Ventilatory Muscle Training
Transcript of Ventilatory Muscle Training
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RespiratoryRespiratoryMuscle TrainingMuscle Training
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Muscles of Inspiration
Diaphragm
Scalene
Parasternals
Sternocledomastoid
Upper Trapezius
Pectoralis major and minor
Subclavius
External intercostals
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Muscles of Expiration
It is a passive process
Rectus abdominals
Transverse abdominals
Internal and external oblique
Pectoralis major
Internal intercostals
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Inadequacy of respiratory musclefunction
weakness and orincreased fatigability ofthe respiratory muscles induced by
structural/metabolic changes in themuscles themselves (e.g., musculardystrophy);
failure of muscle activation by the nervous
system (e.g., multiple sclerosis);
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3. Functional weakness induced by
alterations in the mechanics of the
respiratory system that induce anincreased requirement for muscleforce output (e.g., emphysema);
or a combination of these factors (e.g.,chronic heart failure).
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Symptoms
Dyspnoea
Impaired exercise performance Ineffective coughing Respiratory insufficiency Decreased quality of life
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Ventilatory muscle testing
Tests of Overall Respiratory Function
Static Lung Volumes Dynamic Spirometry and Arterial Blood Gases: Awake Measurements during Sleep Tests of
Respiratory Control
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Tests of Respiratory Muscle Strength Pressure Measurements Devices (Threshold
device)
Electrophysiological Techniques for theAssessment of Respiratory Muscle Function Electromyography Stimulation Tests(EMG)
Tests of Respiratory Muscle Endurance Measures of Respiratory Muscle Activity Ventilatory Endurance Tests Endurance to External Loads
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So what we are going to test
Strength
Endurance
Fatigue
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Strength
Clinically , respiratory muscle strength is
measured as PI max and max
expiratory muscle strength as PE max
.Should be held for 1 5 sec forrecording
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Ventilatory muscle training
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Methods
Strength training
Endurance training
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Strength trainingStrength training
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STRENGTH TRAINING
IMT EMT
With target
(Thereshold device)
Without target
(P-Flex)
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Intensity
40 60 % P ImaxClinical recommendation
Begin with 7 cm h2O Progression 2 cm h2O with
every week
Progress slowly
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Frequency
30 min / day in 2- 3 session
4 - 6 days / weekContinue indefinitely
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Endurancetraining
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Endurance training
Interval based Continuous
Intensity > 60 % maximal work rateFrequency 3- 4 days / weekDuration long duration start with 30 minutes
( warm up and cool down )
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Endurance training - Mode
Cycling Walking
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Threshold trainer
40- 60 % 0f P imax
Hold time
Monitoring CO2
2-3 days / week
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Precautionary monitoring
To avoid fatigue Dis - oriented chest wall movement Observation
Exercise dyspnea during training Observation
Long lasting fatigue after training interview
To avoid muscleinjury
Signs of delayed onset musclesoreness
interview
Reduce strength Measurement ofPI max
Reduce endurance Inability to tolerate
To avoid hypercapnea spo2 Pulse oximeter
Signs of headache , confusion Interview
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Clinical outcomes
Strength Pi max, Pe max Endurance incremental test using on
threshold trainer Dyspnea scale BORG Exercise capacity walk test Quality of life SF-36 questionnaire
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Conditions
Obstructive COPD Asthma
Restrictive Thoracic Deformity
Abdominal Distension
Systemic Diseases
Collagen VascularDiseases
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Conditions ..,
Neuromuscular Diseases
Muscle Dystrophies
Peripheral Nerve: Diaphragmatic
Paralysis, Guillain-BarreSyndrome
Neuromuscular Junction:
Myasthenia Gravis Thoracic and Cardiac Surgery
Abdominal Surgery
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COPD
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Hyperinflation
Cause
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Mechanism
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1.Inspiratory flow resistance.
2.Loss of elastic recoil of the lungs causes the
relaxation volume to move to a higher
volume and causes closure of small airways
in early exhalation (static hyperinflation).3.resting minute ventilation is increased by 50%
to compensate for impaired gas exchange.
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4.Increases in time constants and breathingfrequency cause dynamic lungcompliance to fall below the static value
5.6.Expiratory flow limitation, which occurs in
about 60% of ambulatory patients withCOPD delays lung emptying, with theresult that inspiration begins before therespiratory system has returned to itsrelaxation volume(dynamic hyperinflation)
7.
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What we have to ?????
Strength training orEndurance training
Debate ?????v
v
v
v
v
v 2005 copd review Endurance training + IMT is effective
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Asthma
se Resistance 3 to 10% during acutebronchoconstriction
Hyperinflation
Steroid management
No < / > in respiratory muscle power Increase Diaphragm size Initially muscle fatigue Later starts the muscular weakness
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Restrictive lung diseases
Scoliosis Ankylosis Pectus spondylytis excavatum
horacicdeformity
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Scoliosis
Chest wall compliance is
inversely proportional to the
Cobbs angle
reduction in maximal Inspiratory
and expiratory pressures
Cobbs angle > 70 symptoms
present
http://images.google.co.in/imgres?imgurl=http://www.chiropractic.com.sg/scoliosis.jpg&imgrefurl=http://www.chiropractic.com.sg/scoliosis.html&h=289&w=257&sz=18&hl=en&start=11&um=1&usg=__eCicEzqbDcMPJ17CpoeDTxHXyro=&tbnid=1DuGVvGFIhiA8M:&tbnh=115&tbnw=102&prev=/images?q=scoliosis&um=1&hl=en&sa=X -
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Pectus excavatum
SameHere its is two
dimensionally
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Ankylosis spondylitis
All the spine fused Transverse joint +
ribs also fused
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Mechanism
Intercostals musclesare inhibited
Left out diaphragmactivates more, tillthe pressurecomes to normal
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Spinal cord injury
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CONCLUSION
RMT is effective tool for training therespiratory muscle weakness
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