Benefit of Forced Expiratory Technique for Weak Cough in a Patient with Bulbar Onset Amyotrophic Lateral Sclerosis
|
|
- Thomas Rose
- 6 years ago
- Views:
Transcription
1 Original Article Benefit of Forced Expiratory Technique for Weak Cough in a Patient with Bulbar Onset Amyotrophic Lateral Sclerosis J. Phys. Ther. Sci. 16: , 2004 MITSUAKI ISHII, RPT 1) 1) Department of Physical Therapy, Maizuru Municipal Hospital: Mizoshiri, Maizuru, Kyoto , Japan. TEL FAX mm.ishii@orion.ocn.ne.jp Abstract. The specific purpose of this case study was to investigate whether forced expiratory technique (FET) improves the peak expiratory flow compared to coughing in a 53-year-old man with amyotrophic lateral sclerosis (ALS) who presented with bulbar symptoms. Approximately 12 months after diagnosis, his peak cough flow did not exceed 160 L/min, and cough became ineffective. However, FET could generate peak expiratory flow to a point over the 160 L/min threshold until 14.5 months after diagnosis. As a result, FET delayed the need for tracheostomy. When the forced vital capacity (FVC) was observed to be markedly decreased and it was 1,600 ml, the patient was unable to achieve 160 L/min of peak expiratory flow generated by FET. Patients with bulbar onset ALS who have FVC greater than 1,600 ml may benefit from FET. Key words: Amyotrophic lateral scleroses, Bulbar involvement, Forced expiratory technique (This article was submitted Jun. 29, 2004, and was accepted Sep. 27, 2004) INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by loss of motor neurons 1). In approximately 25 percent of patients with ALS, the initial symptoms begin in muscles innervated by the lower brainstem cranial nerves in the bulb (medulla) 2). As bulbar muscle dysfunction progresses, it impairs the retention of optimal breath with a closed glottis, and cough becomes ineffective 3, 4). During cough, high peak intrapulmonary pressures are reached when the glottis is closed, and with opening of the glottis, high expiratory flows are generated. Incomplete glottic closure can exacerbate cough dysfunction and further decrease peak cough flow (PCF) 5). The inability to effectively cough is associated with aspiration or respiratory infection, and is a cause of respiratory failure and death. The author hypothesized that use of the forced expiratory technique (FET) 6) known as huffing, that creates forced expiratory flows through an open glottis, might be useful in the treatment of patients with ALS presenting with bulbar involvement. FET is a technique to assist in the expectoration of secretions. Unlike a cough in which the glottis is closed, FET requires the glottis to remain open. The technique is taught when cough is ineffective. It has been proposed that FET for patients with chronic bronchitis is an important adjunctive therapy 7). However, little has been reported about the effect on FET in the patients with bulbar onset ALS. The essential purpose of this case study was to investigate whether a patient who had bulbar involvement but adequate other muscles function can benefit from FET compared with coughing on the peak expiratory flow.
2 138 J. Phys. Ther. Sci. Vol. 16, No. 2, 2004 CASE REPORT The patient was a 53-year-old man who noticed dysphagia in November of 2002 and dysarthria in January of In May, he developed weight loss and was subsequently admitted to the University hospital for further examination and management. During this hospitalization, he was diagnosed with ALS and was prescribed Riluzole. He had no upper motor neuron signs. However, physical examination and an electromyographic study revealed that the patient had lower motor neuron signs in the bulbar and cervical regions. Based on progressive muscular weakness with fasciculation in at least two body regions, he fulfilled El-Escorial diagnostic criteria for suspected ALS 8). Pulmonary function testing revealed 3,730 ml of vital capacity (VC), 102 percent of predicted VC, and 79.8 percent of forced expiratory volume in one second per forced vital capacity (FEV 1.0% ). Arterial blood gas values were ph, 7.445; arterial partial pressure of carbon dioxide (PaCO 2 ), 40.5 mmhg; partial pressure of oxygen (PaO 2 ), 97.8 mmhg; bicarbonate (HCO 3 ), 27.2 meq/l; and base excess (BE), 2.9 meq/l. Seven months after diagnosis, he was referred to our hospital at which time he was examined by physical therapy. His voice sounded nasal. Swallowing was disturbed for solid materials. The patient demonstrated muscular fasciculation, atrophy, and weakness in the tongue. The Gag reflex was decreased, in particular on the left side. Position of uvula was deviated to the right side (curtain sigh). Laryngeal elevation was delayed during deglutition. He could benefit from head rotation to the left side to prevent aspiration. Head rotation can divert material down the opposite pyriform sinus into the esophagus 9). Videofluoroscopic study showed (1) delayed bolus propulsion in the oral phase, (2) residue in velleculae after swallow, and (3) removal of the residue by