Module 3 readings (breathing exercises, cardiopulm examination, CNS disorders, cranial nerve disorders, pulse scale, angina types, R vs L heart failure

Diaphragmatic Breathing: Primary Goals

Increase ventilation, improve gas exchange, decrease workload, facilitate relaxation, improve chest mobility.

Diaphragmatic Breathing: Chest Wall Motion

Facilitate outward abdominal wall motion while reducing upper rib cage motion.

Diaphragmatic Breathing: Indications

Obstructive/restrictive diseases, excessive secretions, tachypnea, postoperative care, posttrauma.

Diaphragmatic Breathing: Caution

Not the best technique for chronic pulmonary dysfunction.

Diaphragmatic Breathing: Positioning

Supine, sitting, or semi-Fowler position with posterior pelvic tilt (PPT).

Diaphragmatic Breathing: Hand Placement & Resistance

Hand over subcostal angle; apply pressure through exhalation, inhale against resistance.

Lateral Costal Breathing: Purpose

Addresses asymmetrical chest expansion; relieves localized consolidation or secretions.

Lateral Costal Breathing: Positioning

Side-lying with uninvolved side down, involved arm abducted over head.

Segmental Breathing: Purpose

Improve ventilation to hypoventilated segment, alter gas distribution, restore FRC.

Segmental Breathing: Indications

Pleuritic, incisional, or posttrauma pain causing splinting, and atelectasis risk.

Segmental Breathing: Technique

Apply gentle-to-firm pressure over area during exhalation; inhale against resistance.

Sustained Maximal Inspiration (SMI): Purpose

Increase inhaled volume and restore functional residual capacity.

Sustained Maximal Inspiration (SMI): Indications

Acute situations: posttrauma, postsurgery, acute lobar collapse, ineffective cough.

Sustained Maximal Inspiration (SMI): Hold Time

Inhale slowly to maximum, hold for 3 seconds, then passively exhale.

Incentive Spirometer: Function

Encourages deep inspiration during SMI to prevent alveolar collapse.

Pursed-Lip Breathing: Physiological Effects

Increases TV, reduces RR, reduces dyspnea, facilitates relaxation.

Pursed-Lip Breathing: Mechanism

Positive back pressure prevents early airway collapse and decreases resistive pressure.

Pursed-Lip Breathing: Exhalation Ratio

Inhale through nose, passively exhale through pursed lips for 4-6 seconds.

Stacked Breathing: Description

Series of deep inspirations building without exhalation until max volume tolerated.

Stacked Breathing: Indications

Hypoventilation, atelectasis, ineffective cough, uncoordinated breathing during ADLs.

Upper Chest Inhibition Technique: Indication

Used only after all other techniques have been attempted.

Abdominal Support: Indication

Used in high thoracic/cervical SCI when abdominal muscles lack support for exhalation.

Glossopharyngeal Breathing: Description

Air gulping technique taught to assist coughing in high-level cervical SCI (e.g., C4).

Positioning for Dyspnea Relief

Leaning forward with arms supported lets accessory muscles expand the thorax.

VO₂ Max Moderate Intensity Range

40% to 60% of VO₂ max achieved on ETT.

VO₂ Max Moderate to Vigorous Intensity Range

> 60% of VO₂ max achieved on ETT.

HR Reserve Limitation in Severe Pulmonary Impairment

Patients reach ventilatory maximum before cardiovascular maximum (unable to reach MHR).

MHR Formula (Karvonen)

MHR = 208 - (0.7 × age)

Target Heart Rate Formula (Karvonen)

Target HR = (MHR - RHR) × (% intensity) + RHR

Borg RPE Scale Range

6 to 20

Sympathetic Stimulation: Cardiac & Vascular Effects

Increases HR, contractility, and myocardial metabolism; vasodilates coronary arteries, vasoconstricts peripheral vessels.

Baroreceptors: Location & Mechanism

Located in carotid sinus and aortic arch; stretching from ↑ BP triggers parasympathetic stimulation to ↓ HR.

Chemoreceptors: Triggers for Increased HR

Increased CO₂, decreased O₂, or decreased pH (elevated lactic acid) stimulate chemoreceptors to ↑ HR.

Nonmodifiable CV Risk Factors

Age (males >45, females >55), family history of early cardiac events, race, male sex.

Modifiable CV Risk Factors

Smoking, hypertension (>140/90), hyperlipidemia, sedentary lifestyle, obesity (BMI >30), diabetes (HbA1C >7%).

Central Cyanosis: Definition & Threshold

Bluish discoloration of skin, lips, and tongue associated with O₂ saturation < 80%.

Bilateral vs. Unilateral Peripheral Edema

Bilateral indicates CHF/RV failure; unilateral indicates DVT, thrombophlebitis, or lymphedema.

Apical Pulse Location

5th intercostal space at the left midclavicular line (point of maximal impulse).

Heart Sounds Auscultation Mnemonic (APTM 2245)

Aortic (2nd ICS R), Pulmonic (2nd ICS L), Tricuspid (4th ICS L), Mitral (5th ICS L).

ALL PT MAKE 2245

S1 and S2 Heart Sounds

S1 ('lub') = AV valve closure (systole onset); S2 ('dub') = semilunar valve closure (diastole onset).

S3 Heart Sound (Ventricular Gallop)

Early diastolic turbulence associated with ventricular filling; hallmark sign of CHF.

S4 Heart Sound (Atrial Gallop)

Late diastolic turbulence during atrial contraction; associated with MI, HTN, and LV hypertrophy.

Orthostatic Hypotension Diagnostic Criteria

Drop in SBP > 20 mmHg or DBP > 10 mmHg within 3 minutes of standing.

