(5) Resp Management in Neuromuscular Disease Flashcards
What is Motor Neuron Disease (MND)?
progressive neuro condition that attacks the motor neurones or nerves in the brain or sc meaning messages sto reaching the muscles
What 3 major sites are damaged in a degenerative neurological condition?
- Anterior horn cell (LMN symptoms)
- Corticospinal tract (UMN symptoms)
- Motor nuclei in brain stem (bulbar palsy)
What are UMN signs (3)?
- weakness
- spasticity
- brisk reflexes
What are LMN signs (5)?
- weakness
- muscle wasting
- fasciculations
- cramping
- decreased reflexes
What are bulbar signs (6)?
- dysphagia
- slurred/loss speech
- breathing difficulty
- weak cough
- problems managing saliva
- aspiration
What are 4 types of MND?
- Amyotrophic Lateral Sclerosis (ALS)
- Progressive Bulbar Palsy (PBP)
- Progressive Muscular Atrophy (PMA)
- Primary Lateral Sclerosis (PLS)
Where is the breathing rate controlled?
medulla oblongata (resp centre)
What are the muscles of ventilation?
- diaphragm (C3-5)
- intercostals (T1-11)
- Abdominals (T5-12)
- Accessory Muscles
What are the inspiratory muscles responsible for?
ventilation
What are the expiratory muscles responsible for?
coughing
What are the bulbar muscles responsible for?
protecting the airway
What are the factors in restrictive lung disease?
_ total lung volume too low
- stiffness in chest wall
- reduced FVC
What are the factors in obstructive lung disease?
- difficulty exhaling air from lungs
- smaller airways partially blocked
- results decreased FEV1 & FEV1/FVC ratio
What are different types of resp complications?
- paradoxical breathing patterns
- underdeveloped lungs
- hypercapnia
- weak/ineffective cough
- recurrent RTI
- sleep disordered breathing
What causes respiratory failure in MND (5)?
- resp muscle weakness
- reduced chest compliance
- increased resistive load
- upper airway muscle weakness
- impaired control of breathing
What is involved in the subjective Ax of the resp system in NMD patients?
- Full MHx
- complaints SOB?
- Sleep quality
- Ax for hypoventilation
- change in appetite
What is involved in the objective Ax of the resp system in a NMD patient?
- Increased RR
- Accessory muscle recruitment
- Overnight oximetry
- early morning ABG
- PFTs - FVC
- peak cough
- SNIP & MIP
What do MIP & SNIP measure?
inspiratory muscle strength
How is MIP performed?
- patient inhale against occluded airway
- maximal pressure generated recorded by pressure transducer
- < -60cm significant muscle weakness
How is the SNIP test performed?
- insert pressure transducer into nostril
- patient sniffing action
- <40cm predictor of nocturnal hypoxemia
What does a face mask and stand peak flow meter measure?
Cough flow
What is the technique for using a face mask and stand peak flow meter?
- place mask over patients mouth
- inhale deeply and cough strong as possible
- repeat 3-5 times
- record highest score
What is the focus for physios for low cough efficacy?
- monitor signs and symptoms of resp insufficiency
- manage secretions
- manually assist cough
What are manual assisted cough techniques used for?
Producing a increase in velocity of expiratory flow sufficient to mobilise secretions from the airways, when patient no longer able generate this force