repeated swallowing. Pulmonary examinations revealed 3,500 ml of forced vital capacity (FVC) and 350 L/min of PCF. The patient was able to clear all tracheal secretions independently. Thus, cough function could be classified functional 10). Respiratory rate was 12 breaths per minute. Oxygen saturation was 97 percent. Muscular fasciculation was also reported in the deltoids and biceps bilaterally. However, weakness of these muscles was not detected in manual muscle testing using Daniels and Worthingham grades 11). This means that death of motor neurons innervating these muscles was less than 40 to 50 percent 11, 12). He could perform all functional activities independently. Nine months after diagnosis, he developed dyspnea in the supine position. The author regarded this postural dependent dyspnea as upper airway obstruction due to paretic pharyngeal muscles 13). Ten months after diagnosis, he complained of being heavy-headed 14) in the upright position. Fifteen months after diagnosis, he developed head drop from weak neck extensor muscles. Manual muscle testing grade of the neck extensors revealed fair (3/5) bilaterally. Muscle weakness of limbs initially developed in the deltoids muscle. Thirteen months after diagnosis, the strength of left deltoids was detected as good (4/5) by manual muscle testing. Fifteen months after diagnosis, the manual muscle testing grade deteriorated to poor (2/5) strength of deltoids and fair (3/5) strength of biceps bilaterally. At this time, in room air, his arterial blood gas values were ph, 7.40; PaCO 2, 50.5 mmhg; PaO 2, 81.8 mmhg; HCO 3, 30.5 meq/l; and BE, 4.6 meq/l. Oxygen saturation was 95 percent. Respiratory rate was 20 breaths per minute. Sixteen months after diagnosis, he agreed to undergo tracheostomy. Nineteen months after diagnosis, he required mechanical ventilation. METHODS The author investigated longitudinal changes of the peak expiratory flow by two different methods and FVC. The two different methods were coughing and huffing (FET). Peak expiratory flow was measured with a peak flow meter (Assess; Health scan products Inc; Cedar Grove, NJ). FVC was measured with the Wright Spirometer (Mark 14, Ferraris Development and Engineering Co, Ltd, London UK). A facemask was connected to the measurement devices (Fig. 1). Peak expiratory flow and FVC were measured three times per session and the maximum value of three measurements was taken. Measurements were performed in the sitting position to eliminate the effect of postural dependent upper airway obstruction due to bulbar muscle involvement.
3 139 Fig. 1. Measurement methods. Left: the measurement method of forced vital capacity with the Wright Spirometer (Mark 14, Ferraris Development and Engineering Co, Ltd, London UK). Right: the measurement of peak expiratory flow with the peak flow meter (Assess; Health scan products Inc; Cedar Grove, NJ). A facemask was connected to the measurement devices. Fig. 2. Longitudinal changes of the peak expiratory flow. Peak cough flow decreased over time. Peak expiratory flow was consistently greater in the forced expiratory technique compared to coughing. Fig. 3. Longitudinal changes of the forced vital capacity. Forced vital capacity (FVC) decreased over time. When the peak expiratory flow generated by the forced expiratory technique declined to below 160 L/min, FVC had decreased to 1,600 ml. RESULTS Decrease in PCF progressed over time (Fig. 2). Approximately 12 months after diagnosis, PCF decreased to 140 L/min, and the patient could not cough out the airway secretions independently. However, at this time, FET generated 250 L/min of peak expiratory flow. The peak expiratory flow was consistently greater in FET compared to coughing (Fig. 2). Decrease in PCF persisted, but FET maintained peak expiratory flow above 160 L/min until 14.5 months after diagnosis. However, 15 months after diagnosis, FET generated a peak expiratory flow only 140 L/min. At this time, FVC had decreased to 1,600 ml (Fig. 3). DISCUSSION Cough flows less than 160 L/min are ineffective 15). Approximately 12 months after diagnosis, PCF could not exceed 160 L/min. As a result, cough became ineffective. The results of this case study revealed that peak expiratory flow was improved by FET, even though the patient with ALS demonstrated marked PCF decrease due to bulbar involvement. Despite having bulbar involvement, the patient who had adequate both inspiratory and expiratory muscles could generate peak expiratory flow to a point over 160 L/min threshold until 14.5 months
