Ventilatory Muscle Training

8/14/2019 Ventilatory Muscle Training

1/39

RespiratoryRespiratoryMuscle TrainingMuscle Training


2/39

Muscles of Inspiration

Diaphragm

Scalene

Parasternals

Sternocledomastoid

Upper Trapezius

Pectoralis major and minor

Subclavius

External intercostals


3/39

Muscles of Expiration

It is a passive process

Rectus abdominals

Transverse abdominals

Internal and external oblique

Pectoralis major

Internal intercostals


4/39

Inadequacy of respiratory musclefunction

weakness and orincreased fatigability ofthe respiratory muscles induced by

structural/metabolic changes in themuscles themselves (e.g., musculardystrophy);

failure of muscle activation by the nervous

system (e.g., multiple sclerosis);


5/39

3. Functional weakness induced by

alterations in the mechanics of the

respiratory system that induce anincreased requirement for muscleforce output (e.g., emphysema);

or a combination of these factors (e.g.,chronic heart failure).


6/39

Symptoms

Dyspnoea

Impaired exercise performance Ineffective coughing Respiratory insufficiency Decreased quality of life


7/39

Ventilatory muscle testing

Tests of Overall Respiratory Function

Static Lung Volumes Dynamic Spirometry and Arterial Blood Gases: Awake Measurements during Sleep Tests of

Respiratory Control


8/39

Tests of Respiratory Muscle Strength Pressure Measurements Devices (Threshold

device)

Electrophysiological Techniques for theAssessment of Respiratory Muscle Function Electromyography Stimulation Tests(EMG)

Tests of Respiratory Muscle Endurance Measures of Respiratory Muscle Activity Ventilatory Endurance Tests Endurance to External Loads


9/39

So what we are going to test

Strength

Endurance

Fatigue


10/39

Strength

Clinically , respiratory muscle strength is

measured as PI max and max

expiratory muscle strength as PE max

.Should be held for 1 5 sec forrecording


11/39

Ventilatory muscle training


12/39

Methods

Strength training

Endurance training


13/39

Strength trainingStrength training


14/39

STRENGTH TRAINING

IMT EMT

With target

(Thereshold device)

Without target

(P-Flex)


15/39

Intensity

40 60 % P ImaxClinical recommendation

Begin with 7 cm h2O Progression 2 cm h2O with

every week

Progress slowly


16/39

Frequency

30 min / day in 2- 3 session

4 - 6 days / weekContinue indefinitely


17/39

Endurancetraining


18/39

Endurance training

Interval based Continuous

Intensity > 60 % maximal work rateFrequency 3- 4 days / weekDuration long duration start with 30 minutes

( warm up and cool down )


19/39

Endurance training - Mode

Cycling Walking


20/39

Threshold trainer

40- 60 % 0f P imax

Hold time

Monitoring CO2

2-3 days / week


21/39

Precautionary monitoring

To avoid fatigue Dis - oriented chest wall movement Observation

Exercise dyspnea during training Observation

Long lasting fatigue after training interview

To avoid muscleinjury

Signs of delayed onset musclesoreness

interview

Reduce strength Measurement ofPI max

Reduce endurance Inability to tolerate

To avoid hypercapnea spo2 Pulse oximeter

Signs of headache , confusion Interview


22/39

Clinical outcomes

Strength Pi max, Pe max Endurance incremental test using on

threshold trainer Dyspnea scale BORG Exercise capacity walk test Quality of life SF-36 questionnaire


23/39

Conditions

Obstructive COPD Asthma

Restrictive Thoracic Deformity

Abdominal Distension

Systemic Diseases

Collagen VascularDiseases


24/39

Conditions ..,

Neuromuscular Diseases

Muscle Dystrophies

Peripheral Nerve: Diaphragmatic

Paralysis, Guillain-BarreSyndrome

Neuromuscular Junction:

Myasthenia Gravis Thoracic and Cardiac Surgery

Abdominal Surgery


25/39

COPD


26/39

Hyperinflation

Cause


27/39

Mechanism


28/39

1.Inspiratory flow resistance.

2.Loss of elastic recoil of the lungs causes the

relaxation volume to move to a higher

volume and causes closure of small airways

in early exhalation (static hyperinflation).3.resting minute ventilation is increased by 50%

to compensate for impaired gas exchange.


29/39

4.Increases in time constants and breathingfrequency cause dynamic lungcompliance to fall below the static value

5.6.Expiratory flow limitation, which occurs in

about 60% of ambulatory patients withCOPD delays lung emptying, with theresult that inspiration begins before therespiratory system has returned to itsrelaxation volume(dynamic hyperinflation)

7.


30/39

What we have to ?????

Strength training orEndurance training

Debate ?????v

v

v

v

v

v 2005 copd review Endurance training + IMT is effective


31/39

Asthma

se Resistance 3 to 10% during acutebronchoconstriction

Hyperinflation

Steroid management

No < / > in respiratory muscle power Increase Diaphragm size Initially muscle fatigue Later starts the muscular weakness


32/39

Restrictive lung diseases

Scoliosis Ankylosis Pectus spondylytis excavatum

horacicdeformity


33/39

Scoliosis

Chest wall compliance is

inversely proportional to the

Cobbs angle

reduction in maximal Inspiratory

and expiratory pressures

Cobbs angle > 70 symptoms

present
http://images.google.co.in/imgres?imgurl=http://www.chiropractic.com.sg/scoliosis.jpg&imgrefurl=http://www.chiropractic.com.sg/scoliosis.html&h=289&w=257&sz=18&hl=en&start=11&um=1&usg=__eCicEzqbDcMPJ17CpoeDTxHXyro=&tbnid=1DuGVvGFIhiA8M:&tbnh=115&tbnw=102&prev=/images?q=scoliosis&um=1&hl=en&sa=X


34/39

Pectus excavatum

SameHere its is two

dimensionally


35/39

Ankylosis spondylitis

All the spine fused Transverse joint +

ribs also fused


36/39

Mechanism

Intercostals musclesare inhibited

Left out diaphragmactivates more, tillthe pressurecomes to normal


37/39

Spinal cord injury


38/39

CONCLUSION

RMT is effective tool for training therespiratory muscle weakness


39/39

Documents

Ventilatory Muscle Training