Respiration applications Flashcards
1
Q
What is the efficacy rating of biofeedback for Asthma?
A
Level 3- Probably Efficacious
2
Q
What is the efficacy rating for biofeedback for COPD
A
Level 2- Possible Efficacious
3
Q
what is a peak flow meter?
A
measures how much air you can exhale with a single breath.
4
Q
What is an incentive inspirometer?
A
It measures how much air you can inhale with a single breath.
5
Q
what is a serial-7s Stressor?
A
Mentally count backwards from 1000 by 7s until asked to stop and asked for the number your on.
6
Q
Effortless breathing was a term coined by who?
A
Erik Peper
7
Q
What is effortless breathing?
A
a relaxed breathing pattern Peper used to teach patients. This breathing pattern uses the diaphragm to ventilate the lungs and a more accurate term than diaphragmatic breathing since all breathing uses the diaphragm.
8
Q
When breathing effortlessly it feels like _____% effort as you client utilizes ______ volition.
A
feels like 70% effort; utilizes passive volition
9
Q
Clinicians train patients to substitute maladaptive breathing for effortless breathing to _____ lung ventilation and ____
A
increase lung ventilation and arterial CO2.
10
Q
In effortless breathing attention settles where?
A
below your waist
11
Q
In the effortless breathing the amount of air through your lungs _____.
A
increases
12
Q
In effortless breathing you breathe through your ____ to condition the air.
A
nose
13
Q
In effortless breathing your lungs are ventilated by cyclically contracting the ______ muscle (during inspiration) and ______ (during expiration).
A
contracting diaphragm muscle during inspiration and
contracting rectus abdominis (during expiration).
14
Q
Accessory muscles (scalenes and trapezius) are not used for what?
A
NOT used for moving air
15
Q
True or False: Accessory muscles (scalenes and trapezius) are used for moving air?
A
FALSE THEY ARE NOT
16
Q
During effortless breathing you respiration rate is between what?
A
5 and 7 breaths/minute compared to the normal 15-17 breaths/minute
17
Q
pauses following expiration (post-expiratory pauses) are ____ than those following inspiration (post-inspiratory pauses).
A
pauses following expiration are longer than those following inspiration.
18
Q
during effortless breathing the ribs/back _____ during inspiration
A
widen
19
Q
what is the tidal volume during effortless breathing?
A
over 1000 ml
20
Q
How does effortless breathing affect alpha abundance?
A
It increases alpha abundance
21
Q
How does effortless breathing affect temperature in the hands and feet?
A
It increases the temperature in the hands and feet
22
Q
How does effortless breathing affect blood pressure?
A
It decreases blood pressure
23
Q
How does effortless breathing affect SEMG level?
A
It decreases SEMG level
24
Q
How does effortless breathing affect heart rate?
A
It decreases heart rate
25
How does effortless breathing affect skin conductance?
It decreases skin conductance
26
How does effortless breathing affect parasympathetic tone?
It increases parasympathetic tone
27
How does effortless breathing affect endogenous opioid release
It increases opioid release
28
How does effortless breathing affect blood CO2 levels?
It increases blood Co2 levels, decreasing pH (more acidic)
29
How does effortless breathing affect hemoglobin release of oxygen and Nitric oxide?
It causes hemoglobin to increase release of oxygen adn Nitric oxide
30
How does effortless breathing affect oxygen and glucose levels to tissues and vasodilation?
It increases oxygen and glucose to tissues and vasodilation
31
Raynaud's disease and vascular headache occurs when respiration rate falls below ____ breaths/minute and when PCO2 normalizes to about ___% or ___ torr
falls below 6 breath per minute; and when PCO2 normalizes to about 5% or 36 torr.
32
How can effortless breathing contribute to the treatment of hypertension?
It can increase vasodilation which is critical to the treatment of hypertension.
33
Why should a therapist breath effortlessly when training a patient to breath effortlessly?
There could be a modeling effect where the therapist's breathing behaviors can influence the patient's breathing.
