Respiration

Question 1

Infants chest?

Answer 1

• Occupies 1/3 trunk
• Triangle shape — narrow upper chest
• Lower ribs flare
• Ribs horizontal with narrow spaces for stability
• Diaphragm minimal dome shape and moves inferiority
• Accessory muscles are ineffective except upper traps

Question 2

Adult chest?

Answer 2

• Occupies 1/2 trunk
• Rectangle shape — upper chest is wider
• No flaring
• Downward rotation, wider intercostal spacing for mobility
• Diaphragm is done shaped and moves in all three planes
• All accessory muscles function while breathing

Question 3

When does a child’s rib cage look most like an adult

Answer 3

7-8 years old

Question 4

What are you assessing during your subjective observation

Answer 4

Postural alignment
Skin
Respiratory pattern
What muscles are working/any imbalances

Question 5

Children with CP often have…

Answer 5

Elevated chest — can’t integrate abdominals to bring rib cage down
Flattened anterior chest
Rib Flaring
Small intercostal spaces

Question 6

Children with hypotonia, like DS, have what kind of characteristic in their chest?

Answer 6

Rib flaring

Question 7

What does a blueish tint around the mouth indicate?

Answer 7

Cyanosis - poor oxygen exchange.
Huge red flag — contact pediatrician

Question 8

Abdominal breathing occurs?

Answer 8

Babies! Until about 6 months old.

Question 9

Abdominal thoracic breathing occurs?

Answer 9

Starts around 6-8 months when the child can sit up against gravity, actively rotate and extend trunk.

Question 10

What are some adult breathing patterns?

Answer 10

Chest dominant
Abdominal dominant
Balance/equal
Ant/lat/post chest

Question 11

Why would a child wear an abdominal binder?

Answer 11

To optimize muscle function for postural demands.

Question 12

When should you take the child’s heart rate?

Answer 12

After child has sat quietly for 5 minutes for resting HR
Take during last 10 seconds of walking to get active HR
HR has been shown to be an accurate and convenient estimate of energy expenditure. There is a linear relationship between HR and O2 uptake during walking for normal children and children with CP

Question 13

What are the average HRs throughout childhood?

Answer 13

Premature infant — 120-180bpm
Newborn — 120-160 bpm
Infant — 100-140 bpm
Child — 80-120 bpm

Question 14

What are average respiratory rates throughout childhood

Answer 14

Premature infant - 60-80 breathes per min
Newborn - 40 breathes per min
Infant - 30-40 breathes per min
Child - 25-30 breathes per min

Question 15

Can we work on expiratory and inspiratory volume with children?

Answer 15

Sure can

Question 16

What is the number of syllabus pronounces per breath?

Answer 16

8-10 syllable phrases

Question 17

How long should a timed “ah” or “oh” normally take during a controlled exhalation

Answer 17

10-12 seconds

Question 18

How do we assess coughing?

Answer 18

1. See if they can cough
2. Note the quality and strength of cough // if they can even do it
3. Do we see the three phases?

Question 19

What are the 3 phases of a couch

Answer 19

Inhalation
Thoracic pressure (hold)
Quick exhalation (forced out)

Question 20

How do you do the cough assist in sitting

Answer 20

Stand behind patient
Hands are on both sides of ribs
rotational component
Look up and over right shoulder and rotate down and opposite so down and to the left.
go in both directions

Question 21

How do you do cough assist in side lying?

Answer 21

still aiming for that rotational component
1. Stand at their bottom and face their head
2. Hands on the ribs to help with the expulsion and pressure forward to clear the lungs.
3. Stabilize the pelvis.
4. Inhale - rotate back - come forward and cough pushing down and in to help with the cough.
*want the rotation to come from thoracic spine.

Question 22

What are the developmental considerations when examining thoracic expansion?

Answer 22

Younger kids will have more movement in their belly. As child gets older you will see more and more involvement of their chest.
*measuring chest expansion is a really good thing to see on prognosis notes for any changes in their breathing patterns.

Question 23

Where do you measure chest expansion?

Answer 23

1. Axila
2. Xiphoid
3. Lowest rib — halfway between xiphoid and umbilicus
   tape measure wrapped around their back and crossed over in front of them at each landmark. Look at 10 breaths and take an average. Then look at 3 deep breaths and take that average.

Question 24

What are some ways to measure respiratory endurance?

Answer 24

Treadmill
Bike
6MWT
TUDST
HR
EEI
Fx measures