Exam 3 (Lectures 7-9) Flashcards
(187 cards)
1
Q
Strengthening exercise for CF patients
A
Mode: Free weights, machines, body weight
Frequency: 3-5 days/wk
Intensity: not high for children; 50-60% 1 RM for adults, 3 sets of 12 reps (physician clearance required for adults)
Duration: For adults, 30 min of strength training with inspiratory muscle training
For children, 10 - 30 min depending on # of muscle groups
2
Q
U.S. prevalence of CF
A
30,000 cases
3
Q
Volume in lungs after maximum expiration
A
Residual Lung Volume (RLV)
4
Q
Sympathetic control of the heart
A
Releases norepinephrine
Has a gradual effect
5
Q
US prevalence of spinal cord injury
A
237,000 - 301,000 cases
6
Q
Combining FES leg cycling and arm cycling
A
May cause pain if lower extremity sensation is preserved
7
Q
Systemic adaptations to spinal cord injury (8)
A
1) cardiovascular
2) autonomic dysreflexia
3) pulmonary
4) bowel & bladder function
5) spasticity
6) thermoregulation
7) endocrine
8) osteopenia
8
Q
Sympathetic neurons synapse with
A
The paravertebral ganglia
9
Q
3rd leading cause of death in U.S.
A
COPD
10
Q
Effects of CF on GI Tract (4)
A
1) Exocrine pancreatic insufficiency
2) CF related diabetes
3) Liver disease
4) Gallbladder disease
11
Q
Progression of COPD (8)
A
- ) enlargement of bronchial mucus glands
- ) lung parenchyma
- ) less elastic recoil of lungs
- ) greater RLV & lung hyper-inflation
- ) shortened diaphragm
- ) loss of expiratory capacities
- ) dyspnea
- ) skeletal muscle dysfunction
12
Q
Chronic inflammation of the bronchi
A
Bronchitis
13
Q
20 year old spinal cord patient life expectancy
A
Tetraplegia: 40+ years
Paraplegia: 45+ years
14
Q
< 30% FEV1 or symptoms of chronic respiratory failure
A
Very severe COPD
15
Q
Special considerations for CF patients based on medical history and a physical exam (5)
A
1) Level of pulmonary disease
2) Peripheral factors (scoliosis, kyphosis, etc.)
3) Liver disease
4) CF related diabetes (hyper or hypoglycemia)
5) Hydration level
16
Q
Permanent enlargement of the bronchioles and alveoli
A
Emphysema
17
Q
Sympathetic neurons exit the spinal column at
A
T1 - T6
18
Q
An airway obstruction causing breathing problems
A
Chronic Obstructive Pulmonary Disease (COPD)
19
Q
Other complications of CF
A
Bone disease (20% of CF patients)
Sinusitis and/or nasal polyposis
Depression (2% in children, 25% in 35+ year olds)
20
Q
Volume in lungs after maximum inspiration
A
Total Lung Capacity (TLC)
21
Q
Causes of spinal cord injury
A
Alcohol (25%)
Pediatric (usually congenital like spina bifida or myelomeningocele)
22
Q
Modern life expectancy of CF patients
A
30’s, 40’s, and beyond
23
Q
Diagnostic value of GXT for COPD (5)
A
1) symptoms may present only with exertion
2) evaluate disease progression
3) evaluate hypoxemia during activity
4) determine need for O2 supplementation
5) evaluate response to treatment
24
Q
Indirect lifetime cost of spinal cord injury
A
> $2.1 million/person
25
This is characterized by mucus plugging, inflammation, and an increase in smooth muscle
Lung parenchyma
26
CF symptoms (11)
1) salty tasting skin
2) wheezing or shortness of breath
3) persistent cough & excessive mucus
4) frequent lung infections
5) frequent sinus infections
6) nose growths
7) poor weight gain & growth
8) foul smelling, greasy stools
9) swollen belly
10) abdominal gas & discomfort
11) broadening of fingertips & toes
27
Absolute contraindications to SCI GXT (5)
1) autonomic dysreflexia
2) orthostatic hypotension
3) recent deep vein thrombosis
4) pulmonary embolism
5) pressure ulcers causing autonomic dysreflexia
28
Functional value of exercise testing in SCI
Design an exercise program
| Return to work
29
This is used in a diffusion test
Carbon monoxide
30
Cost of initial hospitalization for tetraplegia
> $80,000 (60 days)
31
Worldwide prevalence of CF
70,000 cases
32
Annual number of spinal cord injuries
40 new cases per million people
33
Modes for SCI exercise testing
Arm-cycling (with Velcro straps)
Wheelchair ergometry (usually higher VO2 peaks than arm-cycling)
Customized equipment
Treadmill
Rollers
34
2 causal mechanisms of COPD
Oxidative stress
| Inflammation
35
Shortened diaphragm = ?