4 140 J. Phys. Ther. Sci. Vol. 16, No. 2, 2004 after diagnosis. As a result, FET delayed the need for tracheostomy. Thus, FET is beneficial for patients with ALS and possibly other neuromuscular disorders which weaken the bulbar muscle. Nonetheless, FET maintained peak expiratory flow for a prolonged period of time until marked weakness from the progressive effects of ALS produced an inadequate contraction of the ventilatory muscles and a subsequent deterioration in FVC. FET, therefore, may be an important adjunctive treatment for patients with ALS and other neuromuscular disorders who have been diagnosed with bulbar involvement. However, when the FVC was observed to be markedly decrease, and it was only 1,600 ml, the patient was unable to reach 160 L/min of peak expiratory flow by FET. The decrease of FVC was associated with a decrease in peak expiratory flow generated by FET, because peak expiratory flows can decrease from not only bulbar dysfunction but also inspiratory or expiratory muscles weakness 5). When the peak expiratory flow generated by FET declined to below 160 L/min, the patient required tracheostomy. In addition, when FET became ineffective, weakness of deltoids, biceps and neck extensors became apparent, and the arterial blood gas values indicated alveolar hypoventilation. The lower motor neuron cell bodies for the diaphragm are in the upper portion of the cervical spinal cord, segments C3 through C5. Lower motor neurons to neck extensors, deltoids, and biceps originate from the same cervical region. Thus, these muscles usually become weak with the diaphragm. Therefore, weakness of deltoids, biceps, and lower cervical-upper thoracic paraspinal muscles predicts involvement of respiratory muscles 12). The effect of FET was dependent on FVC. Thus, appearance of severe weakness less than poor of deltoids, fair of biceps, and fair of neck extensors may be good indication that the beneficial time for FET in the patients with bulbar onset ALS is over. The rate of neuronal deterioration in patients with ALS appears to vary 16). Therefore, the most beneficial time in the stage of the disease for FET for patients with ALS may be different among individuals. This is the major limitation of this study. However, the author believe that, when cough becomes ineffective in patients with bulbar onset ALS, physical therapists should instruct FET to delay the need for tracheostomy, and because FET is a method which can be performed by the patient independently to eliminate bronchial secretions. REFERENCES 1) Francis K, Bach JR, DeLisa JA: Evaluation and rehabilitation of patients with adult motor neuron disease. Arch Phys Med Rehabil, 1999, 80: ) Mitsumoto H: Classification and clinical feature of amyotrophic lateral sclerosis. In: Amyotrophic Lateral Sclerosis; A Comprehensive Guide to Management. New York: Demos Publications, 1994, pp ) Suarez AA, Pessolano FA, Monterio SG, et al.: Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease. Am J Phys Med Rehabil, 2002, 81: ) Mustfa N, Aiello M, Lyall RA, et al.: Cough augmentation in amyotrophic lateral sclerosis. Neurology, 2003, 61: ) Kang SW, Bach JR: Maximum Insufflation Capacity. Chest, 2000, 118: ) van der Schans CP, van der Mark TV, Rubin BK, et al.: Chest physical therapy: mucus mobilizing techniques. In: Pulmonary Rehabilitation; The Obstructive and Paralytic Condition. Philadelphia: Hanley & Belfus, 1996, pp ) van Hengstum M, Festen J, Beurskens C, et al.: Effect of positive expiratory pressure mask physiotherapy (PEP) versus forced expiration technique (FET/PD) on regional lung clearance in chronic bronchitics. Eur Respir J, 1991, 4: ) Brooks BR: El escorial world federation of neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on motor neuron diseases/ amyotrophic lateral sclerosis of the world federation of neurology research group on neuromuscular diseases and the el escorial clinical limits of amyotrophic lateral sclerosis workshop contributors. J Neurol Sci, 1994, 124: ) Logemann JA, Kahrilas PJ, Kobara M, et al.: The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil, 1989, 70: ) Alvarez SE, Peterson A, Lunsford BR: Respiratory treatment of the adult patient with spinal cord injury. Phys Ther, 1981, 61: ) Hislop HJ, Montgomery J: Daniels and Worthingham s Muscle Testing: Techniques of Manual Examination. 6th ed. Philadelphia: W.B. Saunders Co, ) Bromberg MB: Life support: realities and dilemmas. In: Amyotrophic Lateral Sclerosis; A Comprehensive Guide to Management. New York: Demos
5 141 Publications, 1994, pp ) Rabinstein AA, Wijdicks EF: Warning signs of imminent respiratory failure in neurological patients. Semin Neurol, 2003, 23: ) Howell CM: Physical therapy interventions in the management of amyotrophic lateral sclerosis. In: Amyotrophic Lateral Sclerosis; A Comprehensive Guide to Management. New York: Demos Publications, 1994, pp ) Bach JR, Saporito LR: Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning. Chest, 1996, 110: ) Bello-Hass VD, Kloos AD, Mitsumoto H: Physical therapy for a patient through six stages of amyotrophic lateral sclerosis. Phys Ther, 1998, 78:
Motor Neurone Disease NICE to manage Management of ineffective cough. Alex Long Specialist NIV/Respiratory physiotherapist June 2016
Motor Neurone Disease NICE to manage Management of ineffective cough Alex Long Specialist NIV/Respiratory physiotherapist June 2016 Content NICE guideline recommendations Respiratory involvement in MND
More informationKENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES
