(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
What are three types of manual assisted cough techniques?
- Abdominal thrust
- Lateral Costal Compression
- Anterior chest wall compression
How does a cough assist machine work?
- delivers a preset positive pressure into the airways for a set duration inspiration
- followed by abrupt change to a preset negative exsufflation
- simulates a cough
How does breath stacking work?
- pt take deep breath
- pt try take another breath on top
- squeeze bag
- pt breath out or cough
What is glossopharyngeal (frog) breathing?
Lips, larynx, pharynx, tongue “GUP sound”
What does frog breathing do?
- improves VC
- maintains chest wall ROM
- improves pulmonary compliance
What are indications for tracheostomy?
- bulbar dysfunction leading to aspiration
- failure control ventilation with NIV
- failure wean onto NIV following acute decompensation
- vocal cord dysfunction/upper airway problems
What is palliative care?
seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure
What is end of life care?
care concerning the final stages of life and focuses on care of the dying person and their family
Where does the physio fit into end of life care?
- use of transferrable skills
- honest, positive
- problem solving approach
- changes in goals
- maximise patients potential at end of life
What are considerations for suctioning at end of life?
- Patient too weak
- conscious?
- distressing for pt & family
- NEVER routinely done
What are barriers to Palliative Care in COPD?
- Misperception
- Difficulty determining disease prognosis
- impaired comms
- lack practice guidelines