Less force development
36
Why do we tend to avoid upper body exercise with COPD?
It may cause dyspnea
37
These supply blood to the spinal cord
Spinal arteries
38
Secondary spinal cord injury causes (6)
1) limits to blood supply
2) infarction of grey matter 4-8 hours after injury
3) necrosis (possible up to 1-2 levels above injury)
4) fibrous & scar tissue formation
5) obstruction of neural transmission
6) nervous system dysfunction (both somatic & autonomic)
39
Most COPD patients have both of these
Chronic bronchitis and emphysema
40
Components of a Pulmonary Rehabilitation program (4)
Assessment, education, exercise training, psychosocial interventions
41
Parasympathetic control of the heart
Predominates at rest
Releases acetylcholine
Has a rapid effect
42
Shortened diaphragm = ?
Less force development
43
Airway clearance therapies
Exercise
| High frequency chest wall compressions (i.e.: the vest)
44
What is cystic fibrosis (CF)?
A genetic disorder
45
Components of pulmonary rehabilitation for CF (6)
1) exercise training
2) nutritional counseling
3) education on managing lung disease
4) energy-conserving techniques
5) breathing strategies
6) psychological counseling and/or group support
46
Volume in lungs after tidal expiration
Functional Residual Capacity (FRC)
47
Location of the alveoli
End of respiratory tract
48
Life expectancy of CF patients in the 1950's
Few lived to attend elementary school
49
How are spinal cord injuries classified?
Complete vs incomplete
Level
Limbs affected
50
X-Ray of over-extended lungs and a flattened diaphragm would indicate
Positive diagnosis of COPD
51
Direct lifetime medical costs of complete tetraplegia
> $1.7 million/person
52
Role of exercise in COPD treatment
Aerobic training of the lower body
Resistance training in whole body
Ventilatory muscle training
53
Incomplete spinal cord injury
Some nervous signal can be conducted through the effected area
54
Protocol for SCI exercise testing
Start at 5-25 Watts
Increase power 5-10 Watts per stage
1-3 minutes per stage
55
CFTR mutation results from
A genetic mutation on chromosome 7
56
FES provides improvements in (8)
1) Muscular strength and endurance
2) Energy expenditure
3) Stroke volume
4) VO2 peak and peak power
5) Lower extremity bone mineral density
6) HDL
7) Self perception
8) Body composition
57
In 2005, there were this many deaths in COPD patients older than 25
126,000 deaths
58
Accommodations for exercise testing with CF
May have to modify to allow O2 tanks
59
CF is inherited recessively
1 CF gene is inherited from each parent
60
The vagus nerve is part of which system?
