Exclusion Criteria:

• Pre-existing, significant respiratory diseases (e.g., severe COPD, asthma, pulmonary fibrosis, active lung cancer).
• Unstable cardiovascular conditions (e.g., uncontrolled hypertension, unstable angina, recent myocardial infarction within the past 6 months, congestive heart failure NYHA Class III or IV).
• Inability to achieve a proper seal with the breathing trainer mouthpiece due to facial muscle weakness or other anatomical reasons.
• Inability to commit to the 6-week training and assessment schedule

The IPD and supporting documents will not be made available until the study has been published.

In this randomized controlled trial, assessor blinding (also known as single-blinding) refers to the practice where the healthcare professionals responsible for measuring the study's primary and secondary outcomes are kept unaware of which intervention group (AiroFit™ PRO or Pursed-Lips Breathing) each participant has been assigned to.