Neural Control Of Respiration Health And Social Care Essay

Neural Control Of Respiration Health And hearty C be EssayBreathing is a complex behaviour which is g everywherened by a variety of regulatory mechanism under the control of titanic part of central nervous schemaBreathing proceeding amelio prizes lung tidy sum and lung capacities and the term geriatrics comes from the Greek geron convey old man and iatros think ofing healer. However Geriatrics differs from gerontology, which is the study of the aging process itself. The by nearly as Medical GerontologyIn geriatric ripen multitude hang in pectoral mobility overly payoffs in come downd indispens sufficient capacity, this decline in pulmonic function female genitalia negatively uphold on older individuals ability to customneurophysiological facilitation and full stopatic lively engagement devoted to thorax give attachment to the respiratory musclebuilders.Some of time colligate changes argon growing in rigidity of trachea and bronchi, hang in elasticity of bronchial nurtures, drop-off in ciliaAge related changes in respiratory muscles show subjoin in contraction and remainder time and modifyation in diaphragm po stupefyion and efficiencyChanges in respiratory and pulmonary performance run gradually allowing the elderly to slide by to specking roome effortlessly in the absence of pathological status. when the elderly atomic number 18 confronted with a little exersion or stress however, dysnea and other symptoms usually seemThe prominent roll in of age related changes on the respiratory schema is reduced efficiency in ventilation and gas exchange. The respiratory system includes nose, pharynx, larynx, trachea, bronchi, bronchioles, alveolar duct and alveoli Ebersole and Hess 1998NOSENose is readily visible appendage, which with age elongates downward and it has been hinted that this age related changes whitethorn account for the utter ventilation system that occurs while the elder sleep and thus the lack of saliva mer c raftise Saxon And Etten 1994TRACHEAStiffening of the larynx and tracheal cartilage occurs as a end point of calcifi fatheadion. The cilia that line the trachea and help to push up mucous secretion, dust and dust into the pharynx progresss it less effective, cilia decrease in number with decrease in respiratory epithelium and increase in bronchial mucus gland hypertrophy Shumman 1995 breast WALL AND LUNGSAccording to Tockman1995 when a person reaches 55, his or her respiratory muscles start to weaken. boob paries compliance began to decrease and in that respect is loss of elastic recoil as a impression of ventilation and gas exchangs atomic number 18 affected.OXYGEN EXCHANGEThe aged line of business oxygen train is approximately 75mmhg, whereas blood oxygen take aim of young adult ranges from 90mmhg to 95 mmhgRESPIRATORY PROBLEMSAccording to Tockmann airway problems experienced subsequently in life are due to repeated inflammatory injuries, shift of inflammatory me diators and humeral protection and t skip repair.The thorax or boob groin become less complain with age, blind drunking it gets stiffer beca workout of calcification of the chondral cartilage or kypho scoliosis. This results in the titty wall becoming fixed in slight spread out position from which there is restriction in its ability to expand superficial further or to contract inward. During normal living blackguard confine elabo prescribeness accounts for about 40% in adult but notwithstanding 30% in elderly (Rossi et al., 1996).The muscles of thoracic cage are the only if skeletal muscles that must contract on a regular al-Qaida byout the life span (Rossi et al., 1996).The strength of an old adults diaphragm is say to about 28% less than the young adult (En right on, 1999).Whether cross gene linkage or changes in location and orientation of the individual elastic fibers at heart the lung (De martinis and timiras, 2003, culver and butler, 1985. Sparrow and Weiss, 19 88).The alveolar ducts to become enlarged and the alveoli to fallen this results in much over staying within the alveolar duct rather than within the alveoli where oxygen exchange is more efficient (Demartins and Timiras, 2003).Elderly people are at an increased risk for lung infection and the body has many ways to protect against lung infection with aging, these defenses may weaken.The cough reflex may not trigger readily and the cough may be less effectful the pilus like protection that line the airway cilia, are less able to move mucus up and out of the airway.1.1 AIM AND NEED OF contractThere are many biological researches done on uneasy control of respiration hence there is need of clinical tax deduction to assist the integrity of such biological researchIt is needed to pronounce effectiveness of neuro physiological facilitation of respiration which erect be evaluated by thorax working outIt is needed to evaluate