KENNEDY DISEASE PULMONARY CONSIDERATIONS: SCIENCE & MANAGEMENT STRATEGIES When you can t breathe nothing else matters American Lung Association Noah Lechtzin, MD; MHS Associate Professor of Medicine Johns
More informationSample Case Study. The patient was a 77-year-old female who arrived to the emergency room on
Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with
More informationNeuromuscular diseases (NMDs) include both hereditary and acquired diseases of the peripheral neuromuscular system. They are diseases of the
Neuromuscular diseases (NMDs) include both hereditary and acquired diseases of the peripheral neuromuscular system. They are diseases of the peripheral nerves (neuropathies and anterior horn cell diseases),
More informationThe objectives of this presentation are to
1 The objectives of this presentation are to 1. Review the mechanics of airway clearance 2. Understand the difference between secretion mobilization and secretion clearance 3. Identify conditions that
More informationRESPIRATORY PROBLEMS IN MND RICHARD HARRISON MND RESPIRATORY ASSESSMENT SERVICE LUNG HEALTH UNIVERSITY HOSPITAL OF NORTH TEES
RESPIRATORY PROBLEMS IN MND RICHARD HARRISON MND RESPIRATORY ASSESSMENT SERVICE LUNG HEALTH UNIVERSITY HOSPITAL OF NORTH TEES A TYPICAL HISTORY: NON BULBAR ONSET Difficulty walking Weak hands and arms
More informationArtificial External Glottic Device for Passive Lung Insufflation
Original Article http://dx.doi.org/10.3349/ymj.2011.52.6.972 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 52(6):972-976, 2011 Artificial External Glottic Device for Passive Lung Insufflation Dong Hyun
More informationCommissioning Policy for Cough Assist Requests
Commissioning Policy for Cough Assist Requests 1 DOCUMENT CONTROL Reference Number (lead in specific policy area to provide once policy ratified) Version Draft Version 0.3 071015 Status Sponsor(s)/Author(s)
More informationMOTOR NEURONE DISEASE
MOTOR NEURONE DISEASE Dr Arun Aggarwal Department of Rehabilitation Medicine, RPAH Department of Neurology, Concord Hospital. Motor Neurone Disease Umbrella term in UK and Australia (ALS in USA) Neurodegenerative
More informationPediatric Patients. Neuromuscular Disease. Teera Kijmassuwan, MD Phetcharat Netmuy, B.N.S., MA Oranee Sanmaneechai, MD : Preceptor
Patient Management Pediatric Patients with Neuromuscular Disease Teera Kijmassuwan, MD Phetcharat Netmuy, B.N.S., MA Oranee Sanmaneechai, MD : Preceptor Case Thai boy 1 year old Present with Respiratory
More informationMechanical Ventilation of the Patient with Neuromuscular Disease
Mechanical Ventilation of the Patient with Neuromuscular Disease Dean Hess PhD RRT Associate Professor of Anesthesia, Harvard Medical School Assistant Director of Respiratory Care, Massachusetts General
More informationNeuromuscular diseases are characterized by progressive
Maximum Insufflation Capacity* Seong-Woong Kang, MD, PhD; and John R. Bach, MD, FCCP Objective: To investigate the effect of deep lung insufflations on maximum insufflation capacities (MICs) and peak cough
More informationThe great majority of neuromuscular disease morbidity. Prevention of Pulmonary Morbidity for Patients With Neuromuscular Disease*
Prevention of Pulmonary Morbidity for Patients With Neuromuscular Disease* Alice C. Tzeng, MD; and John R. Bach, MD, FCCP Study objective: To evaluate the effects of a respiratory muscle aid protocol on
More informationCauses and Consequences of Respiratory Centre Depression and Hypoventilation
Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During
More information[N] = No product variation, policy applies as stated [Y] = Standard product coverage varies from application of this policy, see below
Original Issue Date (Created): May 3, 2004 Most Recent Review Date (Revised): September 24, 2013 Effective Date: November 1, 2013 I. POLICY Mechanical insufflation-exsufflation (MI-E) may be considered
More informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Motor neurone disease: the use of non-invasive ventilation in the management of motor neurone disease 1.1 Short title Motor
More informationRon Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit.
Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four goals of home NIV Identify candidates
More informationMND Study Day. Martin Latham CNS Leeds Sleep Service
MND Study Day Martin Latham CNS Leeds Sleep Service Objectives: Identifying individuals at risk. Understand issues related to NIV. Understand issues related to secretion management Improve outcomes. Identifying
More informationRespiratory therapy. Anja Raab. Doktorandin Clinical Trial Unit. Anja Raab, MSc. Physiotherapist and Phd-student SPZ Nottwil. June 17th of
Respiratory therapy Anja Raab Anja Raab, MSc Doktorandin Clinical Trial Unit Physiotherapist and Phd-student SPZ Nottwil 1 Content Basis for an effective respiratory therapy Posture Interaction of 3 essential
More informationProblem-solving Respiratory Issues in Children With Neuromuscular Disease. December 13, 2018 Eliezer Be eri, M.D.