Blood Pressure Classification Stages

Elevated: 120-129/

normal respiratory breathing for adult, child, vs newborn

Adult 12-20 br/min

Child 20-30 br/min

Newborn 30-40 br/min

what is cerebellar pathology u would see

asthenia, asynergia, delayed reaction time, dysarthris, dysmetria, gait disorders, hypotonia, hypermetria, nystagmus, rebound phenomenon, titubation

what is basal ganglia pathology u would see

akinesia, athetosis, bradykinesia,chorea, rigidity, resting tremors, hyperkinesis, hypokinesis

Clasp-Knife Effect

Initial high resistance to passive stretch that suddenly gives way; seen in cortical UMN lesions.

Lead-Pipe vs Cogwheel Rigidity

Lead-pipe is sustained resistance; cogwheel is ratchetlike resistance. Non-velocity dependent basal ganglia signs.

Archicerebellum Lesion Features

Central vestibular dysfunction, nystagmus, ocular dysmetria, and gait and trunk ataxia.

Spinocerebellum Lesion Features

Hypotonia, muscle timing mismatch, truncal ataxia, and ataxic gait with high guard posture.

Neocerebellum Lesion Features

Unilateral intention tremor, dysdiadochokinesia, dysmetria, and dyssynergia.

Hemiballismus Cause and Features

Sudden, violent flailing of unilateral limbs caused by contralateral subthalamic nucleus lesion.

Huntington Disease Etiology

Autosomal-dominant neurodegenerative disorder caused by CAG trinucleotide repeat degenerating basal ganglia.

Rebound Phenomenon

Loss of check reflex resulting in inability to stop movement when isometric resistance is removed.

Huntington Disease: Affected Structures

Degeneration of the basal ganglia and cerebral cortex.

Huntington Disease: Age of Diagnosis

35 to 55 years.

Huntington Disease: Non-Motor Manifestations

Cognitive decline and behavioral changes.

Chorea: Presentation in Huntington Disease

Involuntary, rapid, irregular, or jerky movements; upper extremity commonly involved.

Hyperkinesia: Definition

Abnormally increased muscle activity or movement.

Hemiballismus: Pathophysiology & Muscles Involved

Contralateral subthalamic nucleus lesion; affects axial and proximal muscles.

Athetosis: Presentation & Location

Slow, involuntary, wormlike writhing or twisting movements; distal upper extremity commonly involved.

Bulbar Palsy: Definition & Structures Involved

Weakness or paralysis of lower brainstem muscles (CN IX-XII) affecting face, tongue, larynx, and pharynx.

Bulbar Palsy: Etiology

Tumor, vascular, or degenerative disease of the medulla or lower CNs (e.g., GBS, ALS).

Bulbar Palsy: Clinical Findings & Examination

Impaired phonation, swallowing, articulation, dysphonia; bilateral involvement causes severe dyspnea and airway restriction.

Trigeminal Neuralgia (CN V): Characteristics

Brief, recurring paroxysms of stabbing pain along CN V distribution; motor function remains unaffected.

Trigeminal Neuralgia: Triggers & Management

Triggered by cold, touch, chewing, or walking; exacerbated by stress/cold; treated with TENS for pain relief.

CN VII (Facial Nerve): Functions

Muscles of facial expression, taste on anterior 1/3 of tongue, eyelid closure, puffing cheeks.

Facial Palsy Differential: Bell's vs Stroke vs GBS

Bell's: U/L LMN (entire lateral face); Stroke: U/L UMN (C/L lower face only); GBS: B/L LMN.

CN VIII: Rinne Test Findings

Normal is AC > BC. Conductive hearing loss is BC > AC.

CN VIII: Weber Test Interpretation

Unilateral conductive loss lateralizes to affected side; unilateral sensorineural loss lateralizes to unaffected side.

CN IX & CN X: Examination

Evaluates taste/sensation on posterior 1/3 of tongue, gag reflex, swallowing, and uvula elevation ('ahh').

CN XI & CN XII: Functions & Lesion Signs

CN XI: resisted shoulder shrug; CN XII: tongue protrusion (injured tongue deviates toward side of lesion).

Bell's Palsy: Clinical Presentation & PT Interventions

Inability to wink, whistle, or wrinkle forehead; protect cornea with patch/tears, use e-stim and facial exercises.

whats the grading scale for pulse strength

0-absent not palpable

1+ pulse diminished barely palpable

2+ easily palpable, normal

3+ full pulse inc strength

4+ bounding, too strong to obliterate

how do men and women present differently for angina symptoms

men: substernal or chest tightness or indigestion that radiates, into arm or jaw

women: tightness in posteriorly between scapula or symptoms like indigestion, nausea, SOB, or excessive fatigue

what is stable (classic)) angina

occurs by exertion or emotional upset

relieved by rest or nitroglycerin

what is variant angina (prinzmetal's angina)

produced from vasospam of the coronary arteries in absences of occulsive d.

individuals experience vasospam often develop resting chest pain

usually respons to nitroglycerin

more likley to have discomfort due to emotional upset or inspiration of cold air

what is preinfarction angina (unstable)

occurs at rest and worsen with activity

intense and constant pain

required immediate medical treatment to prevent Heart attack

left vs right heart failure

left: occur with LV insult-> LV reduces CO-> leading to backup of fluid into LA and LUNGS-> inc fluid in lungs produce TWO HALLMARK SIGNS: SOB and Cough

right: occurs with direct insult of RV->inc press with PA inc afterload-> greater demand on RV, causing it to go into failure-> with RV failure, blood not effectively ejected from RV- backs up into RA and VENOUS VASCULATURE with two signs: JVD and peripheral edema

again diff between UMN vs LMN

UMN:CNS, inc tone, inc reflexes, disuse atrophy, muscle spasm

LMN: PNS, dec tone and reflexes, neurogenic fasciculations