Parasympathetic nervous system
61
Comorbidities of spinal cord injury (8)
1) cardiovascular diseases (coronary & peripheral artery disease), which may lead to amputations
2) pressure soles
3) pulmonary problems
4) obesity (lower bmr)
5) type 2 diabetes
6) osteoporosis & osteopenia
7) shoulder overuse injuries
8) bony overgrowth in joints
62
Causes of COPD
1. ) Chronic bronchitis - excessive mucus
| 2. ) Emphysema - loss of functional alveoli
63
Medications for CF
Mucolytic agents
| Antibiotics for bacterial lung infections
64
Other tests for diagnosing CF (10)
1) Clinical examination
2) Sputum culture
3) Chest X-Ray
4) Sinus CT scan
5) Static & dynamic lung assessment (if age appropriate)
6) Blood sampling for complete cell count
7) Liver function test
8) Renal function test
9) Nutritional parameters (total protein, albumin, fat soluble vitamins, glucose)
10) Pulmonary function testing
65
How to modify existing protocols for COPD (4)
1) Extend stages
2) Slower progression
3) Ramping protocols
4) Smaller increments
66
Sputum producing cough
Bronchitis
67
Median age of death in CF patients
Late 30's
68
Direct cost of cystic fibrosis
> $900 million/year
69
Maximum volume inspired following tidal expiration
Inspiratory Capacity (IC)
70
Chronic inflammation of the bronchi
Bronchitis
71
Exocrine pancreatic insufficiency results in
Malabsorption of nutrients including fats & proteins
72
The spinal cord is protected by
33 vertebrae
73
Flexibility training in SCI
Contractures
| Spasticity
74
Initial hospitalization costs for paraplegia
> $50,000 (50 days)
75
How to diagnose spinal cord injury
Physical examination
X-Ray
MRI
CT Scan
76
This is better at diagnosing emphysema than an X-Ray
CT scan
77
Risk factors of COPD (5)
1) Smoking
2) Air pollutants
3) Genetic factors
4) Asthma
5) Respiratory infections
78
Maximum volume inspired following tidal expiration
Inspiratory Capacity (IC)
79
Diagnostic value of exercise testing for SCI
Coronary artery disease
| Silent ischemia
80
Paraplegia
Paralysis of two limbs
81
2 ways to test pulmonary function
1) Spirometry
| 2 Pulse oximetry
82
Aerobic exercise for CF
1) Mode: No specific optimal activity
2) Frequency: Gradual progression. 3-5 days/wk for adults. Daily for children
3) Intensity: Start low, progress gradually. Improvement stage is 70%-85% of HRmax
4) Duration: 20-60 min
83
Expected power in wheelchair ergometry
40 - 100 Watts
84
Ventilatory muscle training in COPD
3+ days/week
30% or more max inspiratory pressure
15+ minutes
85
The ______ _______ of COPD is not fully understood.
Causal mechanisms
86
Locomotor training
Improves walking ability
87
Cardiovascular testing for CF
GXT with led exercise
Avoid upper body exercise
Exercise tolerance is predictive of survival
88
Contraindications for CF exercise testing
No absolute contraindications
No testing during severe infections
Monitor symptoms closely
89
How to prevent COPD
Avoid smoking and air pollutants
90
The only athletes limited by lung capacity are
Swimmers
91
Exercise training in SCI
Low initial intensity
| Use of brakes
92
Primary spinal cord injury damages (3)
Neural tracts
Cell bodies
Vasculature
93
Complete spinal cord injury
No nervousness signal can be conducted through the effected level
94
Diagnosis of CF
Sweat test (gold standard, measures chloride amount)
Genetic mutation analysis
Clinical diagnosis required ultimately (both tests can produce uncertain results)
95
Medications for COPD management
Bronchodilators
Beta-2 agonists
Anticholinergic
Corticosteroids
96
Special considerations for SCI exercise training (8)
1) accessibility
2) temperature control
3) abdominal binders
4) leg wraps
5) Velcro straps
6) cuffed weights
7) bladder & bowel evacuation before testing and training (catheters may be necessary)
8) possibility for silent ischemia (no angina)
97
Progression of COPD (8)
1. ) enlargement of bronchial mucus glands
2. ) lung parenchyma
3. ) less elastic recoil of lungs
4. ) greater RLV & lung hyper-inflation
5. ) shortened diaphragm
6. ) loss of expiratory capacities
7. ) dyspnea
8. ) skeletal muscle dysfunction
98
50-79% FEV1
Moderate COPD
99
These people may become independent walkers
Patients with incomplete spinal cord injury
100
Enlargement of the mucus secreting glands in bronchitis causes
Hyper-secretion of mucus clogs the alveoli.
| Cough develops to remove the mucus
101
Maximum inspiration at end of tidal inspiration
Inspiratory Reserve Volume (IRV)
102
Volume of air inspired or expired per breath
Tidal volume (TV)
103
Effects of CF on the respiratory system (3)
Thick mucus in the lungs obstructs the bronchial airway, bacterial infections, and inflammation.
(Progression differs between people.)