34
When trying to effortlessly breath the client should allow the ____, ____, and _____ to relax.
jaw, neck, and shoulders
35
The stomach should _____ before inhaling
contract
36
The patient should pause ____after exhalation than following inhalation
longer
37
What is tidal volume?
air moved in and out of the lungs with each breath.
38
A patient should passively _____ tidal volume not ____ respiration rate
passively increase tidal volume not slow down respiration rate.
39
When tidal volume increase what should happen to respiration rate?
It should decrease
40
Lungs are ventilated by moving _____, not by _____
moving volumes of air not respiration rate
41
Is converting model of effortless breathing a direct or indirect way of teaching effortless breathing?
indirect
42
Is guided imagery that activates trust and hope a direct or indirect way to teach effortless breathing?
Indirect
43
Is pursed lip breathing a direct or indirect way to teach effortless breathing?
Indirect
44
Is hand on the abdomen/chest a direct or indirect way to teach effortless breathing?
Indirect
45
Is breathing with a weight on the abdomen while laying on the floor a direct or indirect way to teach effortless breathing?
Indirect
46
Is observing breathing using a mirror or video a direct or indirect way to teach effortless breathing?
Indirect
47
Is body movement like pelvic rocking a direct or indirect way to teach effortless breathing?
Indirect
48
Is listening to ocean sound tracks or rhythmic music a direct or indirect way to teach effortless breathing?
Indirect
49
Is pacing using devices like an animated pacer, audiovisual stimulation, or metronome a direct or indirect way to teach effortless breathing?
Indirect
50
Is respiratory band biofeedback a direct or indirect way of teaching effortless breathing?
Direct
51
Is accessory muscle SEMG biofeedback a direct or indirect way to teach effortless breathing?
Direct
52
Is HRV biofeedback a direct or indirect way to teach effortless breathing?
Direct
53
Is volumetric (inspirometer) biofeedback a direct or indirect way to teach effortless breathing?
Direct
54
If your patient is breathing smoothly than the piston in an inspirometer should what?
should NOT rattle
55
Kabins, Goedde, Layne, and Grant examined whether brief coaching could increase inhalation volume. In both coaching and non coaching conditions, participants received instructions to exhale before inhaling through an incentive inspirometer and received visual feedback from its rising cylinder. They completed 5 inhalations. In the coaching conditions, an experimenter announced inhalation volume after each inhalation. When it was under 2500 ml they were told "you are doing well. Now lets see if you can go a little higher. Make sure you do not start your next breath until you exhale most of the air from your lungs." When their volume was more over 2500 ml they were told "Great job! Keep it up". In the no-coaching condition no verbal feedback was given. What were the results?
Those that received brief coaching increased inhalation volume by 5%.
56
Instruct your patient to sit ___ while breathing effortlessly
upright
57
With permission, place your hands above the patient's hips. What will this do for the patient?
She will feel expansion against the hands during inspiration and reduced pressure during expiration.
58
What is the main objective of effortless breathing?
normalize end-tidal CO2 to ~ 5% (36 torr)
59
Shaffer, Bergmann, and Dougherty demonstrated what was the best indicator of breathing effortlessly?
end-tidal CO2
60
In breathing effortlessly what accessory muscles should be used?
NONE!! no accessory muscles should be used during effortless breathing.
61
Shaffer found that video game playing did what to breathing?
promoted dysfunctional breathing.
62
You should set a pacer for your client when teaching effortless breathing in which the exhalation is at least ____ as long as inhalation and there is an _____ post-exhalation pause
in which exhalation is at least 2 times as long as inhalation and there is an extended post-exhalation pause.
63
What are indicators that breathing with effort is occurring?
- Increase in accessory muscle EMG
- A decrease in end tidal CO2
- A decrease in respiratory waveform rhythmicity
64
A loss of smooth sinusoidal waveform is an indicator of what?
That effort breathing is occurring.
65
Effortless breathing can be taught in a series of weekly ____ to ____ minute sessions
in a series of weekly 20 to 30 minute sessions
66
In each session teaching effortless breathing it may be structured how?
