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Central chemoreceptors in the medulla sense

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Biology

127 Terms

1

Central chemoreceptors in the medulla sense

pH

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2

Peripheral chemoreceptors in the aorta sense

oxygen

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3

Lesion to the medulla can cause this abnormal breathing pattern

Biots/ataxic breathing

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4

Biots/ataxic breathing

irregular pattern of deep and shallow breaths

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5

Heart failure or TBI can cause this abnormal breathing pattern

Cheyne-Stokes

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6

Cheyne-Stokes

repeated cycles of deep breathing followed by shallow breathing and a short period of apnea

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7

Metabolic acidosis or kidney failure can cause this abnormal breathing pattern

Kussmaul’s Respiration

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8

Kussmaul’s Respiration

RR > 20, increased depth and dyspnea

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9

Stroke and other NM conditions can cause this abnormal breathing pattern

asymmetrical/lateral-costal breathing

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10

Stroke, spasticity, SCI, flail chest can cause this abnormal breathing pattern

chest falls with inspiration and abdomen rises with expiration

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11

Periodic breathing

rapid breathing followed by up to 10 second pause

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12

Periodic breathing is NORMAL for

1st 2 weeks to 5-6 months

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13

Injury above T1 may have these cardiopulm implications

orthostatic hypotension, temp regulation

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14

Components contributing to proper diaphragm pressures

glottis, diaphragm, pelvic floor, postural support

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15

Exercise increases level of this good cholesterol

HDL

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16

How to assess asymmetrical breathing pattern

tape measure

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17

Asymmetrical breathing and postural abnormalities put pt at risk for

under-ventilation of alveoli

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18

Muscles to assess in person post CVA

hamstrings, pecs, rhomboids, QL, middle traps

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19

Interventions for decreased breath sounds, crackles, low pulse ox

posture

stacking

ACB

lateral costal expansion

segmental breathing

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20

Pair this with stand to sit movement

speech (eccentric breathing)

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21

Pair isometric activity with this

breath hold

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22

Pair concentric activity with this

inspiration

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23

A stroke has this effect on muscle fibers

decrease type 2 fibers

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24

This LDL is considered high

100 mg/dL

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25

Decreased power output, lower VO2 max, and shift of muscle fiber types can be caused by

stroke

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26

Things to consider about 6MWT post stroke

limited by balance

poor coordination

low correlation to peak VO2

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27

_% of stroke survivors have co-existing cardiac disease

75

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28

_% of stroke survivors have silent ischemia

40

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29

Aerobic exercise post stroke has shown to improve walking speed by _

0.7 m/s

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30

Pt interventions should address these 4 outcomes

brain repair

neuroplasticity

cardiorespiratory fitness

metabolic health

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31

Aerobic exercises should begin _ hours post stroke

24-48

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32

_ intensity and _ frequency at start of aerobic exercise

low, high

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33

20-30 mins of low intensity walking had this effect in animal models

reduced lesion volume

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34

This trial found that mobilizing before 24 hours since stroke had poor outcomes

AVERT

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35

Optimal neuroplasticity window

within 12 weeks

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36

Within first 12 weeks post stroke, levels of _ are higher allowing for better neuromotor recovery

BDNF

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37

FITTI correlated with increased BDNF levels

F: 5-7 days

I: min-mod

T: 30 mins

T: walking

Initiation: 1-7 days post CVA

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38

Peak VO2 post stroke

8-15 ml/kg/min

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39

Peak VO2 post stroke is about _% of aged matched controls

40-50

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40

ADL’s are _ mets for stroke population

3

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41

To perform ADLs post stroke, need a max MET level of _ and ability to sustain a MET level of _

5.7

3.7

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42

Strokes are correlated with _ regarding metabolic effects

poor glucose tolerance

dyslipidemia

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43

Aerobic exercise recommendations 1-3 weeks post stroke

low intensity

high frequency, 1-3x/day

5-10 mins bouts

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44

Aerobic exercise recommendations 4-7 weeks post stroke

4-6 sessions/week

30-60 mins bouts

low to mod intensity

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45

Aerobic exercise recommendations 8+ weeks post stroke

3-5 sessions/week

20-60 min bouts

55-80% HRR or RPE 11-14/20

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46

Resistance training recommendations post stroke

2-3 sessions/week

1-3 sets

10-15 reps

50-80% 1RM

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47

Age estimated HR equation may _ HR max in those with stroke

overestimate

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48

max HR prediction equation for those with stroke

206.9 - (0.67 x age)