104
53% of CF patients are
Younger than 18 years old
105
Relative contraindications to SCI GXT (5)
1) active tendinitis
2) chronic heterotrophic ossification
3) peripheral neuropathy
4) pressure ulcers of grade 2 or less
5) spasticity
106
CF related diabetes is caused by
Damage to the pancreas and the need to monitor blood sugar
107
Number of 1995 physician visits for COPD
16 million
108
Spirometry examines 3 variables
Lung volume & lung capacity
FEV1
Diffusion capacity
109
Physical therapy for spinal cord injury
Includes physical activity and exercise
| Functional electrical stimulation (FES)
110
Innervation of sympathetic neurons
Sinoatrial and atrioventricular nodes and the ventricular muscle
111
Amount of fresh air reaching alveoli
Alveolar ventilation
112
30-49% COPD
Sever COPD
113
This is characterized by mucus plugging, inflammation, and an increase in smooth muscle
Lung parenchyma
114
Cause of CF
Mutation in gene for protein CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)
Both copies of CFTR or mutated
115
Cost of COPD in 2000
$24 billion
116
Number of people in U.S. with COPD
30 million
16 million diagnosed
14 million undiagnosed
117
Origin of the vagus nerve
Medulla obloganta
118
People with this condition have a decreased ability to perform expiration
Emphysema
119
Measures for CF exercise testing (3)
1) Ventilation
2) ECG
3) Pulse oximetry (if < 90% possibility for supplemental O2 for training)
120
Progression of emphysema (3)
1. ) destruction of elastin in alveolar walls
2. ) alveoli unable to hold functional shape upon exhalation
3. ) prolonged exhalation
121
COPD exercise mode
Walking or leg cycling
122
Functional value of GXT for COPD (2)
1) low functional capacity due to pulmonary limitations
| 2) development of exercise programs
123
The most common life shortening genetic disease in Caucasians
Cystic fibrosis
124
Supplement to diet for CF
Pancreatic enzymes
| Fat soluble vitamins
125
Effects of exercise in COPD treatment
Less dyspnea
| Higher exercise capacity
126
Must last this long to be classified as bronchitis
3 months in 2 consecutive years
127
COPD diagnosed how
Spirometry, chest X-Ray, and CT scan
128
In COPD, the bronchial mucus glands ______.
Enlarge
129
Flexibility exercise for CF
Static training for major muscle groups
Frequency: 2+ days/wk
Before & after aerobic & anaerobic activity
Include with every exercise program
Intensity: Gentle pull in muscle, don't force stretches
Duration: 10-30 sec/stretch
130
Cost per person for CF
$40,000 per year
131
Body composition for CF
Monitor height, weight, & BMI against growth charts
132
Expected response to SCI exercise testing
Low VO2 peak
HR peak of 120 bpm in complete tetraplegia and T1-T3 paraplegia.
HR peak is normal below T7.
133
Maximum volume expired after maximum inspiration
Forced Vital Capacity (FVC)
134
Maximum expiration at end of tidal expiration
Expiratory Reserve Volume (ERV)
135
Occupational therapy for spinal cord injury (5)
1) strengthen muscles & improve function
2) self care
3) transfer & mobility skills
4) domestic and work environment modifications
5) domestic & community living skills
136
Goals of exercise program for CF management (6)
1) Improve physical fitness and ADL
2) Improve quality of life
3) Reduce symptoms
4) Alleviate associated & secondary conditions
5) Ensure enjoyable participation
6) Ensure safety
137
Sputum producing cough
Bronchitis
138
Measured in breaths/minute
Minute ventilation
139
Locomotor training should focus on
Unweighted walking with manual or mechanical exercise
140
Cost of COPD per hospitalization
$10,684
141
Abnormal CFTR results in
Abnormal sodium chloride & water movement across the cell membrane
Abnormally thick and dry mucus
142
Origin of sympathetic neurons
Medulla
143
Secondary spinal cord injury is caused by
Hemorrhage and edema within the spinal cord
144
Exercise training for SCI involves a multidisciplinary team
Exercise physiologist
Physical therapist
Physician
All help with goal setting
145
Goals of pulmonary rehabilitation (5)
1) Decrease airflow limitations
2) Decrease respiratory symptoms
3) Improve exercise capacity
4) Promote independence
5) Improve quality of life
146
Considerations for CF exercise program (5)
1) Start after determining dyspnea level & supplemental O2 need
2) Adjust volume by severity
