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respiratory muscles available in a C1-2 injury
SCM, upper traps, cervical extensors
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respiratory muscles available in a C3-4 injury
- (C1-2) SCM, upper traps, cervical extensors
- (C3-4): scalenes, levator scap, partial diaphragm
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respiratory muscles available in a C5 injury
- (C1-2) SCM, upper traps, cervical extensors (C3-4) scalenes, levator scap, partial diaphragm
- (C5): diaphragm, pec major, serratus, rhomboids
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respiratory muscles available in a C6-8 injury
- (C1-2) SCM, upper traps, cervical extensors
- (C3-4) scalenes, levator scap, partial diaphragm
- (C5) diaphragm, pec major, serratus, rhomboids
- (C6-8): pec minor, lats
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respiratory muscles available in a T1-4 injury
- (C1-2) SCM, upper traps, cervical extensors
- (C3-4) scalenes, levator scap, partial diaphragm
- (C5) diaphragm, pec major, serratus, rhomboids
- (C6-8) pec minor, lats
- (T1-4): upper intercostals and abs
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respiratory muscles available in a T5-10 injury
- (C1-2) SCM, upper traps, cervical extensors
- (C3-4) scalenes, levator scap, partial diaphragm
- (C5) diaphragm, pec major, serratus, rhomboids
- (C6-8) pec minor, lats
- (T1-4) upper intercostals and abs
- (T5-10): more intercostals and segmental abs
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respiratory muscles available in a T11 and below injury
- (C1-2) SCM, upper traps, cervical extensors
- (C3-4) scalenes, levator scap, partial diaphragm
- (C5) diaphragm, pec major, serratus, rhomboids
- (C6-8) pec minor, lats
- (T1-4) upper intercostals and abs
- (T5-10) more intercostals and segmental abs
- (T11 and below): all of the above
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nerve roots for SCM and upper traps, basic role of these two muscles
- CN 11, C2-4
- superior expansion of chest
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scalenes - attachments and nerve roots
- TPs of C-spine 3-6 --> 1st and 2nd rib
- C3-8
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serratus ant nerve roots
C5-7
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pec major nerve roots
pec minor
- major: C5-7 upper pec, C8-T1 lower pec
- minor: C8-T1
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forced vital capacity def
- max air a person can expel from the lungs after a max inhalation
- It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume
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FVCs for C1-2; 3-4; 5; 6-8; T1-4; 5-10; 11 and below
- C1-2: <10% (on a ventilator)
- C3-4: 10-40% (prob on a vent, at least at night?)
- C5: 35-55%
- C6-8: 40-70%
- T1-4: 45-75%
- T5-10: 60-95%
- T11 and below: >80%
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at what level does breathing stop being paradoxical?
- T1-4 (at C6-8 it's still paradoxical)
- reasoning: until abs are involved the energy cost of breathing is so high
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6 cough assist strategies
- abdominal thrust: heimlich -- stand post to seated pt or over supine pt, find costosternal angle, push in on exhalation to stim glottal closure and ask pt to cough or huff - pt can do this with own fist
- costophrenic assist: heimlichish but w quick-stretch -- hands on lat ribs doing lat to med force with a quick stretch right before inhalation, then apply pressure to help push air out on exhalation
- anterior chest wall compression: pressing on chest to force air out
- counter-rotation assist: sidelying, sup arm on thight, PT's hands on shoulder and hip, wring out the body -- exhale when shoudler goes ant and hip goes post
- insp/asist/Glossopharyngeal breathing: gulping air
- insufflation/exsufflation: mechanical device plugged into trach or over mouth to in/deflate lungs
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2 self-assist cough methods
- abd thrust using a fist or object
- long sit - using head-hip rel, sit up straight to inhale, through head forward to help exhalation
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what's a P-flex?
- toy to help w breaghing -- looks like a kazoo
- has apertures you can narrow
- it's exercise, breathing thru smaller and smaller holes - this increased the resistance
- only gives resistance on insp
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what's a Breather device? compare to a Threshold Trainer?
- like a P-flex but gives resistance both to insp and exp
- the threshold trainer is similar, but resistance is via a
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what's an abdominal binder for?
maintain position of diaphragm
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why is oss of supraspinal cardiac control less problematic than loss of supraspinal control or resp muscles?
heart has autonomous function
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results of losing abs and intercostals?
impaired cough, mucuciliary transport, airway clearance
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goals fo PT cardiopulm management
- maximize QOL by optimizing resp fxn
- edu the pt
- optimize: alveolar vent
- optimize: lung volumes & capacities
- optimize: ventilation and perfusion
- increase or maintain: chest expansion
- increase: cough effectiveness
- train intact accessory muslces
- coordination of breathing rate
- increase: ability to maintain brochial hygein
- reduce: work of breathing
- reduce: work of heart
- reduce: risk of aspiration
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what happens to intrathoracic pressure on inspiration?
it decreases as the lung volume increases
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long list of effects of SCI on resp
- decreased vital capacity
- decreased cough effectiveness
- diminished chest expansion due to orthopedic changes and intercostal spasticity--> contractures & less lung compliance
- decreased bronchial hygeine
- increased residual volume
- fatigue of resp muscles (and person) due to increased energy demands of breathing
- chest gets triangular (narrow flat upper, wide round lower)
- paradoxical breathin
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paradoxical breathing
- insp --> inward depression of ribs while abdomen expands
- increased use of accessory muscles
- more energy is consumed by resp muscles than is delivered
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phonation impaired, norm, optimal levels
- 4-5 syllables a breath = impaired
- 8-10 is norm
- 12 is optimal
- 20 sec prolonged phonation is also great
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what to look for in pt's resp eval
- skin color (cyanotic?)
- breath sounds - rales, rhonchi, absent
- cough - is it functional? productive?
- phonation - syllables per breath, seconds of phonation
- chest wall shape - rect. vs triangular, excavatum chest
- distress - dyspnea, DOE, tachypnea, dysphagia
- nasal flaring
- increased use of accessory muscles (necessary to a point, but don't want it overdone)
- tachycardia
- diaphoresis (profuse sweating)
- expressions of fear/anxiety
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problem list for a pt w resp problems
- decreased vital capacity
- absent or impaired cough
- decreased chest wall expansion
- increased/present risk of resp complications
- intolerance to sitting upright (this pos can make breathing harder)
- resp ms fatigure
- tachypnea
- inefficient breathing pattern
- chest wall stiffness
- poor breathing mechanics
- limited resp ms endurance and reserve
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