Problem-solving Respiratory Issues in Children With Neuromuscular Disease December 13, 2018 Eliezer Be eri, M.D. About Our Presenter Eliezer Be eri, M.D. Alyn Rehabilitation Hospital Jerusalem, Israel
More informationPulmonary Rehabilitation in Acute Spinal Cord Injury. Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university
Pulmonary Rehabilitation in Acute Spinal Cord Injury Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university Causes of spinal cord injury Traumatic injury Motor vehicle
More informationRespiratory Management- Your Questions Answered! Michelle Chatwin, PhD Consultant Physiotherapist
Respiratory Management- Your Questions Answered! Michelle Chatwin, PhD Consultant Physiotherapist Why Are People Affected Differently Neuromuscular Disease; A Spectrum Its severity varies widely within
More informationPreventing Respiratory Complications of Muscular Dystrophy
Preventing Respiratory Complications of Muscular Dystrophy Jonathan D. Finder, MD Professor of Pediatrics University of Pittsburgh School of Medicine Children s Hospital of Pittsburgh Introduction Respiratory
More informationThe Effects of Breathing Exercise with Intermittent Positive Pressure Ventilator on Pulmonary Function in Patients with Cervical Spinal Cord Injury
NEUROTHERAPY 6 Sang-Su Hwang, Sang-Mi 대한신경치료학회지 Chung, Kyoung-Bo 제권제Lee 호 The Effects of Breathing Exercise with Intermittent Positive Pressure Ventilator on Pulmonary Function in Patients with Cervical
More informationAnatomy & Physiology 2 Canale. Respiratory System: Exchange of Gases
Anatomy & Physiology 2 Canale Respiratory System: Exchange of Gases Why is it so hard to hold your breath for Discuss! : ) a long time? Every year carbon monoxide poisoning kills 500 people and sends another
More informationWeaning guidelines for Spinal Cord Injured patients in Critical Care Units
RISCI Respiratory Information for Spinal Cord Injury UK Weaning guidelines for Spinal Cord Injured patients in Critical Care Units Introduction It is an unfortunate fact that Spinal Cord Injury Centres
More informationChapter 10. The Respiratory System Exchange of Gases. Copyright 2009 Pearson Education, Inc.
Chapter 10 The Respiratory System Exchange of Gases http://www.encognitive.com/images/respiratory-system.jpg Human Respiratory System UPPER RESPIRATORY TRACT LOWER RESPIRATORY TRACT Nose Passageway for
More informationTeacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology
Title: Spirometry Teacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology I. Measurements of Ventilation Spirometry A. Pulmonary Volumes 1. The tidal
More informationHow Respiratory Muscle Strength Correlates with Cough Capacity in Patients with Respiratory Muscle Weakness
Original Article DOI 10.3349/ymj.2010.51.3.392 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 51(3): 392-397, 2010 How Respiratory Muscle Strength Correlates with Cough Capacity in Patients with Respiratory
More informationUnderstanding Breathing Muscle Weakness
Understanding Breathing Muscle Weakness A N D R E A L. K L E I N P R E S I D E N T / F O U N D E R B R E A T H E W I T H M D w w w.facebook.com/ b r e a t h e w i t h m d h t t p : / / w w w. b r e a t
More informationPolicy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
More informationNorth Wales Critical Care Network
North Wales Critical Care Network Weaning Guidelines for SPINAL CORD INJURED patients in North Wales Critical Care Units NWCCN Spinal Cord Injury Weaning Guidelines_APPROVED February 2014 Page 1 Weaning
More informationCompetency Title: Continuous Positive Airway Pressure
Competency Title: Continuous Positive Airway Pressure Trainee Name: ------------------------------------------------------------- Title: ---------------------------------------------------------------
More informationSleep and Neuromuscular Disease. Sharon De Cruz, MD Tisha Wang, MD
Sleep and Neuromuscular Disease Sharon De Cruz, MD Tisha Wang, MD Case Presentation Part I GR is a 21-year old male with Becker muscular dystrophy who comes to your office complaining of progressively
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationDo Not Cite. For Public Comment Period DRAFT MEASURE #3: Evaluation of Pulmonary Status Ordered MUSCULAR DYSTROPHY
MEASURE #3: Evaluation of Pulmonary Status Ordered MUSCULAR DYSTROPHY Measure Description All patients diagnosed with a muscular dystrophy who had a pulmonary status evaluation* ordered. Measure Components
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationRESPIRATORY COMPLICATIONS AFTER SCI
SHEPHERD.ORG RESPIRATORY COMPLICATIONS AFTER SCI NORMA I RIVERA, RRT, RCP RESPIRATORY EDUCATOR SHEPHERD CENTER 2020 Peachtree Road, NW, Atlanta, GA 30309-1465 404-352-2020 DISCLOSURE STATEMENT I have no
More informationAlternative title: Confessions of a Mucus Enthusiast. Mechanical Insufflation Exsufflation for airway secretion clearance and lung expansion therapy
Mechanical Insufflation Exsufflation for airway secretion clearance and lung expansion therapy Alternative title: Confessions of a Mucus Enthusiast Marty Davig, RRT RCP Philips Respironics Inc. Objectives
More informationA Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness
