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127 Terms
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1
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Central chemoreceptors in the medulla sense
pH
2
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Peripheral chemoreceptors in the aorta sense
oxygen
3
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Lesion to the medulla can cause this abnormal breathing pattern
Biots/ataxic breathing
4
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Biots/ataxic breathing
irregular pattern of deep and shallow breaths
5
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Heart failure or TBI can cause this abnormal breathing pattern
Cheyne-Stokes
6
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Cheyne-Stokes
repeated cycles of deep breathing followed by shallow breathing and a short period of apnea
7
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Metabolic acidosis or kidney failure can cause this abnormal breathing pattern
Kussmaul’s Respiration
8
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Kussmaul’s Respiration
RR > 20, increased depth and dyspnea
9
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Stroke and other NM conditions can cause this abnormal breathing pattern
asymmetrical/lateral-costal breathing
10
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Stroke, spasticity, SCI, flail chest can cause this abnormal breathing pattern
chest falls with inspiration and abdomen rises with expiration
11
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Periodic breathing
rapid breathing followed by up to 10 second pause
12
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Periodic breathing is NORMAL for
1st 2 weeks to 5-6 months
13
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Injury above T1 may have these cardiopulm implications
orthostatic hypotension, temp regulation
14
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Components contributing to proper diaphragm pressures
glottis, diaphragm, pelvic floor, postural support
15
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Exercise increases level of this good cholesterol
HDL
16
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How to assess asymmetrical breathing pattern
tape measure
17
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Asymmetrical breathing and postural abnormalities put pt at risk for
under-ventilation of alveoli
18
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Muscles to assess in person post CVA
hamstrings, pecs, rhomboids, QL, middle traps
19
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Interventions for decreased breath sounds, crackles, low pulse ox
posture
stacking
ACB
lateral costal expansion
segmental breathing
20
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Pair this with stand to sit movement
speech (eccentric breathing)
21
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Pair isometric activity with this
breath hold
22
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Pair concentric activity with this
inspiration
23
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A stroke has this effect on muscle fibers
decrease type 2 fibers
24
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This LDL is considered high
> 100 mg/dL
25
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Decreased power output, lower VO2 max, and shift of muscle fiber types can be caused by
stroke
26
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Things to consider about 6MWT post stroke
limited by balance
poor coordination
low correlation to peak VO2
27
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_% of stroke survivors have co-existing cardiac disease
75
28
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_% of stroke survivors have silent ischemia
40
29
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Aerobic exercise post stroke has shown to improve walking speed by _
0\.7 m/s
30
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Pt interventions should address these 4 outcomes
brain repair
neuroplasticity
cardiorespiratory fitness
metabolic health
31
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Aerobic exercises should begin _ hours post stroke
24-48
32
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*_ intensity and* _ frequency at start of aerobic exercise
low, high
33
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20-30 mins of low intensity walking had this effect in animal models
reduced lesion volume
34
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This trial found that mobilizing before 24 hours since stroke had poor outcomes
AVERT
35
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Optimal neuroplasticity window
within 12 weeks
36
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Within first 12 weeks post stroke, levels of _ are higher allowing for better neuromotor recovery
BDNF
37
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FITTI correlated with increased BDNF levels
F: 5-7 days
I: min-mod
T: 30 mins
T: walking
Initiation: 1-7 days post CVA
38
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Peak VO2 post stroke
8-15 ml/kg/min
39
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Peak VO2 post stroke is about _% of aged matched controls
40-50
40
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ADL’s are _ mets for stroke population
> 3
41
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To perform ADLs post stroke, need a max MET level of *_ and ability to sustain a MET level of* _
5\.7
3\.7
42
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Strokes are correlated with _ regarding metabolic effects
poor glucose tolerance
dyslipidemia
43
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Aerobic exercise recommendations 1-3 weeks post stroke
low intensity
high frequency, 1-3x/day
5-10 mins bouts
44
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Aerobic exercise recommendations 4-7 weeks post stroke
4-6 sessions/week
30-60 mins bouts
low to mod intensity
45
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Aerobic exercise recommendations 8+ weeks post stroke
3-5 sessions/week
20-60 min bouts
55-80% HRR or RPE 11-14/20
46
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Resistance training recommendations post stroke
2-3 sessions/week
1-3 sets
10-15 reps
50-80% 1RM
47
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Age estimated HR equation may _ HR max in those with stroke
overestimate
48
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max HR prediction equation for those with stroke
206\.9 - (0.67 x age)
49
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max HR prediction equation for those on beta blocker
164 - (0.7 x age)
50