1) a 3 minute baseline with no feedback
2) 4 or more 3 minute respiratory segments, each followed by coaching
3) 3 minute base line again with no coaching
4) assign practice
67
You should encourage a client you are teaching effortless breathing to, to practice a breathing exercise ___ minutes a day.
15 minutes a day
68
Gilbert recommended the use of what in breathing training?
A pulse oximeter
69
Why is a blood oxygen saturation of 85-98% ideal?
means oxygen has moved into the tissue where it is needed
70
Why is blood oxygen saturation of 99-100% is not ideal?
It means that almost all the oxygen remains bound to hemoglobin in the blood stream where it can not provide nourishment.
71
What do blood oxygen saturation values below 90% indicate?
indicated that safety may be endangered and may indicate life-threatening condition like a heart failure.
72
What may happen when clients experience hyperventilation symptoms due to excessive breathing?
They may feel starved for oxygen and start to take deeper and faster breaths. This can worsen their symptoms and trigger panic attacks.
73
Gilbert cautioned that hyperventilation alone can not trigger values below ____ % and might warrant medical attention.
below 85%
74
Before initiating HRV biofeedback a clinician may first determine what?
a client's resonance frequency, the breathing rate that maximizes heart rate variability (HRV).
75
spontaneous breathing contains diverse breathing rates that generate what?
corresponding HRV frequencies by modulating vagal control of the heart.
76
A client is trained to breathe at resonance frequency to create a peak around _____ in order to exercise the _____ and ____ HRV.
to create a peak 0.1 Hz; in order to exercise the baroreflex and increase HRV.
77
Ordinary breathing produces ______ frequencies while resonance breathing produce a single summated peak at around _____ Hz.
Ordinary breathing produces 3 HRV frequencies (VLF, LF, and HF); while resonance breathing produces a single summated peak at around 0.1 Hz.
78
Increasing the size of your ______will exercise important reflexes and control your body more efficiently.
respiratory sinus arrythmia; heart rate changes
79
Many clients start to breathe effortlessly, increase parasympathetic activity, and improve autonomic balance within ___ _____ biofeedback training sessions.
4, 30 minute sessions
80
To achieve maximum psychological, physiological, and performance gains it may require ____ HRV biofeedback sessions
10 or more
81
What are the most important HRV training elements?
1) Education about purpose, benefits, and process of HRV biofeedback.
2) Constant modeling the breathing pattern you want your client to learn.
3) Gradually shaping client's respiration rate down towards resonance frequency.
4) Daily practice of resonance frequency breathing for 20 minutes that can be aided by smartphone and computer apps.
5) Practice of slow effortless breathing during common place activities in diverse settings
6) assignment of 20 minutes/day of aerobic activity
7) monitoring HR during exercise to establish personal bench marks (crucial for heart patients) using smartphone apps like iCardio.
8) Monitoring heart rate during activities and emotional states to increase awareness of her stressors and physiological responses to them.
9) Practice of positive emotions to increase quality of life and reduce sympathetic activation.
10) Acceptance and Commitment Therapy (ACT) and stress management training to reduce sympathetic activation.
82
What measures inhaled volume of air?
incentive inspirometer
83
What are symptoms most often observed in COPD patients?
- asthma
- Chronic bronchitis
- emphysema
84
Up to _____% of general internal medical patients for phobia have a primary diagnosis of Hyperventilation syndrome.
10%
85
What is the peak for Hyperventilation syndrome?
15-55 years old.
86
The female to male ratio for hyperventilation syndrome may reach _____
7:1
87
As many as _____% of the United States population presents with some HVR symptoms.
6%
88
Prevalence of Hyperventilation in the United States may be as high as ____%
6%
89
Elevated pH causes hemoglobin to do what?
tightly bind oxygen, slowing oxygen release to body tissues and reducing partial presssure of oxygen (PO2).
90
Changes associated with reduced PCO2 may do what to blood vessels in the brain?