Original Article Yonsei Med J 2016 Nov;57(6):1488-1493 pissn: 0513-5796 eissn: 1976-2437 A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness Sun Mi Kim 1,2, Won Ah
More informationRespiratory Management of Facioscapulohumeral Muscular Dystrophy. Nicholas S. Hill, MD Tufts Medical Center Boston, MA
Respiratory Management of Facioscapulohumeral Muscular Dystrophy Nicholas S. Hill, MD Tufts Medical Center Boston, MA Respiratory Involvement in FSHD Very variable time of onset rate of progression Muscles
More informationHyperinflation Therapy and the Tools to Accomplish It!! Bill Barnes, RN, RRT Good Shepherd Rehabilitation Network
Hyperinflation Therapy and the Tools to Accomplish It!! Bill Barnes, RN, RRT Good Shepherd Rehabilitation Network HYPERINFLATION THERAPY Challenges in Post Acute Care Deconditioning Malnutrition Hydration
More informationAirway Clearance Applications in the Elderly and in Patients With Neurologic or Neuromuscular Compromise
Airway Clearance Applications in the Elderly and in Patients With Neurologic or Neuromuscular Compromise Carl F Haas MLS RRT FAARC, Paul S Loik RRT, and Steven E Gay MD MSc Introduction The Normal Clearance
More informationActive Cycle of Breathing Technique
Active Cycle of Breathing Technique Full Title of Guideline: Author (include email and role): Division & Speciality: Version: 3 Ratified by: Scope (Target audience, state if Trust wide): Review date (when
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationCh 16 A and P Lecture Notes.notebook May 03, 2017
Table of Contents # Date Title Page # 1. 01/30/17 Ch 8: Muscular System 1 2. 3. 4. 5. 6. 7. 02/14/17 Ch 9: Nervous System 12 03/13/17 Ch 10: Somatic and Special Senses 53 03/27/17 Ch 11: Endocrine System
More informationRespiratory System Mechanics
M56_MARI0000_00_SE_EX07.qxd 8/22/11 3:02 PM Page 389 7 E X E R C I S E Respiratory System Mechanics Advance Preparation/Comments 1. Demonstrate the mechanics of the lungs during respiration if a bell jar
More informationAFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL A. Definition of Therapy: 1. Cough machine: 4 sets of 5 breaths with a goal of I:E pressures approximately the same of 30-40. Inhale time = 1 second, exhale
More informationRespiratory Muscle Strength and Cough Capacity in Patients with Duchenne Muscular Dystrophy
Yonsei Medical Journal Vol. 47, No. 2, pp. 184-190, 2006 Respiratory Muscle Strength and Cough Capacity in Patients with Duchenne Muscular Dystrophy Seong-Woong Kang, Yeoun-Seung Kang, Hong-Seok Sohn,
More informationBi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
More informationControl of Respiration
Control of Respiration Graphics are used with permission of: adam.com (http://www.adam.com/) Benjamin Cummings Publishing Co (http://www.awl.com/bc) Page 1. Introduction The basic rhythm of breathing is
More informationThe difference is clear. CoughAssist clears airways with the force of a natural cough
The difference is clear CoughAssist clears airways with the force of a natural cough When only a real cough will do CoughAssist is a noninvasive therapy that safely and consistently removes secretions
More informationMeasure #6: ALS Noninvasive Ventilation Treatment for Respiratory Insufficiency Discussed Amyotrophic Lateral Sclerosis
Measure #6: ALS Noninvasive Ventilation Treatment for Respiratory Insufficiency Discussed Amyotrophic Lateral Sclerosis Measure Description Percentage of patients diagnosed with ALS and respiratory insufficiency
More informationLUNG VOLUME RECRUITMENT IN NEUROMUSCULAR DISEASE
LUNG VOLUME RECRUITMENT IN NEUROMUSCULAR DISEASE Sherri Katz, MDCM, MSc, FRCPC Pediatric Respirologist Children s Hospital of Eastern Ontario University of Ottawa Disclosures Research funding from CIHR,
More informationLesson 9.1: Learning the Key Terms
131 Lesson 9.1: Learning the Key Terms Directions: Place the letter of the best definition next to each key term. 1. alveolar capillary membrane 2. alveoli 3. bronchioles 4. cardiopulmonary system 5. conchae
More informationO X Y G E N ADVANTAGE THEORY 1
O X Y G E N ADVANTAGE THEORY 1 The Oxygen Advantage Measurement appraisal called BOLT Unblock the nose by holding the breath Switch to nasal breathing on a permanent basis Address dysfunctional breathing
More informationSmall Volume Nebulizer Treatment (Hand-Held)
Small Volume Aerosol Treatment Page 1 of 6 Purpose Policy Physician's Order Small Volume Nebulizer Treatment To standardize the delivery of inhalation aerosol drug therapy via small volume (hand-held)
More informationSWALLOW PHYSIOLOGY IN PATIENTS WITH TRACH CUFF INFLATED OR DEFLATED: A RETROSPECTIVE STUDY
SWALLOW PHYSIOLOGY IN PATIENTS WITH TRACH CUFF INFLATED OR DEFLATED: A RETROSPECTIVE STUDY Ruiying Ding, PhD, 1 Jeri A. Logemann, PhD 2 1 University of Wisconsin-Whitewater, Department of Communicative
More information6- Lung Volumes and Pulmonary Function Tests
6- Lung Volumes and Pulmonary Function Tests s (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs. By assessing lung volumes, capacities, rates of
More informationChapter 10 The Respiratory System
Chapter 10 The Respiratory System Biology 2201 Why do we breathe? Cells carry out the reactions of cellular respiration in order to produce ATP. ATP is used by the cells for energy. All organisms need
More informationNON INVASIVE LIFE SAVERS. Non Invasive Ventilation (NIV)