3) Make physical activity fun for children
147
Functional electrical stimulation provides
Electrical stimulation for movement in paralyzed limbs
148
greater than or equal to 80% FEV1
Mild COPD
149
Bronchitis causes the mucus secreting glands to
Enlarge
150
Volume in lungs after tidal expiration
Functional Residual Capacity (FRC)
151
2 causal mechanisms of COPD
Oxidative stress
| Inflammation
152
Aerobic training in COPD
3-5 days/week
20-60 minutes if continuous or intermittent activity depending on COPD severity
Walking or stationary cycling
Follow older adults recommendations
153
Symptoms of COPD (6)
1. ) Coughing
2. ) Wheezing
3. ) Dyspnea
4. ) Fever
5. ) Low tolerance for exercise and physical activity
6. ) 20-30% lower strength
154
HR response in SCI exercise training
Above T7: lower submax HR and lower sympathetic activation
T7 or below: higher submax HR
155
Number of COPD cases in 2000
726,000 cases
156
Components of ventilatory muscle training (3)
1) voluntary isocapnic hyperpnea
2) inspiratory resistive loading
3) inspiratory threshold loading
157
This variable is not valid in advanced CF patients
Predicted HRmax
158
Value of GXT concerning COPD (3)
Diagnostic, prognostic, & functional
159
Characteristics of CF
Obstruction of passageways of the bronchi, intestines, & pancreas & bile ducts by excessively viscid mucus
Increased sodium and chloride in sweat
160
This may cause 20-30% lower strength in COPD
Chronic steroids use which causes myopathy or muscle wasting
161
Treatment for CF (7)
1) Medication
2) Daily mucus clearance techniques
3) Airway clearance therapy
4) Fat-soluble diet
5) High-fat, high calorie diet
6) Pulmonary rehabilitation
7) Supplements
162
Tetraplegia
Paralysis of four limbs
163
Standard exercise termination criteria for COPD patients
Relative: shortness of breath, wheezing, etc.
Also, severe arterial de-saturation of <80%
164
Traps air in lungs and chronically causes anatomical alterations
Emphysema
165
Spinal cord injuries affect
The conduction of neural signals
166
Resistance training in COPD
Improving upper body strength to reduce dyspnea
167
Multi-factorial COPD management (4)
1) Smoking cessation to reduce FEV1 decline.
2) Medication
3) Supplemental O2 therapy
4) Pulmonary rehabilitation for symptomatic COPD patients
168
Strength training in SCI
Focus on scapular stabilization
| Risk of overuse
169
How many new CF cases per year in the U.S.
1000 new cases
170
Management of spinal cord injury
Medication (short & long term)
Surgery
Physical therapy
Occupational therapy
171
In COPD, a low tolerance for physical activity in conjunction with hypoxemia will cause (4)
1. ) loss of muscle mass
2. ) less oxidative enzymes
3. ) alterations in muscle fiber types (less Type I, more Type II B)
4. ) 20-30% lower strength
172
Treatment for bronchitis (2)
Anti-biotics
| Bronchodilators
173
Cardiovascular adaptations to spinal cord injury
Loss of vasomotor tone
Venous pooling
Orthostatic hypertension
174
In COPD, the bronchial mucus glands ______.
Enlarge
175
5 results of nutrient malabsorption in CF
1) Steatorrhea (oily, smelly stools)
2) Malodorous stool
3) Abdominal pain
4) Malnutrition
5) Constant struggle to maintain body weight
176
Collagen and elastic fibers contribute to
Stretching and recoil of alveolus sac
177
The ______ _______ of COPD is not fully understood.
Causal mechanisms
178
Goal of pulmonary testing
To examine the patient's response to exercise.
179
CF affects these systems (3)
Respiratory, digestive, and reproductive systems
180
exercise testing with functional electrical stimulation (FES)
Higher venous return
Higher stroke volume
Higher VO2 peak
181
Must last this long to be classified as bronchitis
3 months in 2 consecutive years
182
Number of alveolus
300 million
183
FES provides improvements in (8)
1) Muscular strength and endurance
2) Energy expenditure
3) Stroke volume
4) VO2 peak and peak power
5) Lower extremity bone mineral density
6) HDL
7) Self perception
8) Body composition
184
If the spinal injury is complete at or above C4
No use of arms
| Exercise with FES
185
Functional electrical stimulation provides
Electrical stimulation for movement in paralyzed limbs
186
Innervation of vagus nerve
Sinoatrial and atrioventricular nodes
187
What does supplemental O2 therapy do?
Prevents tissue hypoxia
| Achieves 90% O2 saturation