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Most common cause of mortality following SCI/MS
respiratory complication
51
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Pts most vulnerable to respiratory illness within _ after SCI
1 year
52
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Risk of respiratory failure directly associated with _
injury level
53
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Injury at C1-C3
vent dependent
diaphragm paralyzed
54
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Injury at C3-C4
periods of unassisted ventilation
need vent at night
55
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Injury at C5
diaphragm intact
intercostals and abdominals paralyzed
decreased lung volume
56
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Injury at C6-C8
independent breathing
below C7 can cough with pecs
57
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Injury at T1-T4
intercostals drive breathing
reduced cough efficiency due to abdominal weakness
58
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Injury at T5-T11
minimal disruption to cardiovascular system below T6
59
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Injury at T12
respiratory function comparable to normal person
60
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Spinal shock
loss of reflexes, motor function, and sensation below lesion
61
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Spinal shock can cause this to occur at chest wall
paradoxical depression of ribs
62
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Significant increase of vital capacity is seen within _ weeks of injury
5
63
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These increase post spinal shock
vital capacity, total lung capacity, inspiratory capacity
64
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This decreases post spinal shock
functional residual capacity
65
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Injury upper 6 thoracic nerves can result in
reduced FEV1
66
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Partial loss of sympathetic tone with injury above this level
T4
67
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Arms at 90, full abduction and ER forces most excursion at _ when breathing
chest
68
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Arms at side forces most excursion at _ when breathing
diaphragm
69
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Position for optimal diaphragmatic breathing
supine, bolster under knees, neck flexed, arms IR
70
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Ways to facilitate diaphragmatic breathing
sniffing
lateral costal expansion
upper chest inhibition
71
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Voice should be _ during diaphragmatic breathing
soft, slow
72
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What will inhibit diaphragmatic breathing in those with cerebral palsy
LE contractures causing poor pelvic alignment
73
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What will inhibit diaphragmatic breathing in those with CVA
one sided weakness, neglect
74
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What will inhibit diaphragmatic breathing in those with SCI
poor resting diaphragm positon
lack of innervation
TLSO
75
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Position to facilitate accessory muscle breathing
anterior pelvic tilt
no pillows
arms ER
towel along spine
76
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Voice should be _ during accessory muscle facilitation
loud, demanding
77
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Ways to facilitate accessory muscle breathing
diaphragm inhibition
pec stretch
lateral-costal expansion
butterfly maneuver
78
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What will inhibit accessory muscle breathing in those with cerebral palsy
forward head
torticollis
UE contracture
79
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What will inhibit accessory muscle breathing in those with CVA
muscle imbalance, neglect
80
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What will inhibit accessory muscle breathing in those with Guillian Barre
tracheostomy
muscle weakness
81
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What will inhibit accessory muscle breathing in those with Parkinson’s
stiff trunk
82
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What will inhibit accessory muscle breathing in those with SCI
cervical collar
lack of muscle innervation
bad wheelchair prescription
83
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Abdominal binder can improve these
voice
FVC
orthostatic hypotension
84
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Abdominal binder must be placed below _
ribs
85
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Accessory muscles of inspiration
SCM
scalenes
pec minor
86
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Primary muscles of inspiration
external intercostals
diaphragm
87
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Muscles of quiet expiration
passive recoil of lungs, ribs, and diaphragm
88
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Muscles of active expiration
internal intercostals
abs
QL
89
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Desired outcomes of IMT in SCI
increase strength
increase aerobic capacity
reduce dyspnea
90
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Desired outcomes of EMT in SCI
increase strength
improve cough force
improve speech
91
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Non-targeted inspiratory resistance trainer
P-Flex
92
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Targeted inspiratory trainer
Threshold trainer, provides visual target
93
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What position does pt have to be in to use P-Flex
upright
94
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RR has litte effect on resistance provided with this device
threshold
95
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resistance dependent on _ *and* _ for P-Flex
RR and size of hole
96
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Expiratory muscle trainer
The Breather
97
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Only use airway suctioning if pt can’t
expectorate on their own
other techniques not working
98
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How does constipation impact breathing?
less space for lungs to expand
99
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What can cause constipation in NM population
sphincter spasticity
100
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T6 injury and above experience chronotropic incompetence resulting in
blunter HR response
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