Table 1. NIV: Mechanisms Of Action Decreases work of breathing Increases functional residual capacity Recruits collapsed alveoli Improves respiratory gas exchange Reverses hypoventilation Maintains upper
More informationSwallowing Screen Why? How? and So What? พญ.พวงแก ว ธ ต สก ลช ย ภาคว ชาเวชศาสตร ฟ นฟ คณะแพทยศาสตร ศ ร ราชพยาบาล
Swallowing Screen Why? How? and So What? พญ.พวงแก ว ธ ต สก ลช ย ภาคว ชาเวชศาสตร ฟ นฟ คณะแพทยศาสตร ศ ร ราชพยาบาล Dysphagia in Stroke The incidence of dysphagia after stroke ranging from 23-50% 1 Location
More informationChapter 10 Lecture Outline
Chapter 10 Lecture Outline See separate PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright 2016 McGraw-Hill Education. Permission required for reproduction
More informationPULMONARY FUNCTION. VOLUMES AND CAPACITIES
PULMONARY FUNCTION. VOLUMES AND CAPACITIES The volume of air a person inhales (inspires) and exhales (expires) can be measured with a spirometer (spiro = breath, meter = to measure). A bell spirometer
More informationLUNGS. Requirements of a Respiratory System
Respiratory System Requirements of a Respiratory System Gas exchange is the physical method that organisms use to obtain oxygen from their surroundings and remove carbon dioxide. Oxygen is needed for aerobic
More informationPulmonary Functions and Effect of Incentive Spirometry During Acute and Post Acute Period in Tetraplegia
IJPMR 13, April 2002; 28-34 Pulmonary Functions and Effect of Incentive Spirometry During Acute and Post Acute Period in Tetraplegia Dr M Joshi, M.D., Research Associate Dr N Mathur, M.S., DNB, Associate
More informationPhases of Respiration. Chapter 18: The Respiratory System. Structures of the Respiratory System. Structures of the Respiratory System
Phases of Respiration Chapter 18: The Respiratory System Respiration Process of obtaining oxygen from environment and delivering it to cells Phases of Respiration 1. Pulmonary ventilation between air and
More informationMedStar Health considers Cough Assist Devices medically necessary for the following indications:
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.047.MH Cough Assist Devices This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst
More informationI Need to Cough Ways to Keep Your Airways Clear
I Need to Cough Ways to Keep Your Airways Clear 2018 Annual Cure SMA Conference Richard Kravitz, MD Duke University School of Medicine Duke University Medical Center Durham, North Carolina Presenters Jane
More informationHigh Frequency Chest Wall Oscillating Devices (HFCWO) (Airway Clearance Systems)
High Frequency Chest Wall Oscillating Devices (HFCWO) (Airway Clearance Systems) Date of Origin: 05/2015 Last Review Date: 07/26/2017 Effective Date: 07/26/2017 Dates Reviewed: 07/2016 Developed By: Medical
More informationCoughAssist E70. More than just a comfortable cough. Flexible therapy that brings more comfort to your patients airway clearance
CoughAssist E70 More than just a comfortable cough Flexible therapy that brings more comfort to your patients airway clearance Flexible, customisable loosening and clearing therapy An effective cough is
More informationSpeech and Swallowing in KD: Soup to Nuts. Neil C. Porter, M.D. Assistant Professor of Neurology University of Maryland
Speech and Swallowing in KD: Soup to Nuts Neil C. Porter, M.D. Assistant Professor of Neurology University of Maryland Disclosures I will not be speaking on off-label use of medications I have no relevant
More informationOxygenation. Chapter 45. Re'eda Almashagba 1
Oxygenation Chapter 45 Re'eda Almashagba 1 Respiratory Physiology Structure and function Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen,
More informationChapter 16. The Respiratory System. Mosby items and derived items 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 16 The Respiratory System Objectives Discuss the generalized functions of the respiratory system List the major organs of the respiratory system and describe the function of each Compare, contrast,
More informationRespiratory System. Chapter 9
Respiratory System Chapter 9 Air Intake Air in the atmosphere is mostly Nitrogen (78%) Only ~21% oxygen Carbon dioxide is less than 0.04% Air Intake Oxygen is required for Aerobic Cellular Respiration
More informationThe more you know, the more you can do
The more you know, the more you can do How Duchenne muscular dystrophy affects lung function As life expectancy of patients with Duchenne muscular dystrophy (DMD) has increased over the past few decades,
More informationThe Role of Facemask Spirometry in Motor Neurone Disease (MND) Respiratory Sleep and Support Centre, Papworth Hospital NHS Trust, Papworth
The Role of Facemask Spirometry in Motor Neurone Disease (MND) Banerjee SK 1, Davies MG 1, Sharples LD 2, Smith IE 1 1 Respiratory Sleep and Support Centre, Papworth Hospital NHS Trust, Papworth Everard,
More informationRespiratory system. Applied Anatomy &Physiology
Respiratory system Applied Anatomy &Physiology Anatomy The respiratory system consists of 1)The Upper airway : Nose, mouth and larynx 2)The Lower airways Trachea and the two lungs. Within the lungs,
More informationThe Use of Active Cycle of Breathing Technique (ACBT) In Pulmonary Physiotherapy: A Critical Review of the Literature Lauro G. Villegas Jr.
