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Particular Impairments

Particular Impairments

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Particular Impairments

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  1. Particular Impairments • Pulmonary Function Tests Ventilation & Respiration • Chest X-Ray  Ventilation • Arterial Blood Gases  Respiration • SpO2 Respiration • Lung Sounds  Ventilation • Exercise Test  Oxygen Consumption • Ventilatory Muscle Strength Ventilation • Thoraco Abdominal Movements  Ventilation • Breathing Patterns  Ventilation / Respiration

  2. Capability for Work Skeletal Muscle Oxygen Consumption Advanced Methods for Understanding the medical complexity of your pulmonary patient….Impairment Interactions PaCO2 Oxygen Carrying Capacity PaO2 Respiration Alveoli Health RBC Alveolar (PAO2) Alveolar (PACO2) Renal Function Pump Effectiveness Pulmonary Blood Flow Alveolar Ventilation Arrhythmia Ventilation “Cardiac Effects” Breathing Mechanics

  3. Pulmonary Function Tests Ventilation & Respiration

  4. Pulmonary Function Tests Ventilation & Respiration • Mild COPD • FEV1/FVC 70-80% predicted • FEV165-80 % predicted • With or withoutsymptoms • Moderate COPD • FEV1/FVC 50-70% predicted • FEV1 50-65% predicted • With or without symptoms • Very Severe COPD • FEV1/FVC < 50% • FEV1 < 30% predicted or presence of respiratory failure or right heart failure • Severe COPD • FEV1/FVC < 50% • FEV1 30-50% predicted • With or without symptoms

  5. Pulmonary Function Tests Ventilation & Respiration DLCO – Diffusion Limited Carbon Monoxide

  6. Chest X-Ray  Ventilation

  7. Chest X-Ray  Ventilation

  8. Arterial Blood Gases  Respiration • PO2 • PCO2 • pH • HCO3-

  9. SpO2 Respiration • Oxyhemoglobin Dissociation Curve • CO2? • Related to exercise capacity?

  10. Exercise Test  Oxygen Consumption • Peak VO2 • Peak Ve • VE/VO2 • VE/VCO2

  11. What is required for the examination – evaluation? • Functional task – absolute workload and how long the patient was able to sustain • What was the relative response? • System (HR, BP, RPE, Dyspnea, muscle strength) • Ventilation (RR, chest wall, breathing mechanics, breathing patterns, spirometry, ventilatory muscle strength) • Respiration (SpO2, ABG’s, color, mentation)

  12. Hyperinflation • Irreversible (chest x ray; Hoover’s sign; barrel chest; accessory muscle use; chest wall mobility; lung sounds) • Reversible or Dynamic (chest x ray; Hoover’s sign; barrel chest; accessory muscle use; chest wall mobility; lung sounds)

  13. O’Donnell et al. 2001. Am J Respir Crit Care Med 164: 770-777

  14. O’Donnell et al. 2001. Am J Respir Crit Care Med 164: 770-777

  15. Hypoventilation • Can be caused by Hyperinflation (as in obstructive conditions) or from restrictive processes • ILD • Pneumonia • Masses • Pleural effusions

  16. Breathing Mechanics / Chest wall  Ventilation • Normal Movements – how to measure? evaluate? • Paradoxical movements • Accessory muscle use • Measurement • Palpation • Tape measure • Hoover’s sign

  17. Ventilatory Muscle Strength  Ventilation • Maximal Inspiratory Pressure • Maximal Expiratory Pressure • Endurance • Relationship between strength and endurance

  18. Breathing Patterns  Ventilation / Respiration • Ve = Vt x RR • How does pattern / balance of Vt and RR influence alveolar ventilation? • How do you assess this influence?

  19. SpO2 & ABG’s  Respiration • How do these influence your evaluation of ventilatory impairments?

  20. Interventions • Remember – as therapists we treat Impairments, Functional Limitations and Disability – NOT Disease • Therefore – we have spent time to understand impairments and their functional implications and as such we focus our interventions here • We use disease knowledge to help identify probable impairments and to establish whether impairments are reversible or irreversible, medical optimization, and overall prognosis – but we DO NOT HAVE A PARTICULAR TREATMENT FOR A PARTICULAR DISEASE

  21. Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? Yes No • Can response be changed? • Reversible vs. Irreversible? • Medically optimized? • What does this workload allow? • Pacing • Maximize Efficiency • Conditioning • Biomechanical optimization • What is limiting factor? • Degree / time frame of reversibility? • Specific vs. General training - • Increase maximal workload • Conditioning

  22. Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? Yes Ventilatory Ms Strength DHI – PLB Posture Chest wall exercises BPH - ACT Can response be changed? Reversible? Yes No Medically optimized? Yes No • What does this workload allow? • Pacing • Maximize Efficiency • Conditioning • Biomechanical optimization

  23. Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? No • What is limiting factor? • Degree / time frame of reversibility? • Specific vs. General training - • Increase maximal workload • Conditioning