What are the 3 muscles groups involved in breathing and what do they control
- Muscles of pharynx and larynx control the upper airway
- Diaphragm, spine, ribcage, and neck muscles contribute to inspiration
- Muscles of abdominal wall, ribcage and spine contribute to expiration
Diaphragm contributes to __% of inspiration
40%
Diaphragm spends __% of the day contracting
45%
What are the two regions of the diaphragm
- costal - arising from lower 6 ribs and xiphoid process
- crural arises from upper 3 lumbar vertebrae
What is the most important accessory muscle of inspiration
sternocleidomastoid
What are the 4 accessory muscles of inspiratinon
- SCM
- Scalenes
- Pec minor
- Intercostals
Which intercostal is the primary muscle of inspiration
parasternal
What intercostal are accessory for inspiration
external intercostals
what intercostals are accessory in expiration
internal intercostals
Expiration is ___ at rest
passive
during active breathing which muscle group is involved in expiration
abdominals increase abdominal pressure
Which abdominals have the greatest contribution to expiration
transversus abdominis
What is the results of weak abdominals
No firm base for diaphragm contraction -> diaphragm is resting lower, decreased ROM, generation of pressure is not as efficient - leads to outward motion of abdomen rather than inflation of rib cage
What is the result of the denervation of intercostals
loss of outward movement of upper chest wall. During diaphragm contraction upper chest is sucked inward, abdomen is pushed outward, less of a volume increase for diaphragm contraction
In what populations is IMT effective
- some athletes
- COPD
- Congestive heart failure
- Spinal cord injury
In people with COPD, CHF, SCI IMT can…
- improve inspiratory muscle strength
- decrease dyspnea
- improve exercise tolerance
What are the 4 steps to IMT treatment
- patient selection
- chose IMT device
- Measure IMT strength and/or endurance
- Prescription parameters
What are the prescription parameters of IMT
- frequency
- intensity
- duration
- outcome measures
What are the main considerations for patient selection for IMT in people with COPD and CHF
- Stable condition and properly managed; not during or immediately after an exacerbation
- Weakness of inspiratory muscles
- Dyspnea that is more than usual
What are the main considerations for patient selection for IMT in people with SCI
- Those with higher level of injury but still partially intact diaphragm
What are the main considerations for patient selection for IMT in athletes
depends on sport and individual
What are two contraindication for IMT
- acute respiratory failure
- cognitive impairment
What is the most common appropriate device for IMT
Threshold type trainers (NOT trainers without target nonono)
How do you measure IMT strength/endurance
- measure maximal inspiratory pressure with electronic force meter
- measure inspiratory muscle endurance with threshold device
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RESP - ASSESSMENT29
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Go to neuro for chest xray0
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Arterial blood gases29
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Anaesthetics and surgery29
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IMT30
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ECG42
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BREATHING EXERCISES25
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Diaphragmatic assessment & treatment18
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Pulmonary rehabilitation24
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Therapeutic mobilization in acute care41
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Secretion Clearance30
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GERIATRIC AND MEDICAL PATIENTS30
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Clinical positioning for optimizing dyspnea, ventilation & perfusion20
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Hemodynamic instability9
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Suctioning19