The Use of Active Cycle of Breathing Technique (ACBT) In Pulmonary Physiotherapy: A Critical Review of the Literature Lauro G. Villegas Jr., PTRP Keywords: Active Cycle of Breathing Technique (ACBT), Pulmonary
More informationRespiratory System. Student Learning Objectives:
Respiratory System Student Learning Objectives: Identify the primary structures of the respiratory system. Identify the major air volumes associated with ventilation. Structures to be studied: Respiratory
More informationMaster of Physical Therapy Program: Year 2 CARDIORESPIRATORY COURSE OUTLINES SUMMARY
Master of Physical Therapy Program: Year 2 CARDIORESPIRATORY COURSE OUTLINES SUMMARY Course: PT 6124 Physical Therapy and Hospital based Care Through lecture, tutorial and laboratory sessions, students
More informationOverview. The Respiratory System. Chapter 18. Respiratory Emergencies 9/11/2012
Chapter 18 Respiratory Emergencies Slide 1 Overview Respiratory System Review Anatomy Physiology Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination Emergency
More informationCOMMUNICATION. Communication and Swallowing post Tracheostomy. Role of SLT. Impact of Tracheostomy. Normal Speech. Facilitating Communication
Communication and Swallowing post Tracheostomy. Role of SLT 1. 2. 3. Management of communication needs. Management of swallowing issues. Working with the multidisciplinary team to facilitate weaning. Impact
More informationPulmonary Pathophysiology
Pulmonary Pathophysiology 1 Reduction of Pulmonary Function 1. Inadequate blood flow to the lungs hypoperfusion 2. Inadequate air flow to the alveoli - hypoventilation 2 Signs and Symptoms of Pulmonary
More informationLab 4: Respiratory Physiology and Pathophysiology
Lab 4: Respiratory Physiology and Pathophysiology This exercise is completed as an in class activity and including the time for the PhysioEx 9.0 demonstration this activity requires ~ 1 hour to complete
More informationA Place For Airway Clearance Therapy In Today s Healthcare Environment
A Place For Airway Clearance Therapy In Today s Healthcare Environment Michigan Society for Respiratory Care 2015 Fall Conference K. James Ehlen, MD October 6, 2015 Objectives Describe patients who will
More informationAmyotrophic Lateral Sclerosis: Predictors for Prolongation of Life by Noninvasive Respiratory Aids
828 Amyotrophic Lateral Sclerosis: Predictors for Prolongation of Life by Noninvasive Respiratory Aids John Robert Bach, AID ABSTRACT. Bach JR. Amyotrophic lateral sclerosis: predictors for prolongation
More information(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
More informationExercise Stress Testing: Cardiovascular or Respiratory Limitation?
Exercise Stress Testing: Cardiovascular or Respiratory Limitation? Marshall B. Dunning III, Ph.D., M.S. Professor of Medicine & Physiology Medical College of Wisconsin What is exercise? Physical activity
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationSwallowing Disorders and Their Management in Patients with Multiple Sclerosis
National Multiple Sclerosis Society 733 Third Avenue New York, NY 10017-3288 Clinical Bulletin Information for Health Professionals Swallowing Disorders and Their Management in Patients with Multiple Sclerosis
More informationAIRWAY MANAGEMENT AND VENTILATION
AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management D2 Basic
More informationThe Respiratory System
The Respiratory System If you have not done so already, please print and bring to class the Laboratory Practical II Preparation Guide. We will begin using this shortly in preparation of your second laboratory
More informationOperation Manual for clinical use of SIARE Pulsar
Operation Manual for clinical use of SIARE Pulsar This manual is for clinical use only 1-12 INDEX 1) Indications /Contraindications and cautions 2) Questions to ask before using a MI-E machine 3) Guideline
More informationAirway clearance in neuromuscular weakness
DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY REVIEW Airway clearance in neuromuscular weakness LEANNE MAREE GAULD MBBS FRACP MD Royal Children's Hospital, Herston, Australia. Correspondence to Dr Leanne Maree
More informationSwallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation David A. Muir Course Outline Physiology of Swallow
Swallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation Mary Spremulli, MA, CCC-SLP Passy-Muir Clinical Consultant spre713@hotmail.com (949) 833-8255 David A. Muir 23 year-old ventilator
More informationRegulation of respiration
Regulation of respiration Breathing is controlled by the central neuronal network to meet the metabolic demands of the body Neural regulation Chemical regulation Respiratory center Definition: A collection
More informationRaxone (idebenone) and pulmonary care in Duchenne Muscular Dystrophy (DMD)
Raxone (idebenone) and pulmonary care in Duchenne Muscular Dystrophy (DMD) Thomas Meier, PhD February 2018 Agenda Medical need for effective treatment of respiratory illness in DMD Understanding respiratory
More informationACVECC Small Animal Benchmark, May 2012
ACVECC Small Animal Benchmark, May 2012 A 25 kg, 9 y MC Labrador Retriever presents with a 2-day history of cough and tachypnea. Physical exam revealed T 101.7 F, HR 120 BPM, pulses strong and synchronous,
More information