Deck 39: Multisystem Clinical Implications of Impaired Breathing Mechanics and Postural Control

Question 1

A child with pronounced muscle imbalance from lying in the recumbent position does not have which of the following?

A) Triangular-shaped thorax or chest wall
B) Ability to meet ventilation needs
C) Anteriorly flared lower ribs
D) Posteriorly flared ribs

Answer 1

D
The triangular shape of the chest wall is a primitive form that most infant grow out of in response to normal stresses against gravity on differing positions.Decreased lung volume may be a result of the weakened muscles and a result of malformation.Anteriorly flared ribs occur in the recumbent position if the diaphragm continues to work properly because the lower abdominals perform most of the work for respiration.

Question 2

Which of the following is not a distinguishing characteristic of types I and II paradoxical breathing?

A) Strong diaphragmatic or upper respiratory muscles contractions
B) Intercostal muscle insufficiency
C) Poor pelvic floor elevation
D) Weakness of the abdominal or diaphragm

Answer 2

C
Although the diaphragm is considered to be the primary respiratory muscles,the upper respiratory muscles,abdominals,and intercostal all play a role.Damage to one of these muscles may change the normal pattern of breathing for a patient.

Question 3

The inefficiency of the diaphragm in patients with lung disease,who have greater pressure in the thoracic cavity than in the abdominal cavity,stems from which of the following?

A) The inability of the diaphragm to rebound into the thoracic cavity because of increased pressure
B) The inability of the diaphragm to overcome pressure in the abdomen
C) The ability of the intercostals to maintain greater pressure in the thoracic cavity
D) The ability of the abdominals to overcome the pressure created in the abdomen.

Answer 3

A
Patients with lung disease often have a reversal of the pressure gradients normally found in the thorax and abdomen.Where usually there is more pressure in the abdomen as seen with the shape of the "dome" of the diaphragm,in patients with lung disease,there is often the need to fully expand and maintain high pressure in the lungs to respiration.

Question 4

When should correction of imbalances of the thoracic muscles be initiated?

A) As soon as the deficits are found
B) After the child reaches skeletal maturity
C) Only if ventilation capacity is compromised
D) After the child is able to expand the thorax in all three planes

Question 5

Changes to the child's thorax from 3 to 6 months of age include which of the following?

A) A more rectangular shape because of strengthening of the lower abdominals
B) A more rectangular shape because of strengthening of the anterior chest wall and intercostals
C) Development of slight concave configuration to the thorax
D) Breathing maintained in one plane of motion

Question 6

If a patient is to work on strengthening muscles to help with expansion of the anterior abdominal wall,how should the therapist position the patient?

A) Prone
B) Supine
C) Side-lying
D) Sitting

Question 7

Which of the following is not a function of the diaphragm?

A) Respiration
B) Creation of pressure in the thoracic and abdominal cavities
C) Trunk stabilization
D) Works in an isolated role to provide respiration and postural support

Question 8

Which anatomical valves represent the superior and inferior valves of the soda can model of respiratory and postural control?

A) The vocal cords and pelvic floor
B) The vocal cords and the diaphragm
C) The diaphragm and the pelvic floor
D) All of the above

Question 9

The primary muscles involved in the soda can model of respiratory and postural control include which group?

A) Pectorals, upper trapezius, abdominals and gluteals
B) Intercostals, scalenes, lower abdominals, and back extensors
C) Diaphragm, scalenes, pectorals, and lower abdominals
D) Back extensors, abdominals, diaphragm, and intercostals

Question 10

Paradoxical breathing type I has the end result of upper chest wall collapse because of which of the following muscular functions?

A) Lack of stabilizing contractions of the intercostal
B) The diaphragm fails to descend into the abdomen
C) The abdominal muscle contract decreasing the diaphragms descent into the abdomen
D) The upper respiratory muscles are unopposed in their pull of the chest wall superiorly

Question 11

Infants typically breathe in one plane compared with adults,who typically breathe in three planes.Reasons for this include all of the following except which statement?

A) The shape of their chest wall is conducive to diaphragmatic breathing
B) Arms are typically adducted, causing decreased expansion in the lateral plane
C) Infants have longer neck muscles, allowing superior movement of the thorax to assist with breathing.
D) The newborn chest wall is triangular in shape with the lower portion more easily expanded.

Question 12

Which of the following strategies may be used to optimize thoracic development?

A) Frequent changes in position
B) Facilitation of the weakened chest wall muscles
C) Promotion of optimal breathing patterns
D) All of the above

Question 13

Patients with which form(s)of compensatory breathing patterns need assistance from a ventilator?

A) Type I paradoxical
B) Paradoxical Type II paradoxical
C) Asymmetrical
D) Lateral or gravity eliminated

Question 14

Shallow breathing is the result of injury to or from which of the following?

A) Central nervous system
B) Peripheral nervous system
C) Muscle weakness
D) Low tone-associated pathology (spinal cord injury)

Question 15

Breathing for an infant from 3 to 6 months of age includes which of the following?

A) Continues to be primarily in one plane
B) Has expanded to more than one plane
C) Has fully matured to all three planes
D) Is more restricted in all three planes

Question 16

Type II of paradoxical breathing characterized by intact upper respiratory muscles.Why does this type of breathing usually require some form of ventilatory support?

A) The abdominals are insufficient to control the pull of the upper respiratory muscles.
B) Decreases in postural control do not allow for proper filling of air space.
C) The abdomen is drawn inward because of weakness and is unable to oppose the pull of the diaphragm.
D) The accessory muscles are not designed to meet the needs of long-term ventilation.

Question 17

How can the pelvic floor influence one's ability to cough?

A) Increasing positive pressure in the abdomen to produce a more forceful cough
B) Decreasing positive pressure in the abdomen reducing a forceful cough
C) Allowing pressure release of pressure created by the abdomen and thorax
D) All of the above

Question 18

Which of the following is not the cause of symmetrical breathing patterns?

A) Stroke
B) Scoliosis
C) Unilateral spinal or nerve root injuries
D) Bilateral spinal cord injuries

Question 19

Why is pectus excavatum is the end result of continued function of the upper respiratory and diaphragm breathing?

A) The abdominal pressure is greater than that of the thoracic pressure because of the strength of the abdominals and weakness of the intercostals.
B) The pull of the upper respiratory accessory muscles is unopposed.
C) The intercostal do not sufficiently oppose the pull of the negative pressure in the thorax, causing a collapse.
D) The pull of the diaphragm is less than that of the intercostals.

Question 20

The soda can model of respiratory and postural control outlines the needs for which of the following organ systems?

A) Skeletal supports for a weakened muscular system
B) Muscular support for poor development of organ systems
C) Muscular support for an incapable skeletal frame
D) Skeletal support for an incapable respiratory system