IMT Flashcards
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
What is the frequency prescription for IMT
4-5 times per week
What is the intensity prescription for IMT and progression
start very low (9 cmH2O) progress intensity slowly not more than 5% per week
What is the duration prescription for IMT and progression
begin at 5-15 mins per day
add 1-3 minutes every 3rd day
continue until you can sustain two 15 min period or one 30 min period
How do you monitor fatigue in a patient
- chest wall movement
- excessive dyspnea
- long lasting fatigue after treatment
- HR
- SpO2
- RR
IMT should always be combined with…
aerobic and resistance training of the extremities
What are outcome measures of IMT
- Inspiratory muscle testing
- Dyspnea (Borg scale)
- Exercise capacity
- Quality of life
- Vitals
- RPE
