lunedì, giugno 30, 2008

Diaphragm Training

Respiratory weakness is a problem ultimately affecting all patients with ALS, reducing their quality of life as well as their ability to breathe independently. At the Beth Israel Deaconess Medical Center we have developed a breath training program we call diaphragm training, which is designed to help individuals breathe more comfortably and effectively.

Diaphragm training is a simple, non-invasive technique that helps subjects to control their pattern of breathing in order to breathe more effectively; ultimately, this may also strengthen the respiratory muscles. This study involves eight visits over a six month period of time. The first three appointments test breathing capacity without the training, lasting. The subsequent visits will include the diaphragm training with a speech therapist and specialized pulmonary tests. (...)

Shortness of breath (dyspnea)

Central causes
Loss of consciousness suggests a central (central nervous system) cause. Central causes may present without loss of consciousness. A lot of information can be deduced from observing the pattern of shortness of breath involved.
A. Cheyne-Stokes breathing pattern

Regularly irregular with progressive increase in depth & sometimes frequency in a crescendo-decrescendo manner ends in apnoea (15-60 secs)
Normal in some persons during sleep. It is abnormal when it occurs while the subject is awake (signifies that the respiratory centers are sluggish in their response to variations CO2. Possible causes include aging, obesity, congestive heart failure, neurologic disorders e.g. meningitis, infarction, pontine hemorrhage). It is really more of a folklore than it is a practical clinical sign.
B. Biot's breathing pattern

A variant of Cheyne-Stokes. There is a succession of hyperpnoea, hyperventil, apnoea; but not regular, no crescendo-decrescendo.
Causes include meningitis, medullary compression. It eventually leads to death.
C. Apneustic breathing breathing pattern

Deep inspiration - breath holding - rapid exhalation
This usually signifies the presence of brainstem lesions usually at the level of the pons.
D. Central hyperventilation breathing pattern

Very rapid, very deep (faster than Kussmaul which is mainly very deep).
Found in midbrain / upper pointine lesions.

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