PT7120- Pulmonary Rehab and Pulmonary Neurologic Considerations

Pulmonary rehabilitation

_____________________________ is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.

Dyspnea; function; costs

Goals of Pulmonary Rehab:

- Reduce __________________

- Improve ___________________

- Reduce health care associated ____________________

Note: PR does not improve lung function.

Goal; education; psychosocial

Components of Pulmonary Rehab:

- Individual assessment and ____________________ setting

- ___________________ for self management

- Exercise

- ____________________ support

- Measured outcomes

<70%; 2-4

Eligibility Requirements for Pulmonary Rehab:

PFT indicating _____________________ FEV1/FVC after bronchodilator plus GOLD Severity Groups ______________________

Weakness; transplant; kidney; >4

Diagnosis/Conditions Appropriate for Pulmonary Rehab:

- COPD

- Asthma

- Cystic fibrosis

- Bronchiectasis

- Interstitial restrictive disease

- Chest wall diseases such as kyphoscoliosis

- ___________________ from neuromuscular disease (MS, PD, ALS)

- Lung cancer (before and after surgery/treatment)

- Lung ___________________ (both before and after)

- Obesity

- Pulmonary HTN

- Ventilatory dependency

- Pre/post heart, liver, __________________ transplant

-Suspected or confirmed COVID-19 with __________________ weeks persistent symptoms

Cardiac; pulmonary HTN; cognition; mobility

Contraindications to Pulmonary Rehab:

- Unstable _____________________ conditions

- Severe untreated _____________________

- Advanced liver disease

- Inability to participate → Severe orthopedic conditions, poor _______________________, poor baseline _______________________

Contraindication

Active smoking is not a _____________________ to pulmonary rehab in most programs.

B; Advantage; 36

Benefit and Insurance Coverage for Pulmonary Rehab:

- Active Medicare Part _________________ benefit

- Medicare ____________________ Plans

- Private insurers

- ___________________ visits

Diaphragm and external intercostals

What are your primary inspiratory muscles?

Diaphragm

Phrenic n. (C3, 4, 5)

External intercostals

T1-T12

Internal intercostals, rectus abdominis, external and internal obliques, transversus abdominis

What are your primary expiratory muscles?

Internal intercostals

T1-T11

Rectus abdominis

T1-T12

External and internal obliques

T6-T12

Transversus abdominis

T6-T12

Can't cough as well → not enough secretion clearance → pneumonia

What is compromised if expiratory muscle activation is weak or absent and what diagnosis does it place the patient at risk for developing?

Functional, weak functional, non-functional

How is cough categorized?

Symmetry → Ranges from normal to abnormal and depends on location of lesion

Excursion → Abnormal d/t muscle weakness

Timing → Abnormal, may change each time

Ratio → Abnormal, may recruit abdominals

What chest exam findings do you expect to find in the neurologically compromised patient?

Huffing; forward

If they have a weak functional cough → ______________________ in combination with manual assist -or- Instruct patient to tilt head back initially and throw head __________________ with assist.

Cough assist device

If they have non-functional cough → Need _____________________.

Autonomic dysreflexia

Avoid triggers (often related to pain below level of injury) - typical in T6 or higher injuries with unopposed SNS activity causing large spikes in blood pressure - considered emergency.

Lay patient down

If patient has autonomic dysreflexia, don't __________________. Find and remove trigger!

Orthostatic hypotension

Abdominal binder and TED hose, decreased muscle tone and increased time in the bed.

DVT

Prophylaxis needed → TED hose, blood thinners

Apnea

Sleep ___________________ and PNA are common respiratory complications.

Decreased vital capacity

Loss of muscular support for posture, impaired respiratory strength for ventilation.

Diaphragm; ventilator

C3 injury → loss of __________________ → need total ___________________ support

Weakened; ventilatory

C4-C5 injury → ___________________ diaphragm → need _________________ assist, may need ventilator support

Intercostal; abdominals

C6-T5 injury → diaphragm intact, weak _____________________ and ____________________ (cannot sit unsupported) → will need total assist for cough/secretion clearance, non functional cough

Abdominal; assist

T5-T12 injury → weak _____________________ muscles - weak functional cough → require ____________________ for cough (self/external)

Respiratory deficit

L1-S4 injury → Likely no ____________________; able to cough, sneeze, breathe