Cardio Final

Central chemoreceptors in the medulla sense

pH

Peripheral chemoreceptors in the aorta sense

oxygen

Lesion to the medulla can cause this abnormal breathing pattern

Biots/ataxic breathing

Biots/ataxic breathing

irregular pattern of deep and shallow breaths

Heart failure or TBI can cause this abnormal breathing pattern

Cheyne-Stokes

Cheyne-Stokes

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

Metabolic acidosis or kidney failure can cause this abnormal breathing pattern

Kussmaul’s Respiration

Kussmaul’s Respiration

RR > 20, increased depth and dyspnea

Stroke and other NM conditions can cause this abnormal breathing pattern

asymmetrical/lateral-costal breathing

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

chest falls with inspiration and abdomen rises with expiration

Periodic breathing

rapid breathing followed by up to 10 second pause

Periodic breathing is NORMAL for

1st 2 weeks to 5-6 months

Injury above T1 may have these cardiopulm implications

orthostatic hypotension, temp regulation

Components contributing to proper diaphragm pressures

glottis, diaphragm, pelvic floor, postural support

Exercise increases level of this good cholesterol

HDL

How to assess asymmetrical breathing pattern

tape measure

Asymmetrical breathing and postural abnormalities put pt at risk for

under-ventilation of alveoli

Muscles to assess in person post CVA

hamstrings, pecs, rhomboids, QL, middle traps

Interventions for decreased breath sounds, crackles, low pulse ox

posture

stacking

ACB

lateral costal expansion

segmental breathing

Pair this with stand to sit movement

speech (eccentric breathing)

Pair isometric activity with this

breath hold

Pair concentric activity with this

inspiration

A stroke has this effect on muscle fibers

decrease type 2 fibers

This LDL is considered high

> 100 mg/dL

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

stroke

Things to consider about 6MWT post stroke

limited by balance

poor coordination

low correlation to peak VO2

_% of stroke survivors have co-existing cardiac disease

75

_% of stroke survivors have silent ischemia

40

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

0\.7 m/s

Pt interventions should address these 4 outcomes

brain repair

neuroplasticity

cardiorespiratory fitness

metabolic health

Aerobic exercises should begin _ hours post stroke

24-48

*_ intensity and* _ frequency at start of aerobic exercise

low, high

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

reduced lesion volume

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

AVERT

Optimal neuroplasticity window

within 12 weeks

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

BDNF

FITTI correlated with increased BDNF levels

F: 5-7 days

I: min-mod

T: 30 mins

T: walking

Initiation: 1-7 days post CVA

Peak VO2 post stroke

8-15 ml/kg/min

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

40-50

ADL’s are _ mets for stroke population

> 3

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

5\.7

3\.7

Strokes are correlated with _ regarding metabolic effects

poor glucose tolerance

dyslipidemia

Aerobic exercise recommendations 1-3 weeks post stroke

low intensity

high frequency, 1-3x/day

5-10 mins bouts

Aerobic exercise recommendations 4-7 weeks post stroke

4-6 sessions/week

30-60 mins bouts

low to mod intensity

Aerobic exercise recommendations 8+ weeks post stroke

3-5 sessions/week

20-60 min bouts

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

Resistance training recommendations post stroke

2-3 sessions/week

1-3 sets

10-15 reps

50-80% 1RM

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

overestimate

max HR prediction equation for those with stroke

206\.9 - (0.67 x age)

max HR prediction equation for those on beta blocker

164 - (0.7 x age)

Most common cause of mortality following SCI/MS

respiratory complication

Pts most vulnerable to respiratory illness within _ after SCI

1 year

Risk of respiratory failure directly associated with _

injury level

Injury at C1-C3

vent dependent

diaphragm paralyzed

Injury at C3-C4

periods of unassisted ventilation

need vent at night

Injury at C5

diaphragm intact

intercostals and abdominals paralyzed

decreased lung volume

Injury at C6-C8

independent breathing

below C7 can cough with pecs

Injury at T1-T4

intercostals drive breathing

reduced cough efficiency due to abdominal weakness

Injury at T5-T11

minimal disruption to cardiovascular system below T6

Injury at T12

respiratory function comparable to normal person

Spinal shock

loss of reflexes, motor function, and sensation below lesion

Spinal shock can cause this to occur at chest wall

paradoxical depression of ribs

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

5

These increase post spinal shock

vital capacity, total lung capacity, inspiratory capacity

This decreases post spinal shock

functional residual capacity

Injury upper 6 thoracic nerves can result in

reduced FEV1

Partial loss of sympathetic tone with injury above this level

T4

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

chest

Arms at side forces most excursion at _ when breathing

diaphragm

Position for optimal diaphragmatic breathing

supine, bolster under knees, neck flexed, arms IR

Ways to facilitate diaphragmatic breathing

sniffing

lateral costal expansion

upper chest inhibition

Voice should be _ during diaphragmatic breathing

soft, slow

What will inhibit diaphragmatic breathing in those with cerebral palsy

LE contractures causing poor pelvic alignment

What will inhibit diaphragmatic breathing in those with CVA

one sided weakness, neglect

What will inhibit diaphragmatic breathing in those with SCI

poor resting diaphragm positon

lack of innervation

TLSO

Position to facilitate accessory muscle breathing

anterior pelvic tilt

no pillows

arms ER

towel along spine

Voice should be _ during accessory muscle facilitation

loud, demanding

Ways to facilitate accessory muscle breathing

diaphragm inhibition

pec stretch

lateral-costal expansion

butterfly maneuver

What will inhibit accessory muscle breathing in those with cerebral palsy

forward head

torticollis

UE contracture

What will inhibit accessory muscle breathing in those with CVA

muscle imbalance, neglect

What will inhibit accessory muscle breathing in those with Guillian Barre

tracheostomy

muscle weakness

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

stiff trunk

What will inhibit accessory muscle breathing in those with SCI

cervical collar

lack of muscle innervation

bad wheelchair prescription

Abdominal binder can improve these

voice

FVC

orthostatic hypotension

Abdominal binder must be placed below _

ribs

Accessory muscles of inspiration

SCM

scalenes

pec minor

Primary muscles of inspiration

external intercostals

diaphragm

Muscles of quiet expiration

passive recoil of lungs, ribs, and diaphragm

Muscles of active expiration

internal intercostals

abs

QL

Desired outcomes of IMT in SCI

increase strength

increase aerobic capacity

reduce dyspnea

Desired outcomes of EMT in SCI

increase strength

improve cough force

improve speech

Non-targeted inspiratory resistance trainer

P-Flex

Targeted inspiratory trainer

Threshold trainer, provides visual target

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

upright

RR has litte effect on resistance provided with this device

threshold

resistance dependent on _ *and* _ for P-Flex

RR and size of hole

Expiratory muscle trainer

The Breather

Only use airway suctioning if pt can’t

expectorate on their own

other techniques not working

How does constipation impact breathing?

less space for lungs to expand

What can cause constipation in NM population

sphincter spasticity

T6 injury and above experience chronotropic incompetence resulting in

blunter HR response