Question 1

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

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

Waiting to correct imbalances can be detrimental to the overall development of the child.Not only are musculoskeletal issues of concern but also the eventual development of all organ systems.Developmental deficits may include changes to cardiac,digestive,muscular,and skeletal systems,among others.

Question 5

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

Accepted Answer

During the first 3- to 6-month period of development,a child is beginning to reach and use the upper extremities,causing strengthening of the anterior chest wall and intercostals.This allows for expansion of the ribs in the lateral plane as well as better resistance to gravity in the anterior plane.The child is able to better breathe in multiple planes of movement.With strengthening of the anterior wall,there is also better strength of the posterior spine stabilizers,causing a slight reversal of the concave posture initially seen.

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?

Accepted Answer

If a patient is weak and needing additional resistance to work against,the best position would be to have the patient lay supine so he or she can work against gravity.Lying prone would be a gravity-assisted position; sitting and side-lying is a gravity-eliminated position.

Question 7

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

Accepted Answer

Although the diaphragm participates in all of these functions,it does so in a synergistic relationship with the intercostals,abdominals,and other thoracic musculature.Optimal function of respiration and postural support comes from this relationship.

Question 8

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

Accepted Answer

The vocal cords allow for pressure increases in the thoracic cavity to be controlled for activities such as coughing and talking and the evacuation of bowel and bladder.The pelvic floor maintains the pressure gradient for the vocal cords to perform their actions.The diaphragm is responsible for creating those pressure gradients.

Question 9

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

Accepted Answer

Although all of these muscles play a role in supporting the respiratory and postural skeletal support,the back extensors,abdominals (particularly the transverse abdominus),diaphragm,and intercostals provide the majority of this support.

Question 10

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

Accepted Answer

The triad of muscles-the diaphragm,intercostals,and abdominals-plays a role in this first type on paradoxical breathing.In this type,the abdominals are insufficient to stop the descent of the diaphragm,the intercostal are unable to stabilize the chest wall,and the diaphragm dominates the movement.

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?

Accepted Answer

The shape of the chest wall is wider at the inferior portion of the thorax.There is less restriction in this area for the diaphragm to depress and fill the lungs with air.Infants typically have shorter necks,rendering the upper respiratory muscles useless initially.

Question 12

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

Accepted Answer

All of these items are helpful in promoting well-rounded development of breathing in all planes while minimizing deficits.Changing positions helps to stimulate development in all planes.Facilitation and promotion of breathing pattern can help to catch deficits and promote the correct use of muscles in the correct planes of movement.

Question 13

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

Accepted Answer

Type I is paradoxical not an efficient breathing pattern,but it is usually enough to suffice without assistance.Asymmetrical is also sufficient to allow oxygenation of tissues.Positional changes can allow for patients with spinal cord injuries and those recovering from illness to breathe without assistance.

Question 14

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

Accepted Answer

Injuries such as head injury as well as Parkinson disease and other high-tone conditions may lead to shallow breathing.Injury to a peripheral nerve root is not enough to cause a shallow breathing pattern unless it is the result of another injury or secondary pathology (e.g.,lumbar spine pain).

Question 15

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

Accepted Answer

Development of the anterior chest wall and use of the upper extremities in motions away from the body help to expend the chest wall in both the lateral and superior directions.As the child works to hold him- or herself up,the child works muscles that allow the anterior chest wall to better work against gravity in a supine position.

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?

Accepted Answer

Rational: When the primary muscle of respiration is affected,the supporting muscles try to maintain normal airflow.Although this may be sufficient for the short term,these supporting muscle do not have the endurance or strength to support the O₂ demand of the body without some form of support.

Question 17

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

Accepted Answer

If pelvic floor muscles are weak or compromised from trauma or injury,the bottom valve of the system is unable to maintain the pressure.When this happens,the pressure buildup is lost,and the effectiveness of the cough is reduced.

Question 18

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

Accepted Answer

Asymmetrical breathing patterns are the result of pathologies or injuries affecting one side of the body and not the other.As a result,the patient is left with one side stronger than the other.Over time,this may contribute to deformities of the skeletal system because of the unopposed pull of the stronger side.

Question 19

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

Accepted Answer

When the intercostals are not functioning properly,the negative pressure created by the diaphragm and upper respiratory muscles is not opposed,as it normally would be.This causes the chest wall to migrate superiorly and collapse inward.This is common in patients who have high levels of paraplegia,patients with tetraplegia,and patients with congenital pectus excavatum deformities.

Question 20

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

Accepted Answer

The structural integrity of the thorax's skeletal system is not enough to withstand the forces of gravity.Postural and breathing functions are better performed with the support of the muscular system surrounding the thorax.Thoracic and abdominal organ systems and respiratory function also fall into this supports system with regard to normal development and function.

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