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49

max HR prediction equation for those on beta blocker

164 - (0.7 x age)

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50

Most common cause of mortality following SCI/MS

respiratory complication

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51

Pts most vulnerable to respiratory illness within _ after SCI

1 year

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52

Risk of respiratory failure directly associated with _

injury level

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53

Injury at C1-C3

vent dependent

diaphragm paralyzed

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54

Injury at C3-C4

periods of unassisted ventilation

need vent at night

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55

Injury at C5

diaphragm intact

intercostals and abdominals paralyzed

decreased lung volume

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56

Injury at C6-C8

independent breathing

below C7 can cough with pecs

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57

Injury at T1-T4

intercostals drive breathing

reduced cough efficiency due to abdominal weakness

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58

Injury at T5-T11

minimal disruption to cardiovascular system below T6

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59

Injury at T12

respiratory function comparable to normal person

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60

Spinal shock

loss of reflexes, motor function, and sensation below lesion

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61

Spinal shock can cause this to occur at chest wall

paradoxical depression of ribs

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62

Significant increase of vital capacity is seen within _ weeks of injury

5

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63

These increase post spinal shock

vital capacity, total lung capacity, inspiratory capacity

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64

This decreases post spinal shock

functional residual capacity

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65

Injury upper 6 thoracic nerves can result in

reduced FEV1

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66

Partial loss of sympathetic tone with injury above this level

T4

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67

Arms at 90, full abduction and ER forces most excursion at _ when breathing

chest

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68

Arms at side forces most excursion at _ when breathing

diaphragm

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69

Position for optimal diaphragmatic breathing

supine, bolster under knees, neck flexed, arms IR

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70

Ways to facilitate diaphragmatic breathing

sniffing

lateral costal expansion

upper chest inhibition

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71

Voice should be _ during diaphragmatic breathing

soft, slow

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72

What will inhibit diaphragmatic breathing in those with cerebral palsy

LE contractures causing poor pelvic alignment

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73

What will inhibit diaphragmatic breathing in those with CVA

one sided weakness, neglect

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74

What will inhibit diaphragmatic breathing in those with SCI

poor resting diaphragm positon

lack of innervation

TLSO

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75

Position to facilitate accessory muscle breathing

anterior pelvic tilt

no pillows

arms ER

towel along spine

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76

Voice should be _ during accessory muscle facilitation

loud, demanding

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77

Ways to facilitate accessory muscle breathing

diaphragm inhibition

pec stretch

lateral-costal expansion

butterfly maneuver

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78

What will inhibit accessory muscle breathing in those with cerebral palsy

forward head

torticollis

UE contracture

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79

What will inhibit accessory muscle breathing in those with CVA

muscle imbalance, neglect

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80

What will inhibit accessory muscle breathing in those with Guillian Barre

tracheostomy

muscle weakness

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81

What will inhibit accessory muscle breathing in those with Parkinson’s

stiff trunk

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82

What will inhibit accessory muscle breathing in those with SCI

cervical collar

lack of muscle innervation

bad wheelchair prescription

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83

Abdominal binder can improve these

voice

FVC

orthostatic hypotension

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84

Abdominal binder must be placed below _

ribs

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85

Accessory muscles of inspiration

SCM

scalenes

pec minor

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86

Primary muscles of inspiration

external intercostals

diaphragm

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87

Muscles of quiet expiration

passive recoil of lungs, ribs, and diaphragm

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88

Muscles of active expiration

internal intercostals

abs

QL

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89

Desired outcomes of IMT in SCI

increase strength

increase aerobic capacity

reduce dyspnea

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90

Desired outcomes of EMT in SCI

increase strength

improve cough force

improve speech

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91

Non-targeted inspiratory resistance trainer

P-Flex

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92

Targeted inspiratory trainer

Threshold trainer, provides visual target

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93

What position does pt have to be in to use P-Flex

upright

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94

RR has litte effect on resistance provided with this device

threshold

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95

resistance dependent on _ and _ for P-Flex

RR and size of hole

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96

Expiratory muscle trainer

The Breather

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97

Only use airway suctioning if pt can’t

expectorate on their own

other techniques not working

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98

How does constipation impact breathing?

less space for lungs to expand

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99

What can cause constipation in NM population

sphincter spasticity

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100

T6 injury and above experience chronotropic incompetence resulting in

blunter HR response

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