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G - Independence in Breathing

Independence in Breathing | Body Structure and Function D Tsui, MScPT; R Vaughan, RRT; VK Noonan, PhD; C O’Connell, MD; C Craven, MD; and the E-Scan Investigative Team Promoting independence in breathing after spinal cord injury (SCI) involves maximizing respiratory function, through timely and comprehensive assessment and treatment. SCI can cause paralysis or weakness of respiratory muscles, including the diaphragm, abdominal muscles responsible for coughing, and upper airway muscles responsible for speech, swallowing and clearing secretions (Figure 1.0). The number and extent of respiratory impairments depends upon the level of injury (Figure 1.0).1,2 Figure 1.0 Innervation of Primary and Accesory Muscles of Ventilation Explains Many of the Respirator y Problems Observed in Individuals with SCI. The result is changed effectiveness of the respiratory system and muscles responsible for ventilation.3 Ventilation is the process by which oxygen and gas enter and leave the lungs. Hence, clinical manifestations of respiratory muscle dysfunction can range from an inability to maintain effective spontaneous ventilation, ineffective cough (with decreased clearance of secretions and debris), recurrent infections and poor gas exchange, to limited muscle endurance with respiratory fatigue (Figure 2.0).2,4 Furthermore, individuals with SCI are at risk of developing sleepdisordered breathing, and the prevalence of obstructive sleep apnea ranges from 15-83%.5 Obstructive sleep apnea is a breathing disorder characterized by recurrent collapse of the upper airway during sleep, which can lead to desaturation, hypoxemia, sleep fragmentation and excessive daytime sleepiness.1,5 Undetected sleep apnea increases the risk of stroke and heart attack after SCI.6 Obstructive sleep apnea is most common in elderly men with high tetraplegia, and a large neck circumference.7 Regardless of the degree of respiratory dysfunction, rehabilitation respiratory care should provide individualized interventions to optimize bronchial hygiene, chest mobility and respiratory performance.4 Specific goals of respiratory rehabilitation are to prevent complications (e.g., pneumonia, atelectasis), maximize recovery of respiratory muscles, and increase respiratory endurance, so that individuals with SCI can fully participate in rehabilitation. Incidence of respiratory complications (such as pneumonia, pulmonary edema, pulmonary embolism, aspiration, and ventilatory failure) range from 36 to 83%.3,8-13 Respiratory complications are the leading causes of morbidity and mortality in the SCI population.3,8-13 Most importantly, 11% of early deaths, in the first month after SCI, are due to respiratory complications.14 Primary Muscles of Ventilation Accessory Muscles of Ventilation C1 Trapezius Sternocleidomastoid Scalenes • Assist primary muscle in breathing in • Only active voluntarily Pectoralis Major • Assists in breathing out • Only active voluntarily SCI at this level will require mechanical support for breathing Abdominal Muscles • Main muscles produce a strong cough • Improves diaphragm`s function SCI at any of these levels will decrease the ability to clear secretions Diaphragm • Main muscle of ventilation SCI at this level may require varying extents of assistance to breathe Intercostals • Muscles between ribs that aid in breathing SCI at any of these levels will decrease both the ability to breathe deeply and to cough C2 C3 C4 C5 C6 C7 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 Sacrum Coccyx Pelvic Segment Lumbar Vertebrae Thoracic Vertebrae Cervical Vertebrae INDEPENDENCE IN BREATHING | BODY STRUCTURE AND FNUCTION 75


G - Independence in Breathing
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