Constrict them which is linked to transient ischemic attacks in stroke
91
Changes associated with reduced PCOs may do what to blood vessels in the heart?
Constrict them and may cause angina
92
What can contribute to gran mal seizures?
Too high of a pH which has raised the neuronal excitability.
93
Hyperventilation does what to BP
Increases it
94
Hyperventilation does what to HR?
Increase it
95
Hyperventilation does what to cardiac output?
Increases it
96
Hypertensives often can not breathe and ____ at the same time?
talk
97
When hypertensives talk there BP often ____, _____ for air.
BP often increases; gasping for air
98
Hyperventilation does what to variability in HR?
removes normal, chaotic, variability in HR and replaces it with non varying HR that is less adaptive when workload changes. Normal parasympathetic control is replaced with sympathetic control.
99
Absence of RSA is a prediction of what?
Heart disease
100
What happens in the startle response?
Contraction of the rectus abdominis produces thoracic breathing which may escalate to hyperventilation. Abdominis muscles contraction depresses the rib cage and abdominis cavity, and pressures the viscera (constricting it). This interferes with diaphragm's downward movement, suddenly stopping breathing.
101
The senile posture does what?
the muscles at your center of gravity simultaneously pull the pelvis and hips up toward the trunk, yet pull the trunk and shoulder girdle down towards the pelvis. Producing chronic shallow breathing and hyperventilation by immobilizing the chest.
102
Why can tight close cause hyperventilation?
Tight clothes hold the stomach in, this constricts the viscera and interferes with diaphragm's downward movement during inspiration. Which reduces lung ventilation and the respiratory system compensates by breathing more rapidly.
103
Shaffer, Mayhew, Bergman, Dougherty, and Irwin, demonstrated that tight jeans increase minute volume by ____% and oxygen uptake per kg of body weight by ____ %compared to loose jeans
11%; 6%
104
Hyperventilation occurs when pH drops below?
7.00 bc the body compensates for increased acidity by raising respiration rate and expelling more CO2
105
Hyperventilation occurs when pH drops below?
7.00 bc the body compensates for increased acidity by raising respiration rate and expelling more CO2. The lungs account for 85% of adjustment and the kidneys the other 15%.
106
A food containing or can create _____ is a main culprit of food that can cause hyperventilation.
Tyramine
107
What is Tyramine
An amino acid that produces components of the fight-flight response.
108
Some foods that contain tyramine that a small percentage of head ache patients should avoid include:
aged cheese, alcohol, and chocolate.
109
What evidence is there that Tyramine may be involved in vasoconstriction disorders?
Bc it is in circulating blood constriction vessels.
110
What are the main conditions Tyramine is involved in causing?
angina, hypertension, idiopathic epilepsy, migraine and Raynaud's.
111
How does Histamine affect blood oxygen?
reduces blood oxygen by constricting vessels and directly affecting RBC transport of oxygen
112
When is histamine often released?
During an allergic reaction
113
Histamine is a ______
vasoconstrictor
114
Early phase response of asthma features what?
smooth muscle spasm and excessive mucus secretion, which obstructs airway. Air gets trapped in alveoli
115
Late phase response involves what?
inflammation, scar tissue formation, fluid accumulation, and death of epithelial cells lining brochiolies.
116
What is the estimate prevalence of asthma in the United States?
3-10%
117
According to Tortora and Derrickson what are the symptoms for asthma?
- difficulty breathing
- coughing
- wheezing
- chest tightness
- HR over 100 bpm (tachycardia)
- fatigue
- moist skin
- anxiety
118
The optimal training protocol for asthma and cardiovascular health teaches clients to increase power in the ____ band
lower frequency band
119
Lehrer's cardiovascular resonance frequency biofeedback for asthma includes what?
Combines HRV biofeedback with abdominal pursed-lip breathing.
120
Lehrer speculates HRV biofeedback may increase compliance in ____ tissue through ____
may increase compliance in airway tissue through reducing inflammation