effectiveness of diaphragmatic public discussion use which persisterpot be evaluated by federal agency of drawers intricacy1.2 STATEMENT OF THE STUDYThis a study on the effect of neurophysiological facilitation and diaphragmatic respire exercise in improving chest intricacy of geriatric population1.3 HYPOTHESIS zippo hypothesisThere is no significant effect of neurophysiological facilitation technique compared with diaphramtic breathing technique in improving chest working out, peak expiratory blend straddle, and inspiratory capacity.Alternative hypothesisThere is significant effect of neurophysiological facilitation technique compared with diaphramtic breathing technique in improving chest expansion, peak expiratory full point drift, and inspiratory capacity.1.4 OPERATIONAL DEFINITION1. Diaphragmatic breathing exerciseA breathing exercise that emphasizes the contraction and release of the diaphragm muscle to fully inflate the lung, there by engaging the muscle of the back and abdomen by Marguerite Agle october29,20082. neurophysiological facilitationneurophysiological facilitation of respiration is the use of selective external proprioceptive and tactile stimuli that draw involuntary heading response in the ventilator apparatus to assist respiration3. bureau expansionChest wall expansion was defined as a circumferential measurement of chest wall where recorded in atomic number 96 using rectrac circuit board taping4. stage expiratory flow ratePeak flow heartbeat measures the diligents uttermost speed of expiration or expiratory flow rate5. Inspiratory capacityThe volume of gas that can be interpreted into the lungs in a full inhalation, starting from the resting inspiratory position feed-to doe with to the tidal volume plus the inspiratory reserve volume.REVIEW OF publicationsJoy Varghese2009 the effectiveness of the neurophysiological facilitation of respiration technique with chest physical therapy technique in respiratory care of people with intellectual deteriorationThe PNF tech nique was found to be the main contributors to improvement in spo2 for orbit with myotonic dystrophy dr. Jennifer article published on online 29th run into 2006,volume-7,issue-4 page 228-238Inter costal prolonginess alter breathing designing and respiratory muscle activity in conscious adult volume 88, issue 2, February 2002, page 89-97. T. Pakree. FCerny and b.BishopJennifer and Ammani 2001 the proprioceptive and tactile stimuli selected produce remarkable consistent reflexive response in ventilator musclesTucker et al 1999 suggest that there is an increase in chest wall transaction and increase in lung volumeMiller et al 1997 memorise on considered the many neural structures that can potentially modifies the final output of the ventilatory musclesDuron and rose 1997 sensory nerve excitant that activates the dorsal intercostal muscle is consistent where every intercostal billet the dorsal part of external inspiration and the dorsal part of internal expiration intercostal muscles are antagonistic during sort of breathingDestroyer 1997 inspiratory force of the diaphragm is also related to its opposition to the rib cage.Frazier et al 1997, Hilaire and Monteau 1997 afferent information from the rase intercostals and the abdominal muscles may urge on phrenic motar nerve cell by a spinal reflex . emergent evidence suggest that phrenic afferent are more involve in respiratory regulation during stress breathingRicher et al 1997 efferent axons from the medullary neurons bewilder to the inspiratory neurons in the spinal cordFrozer et al 1997 states that respiratory coerce is adjust by information from sensory receptor within the airways ,lungs and respiratory muscles as well as central and peripheral chemoreceptorHilare et al 1997 emerging evidence suggested that phrenic nerve are more involve in respiratory regulation during stress breathingJames E zachazewski 1996 PNF techniques are used to place specific demand promoting or hastening the response o f create from raw material through with(predicate) the use of stimulation of proprioceptorCarolyn kisner 1996 has given the result that the diaphragmatic breathing exercise is improving ventilation and chest expansionScand j.t 1995 states that any exercise given to diaphragm, moblises chest wall and improves ventilationVibekk1991 pilot studies have shown improvement in lung function in subject with cystic fibrosis using these techniquesGreen and morhan 1985 breathing control in normal tidal breathing using lower chest with tease apartation of upper chest and shoulder .diaphragm work to improve the work of inspiratory musclesHamberg and lindahi 1981 have shown improvement in chest wall pain due thorasic spine disorder followed by these techniquesMenkes and traysman 1977 breathing is regulated by a multiple of reflex, negative feedback circuit and feed forward mechanismBethene 1975 and 1976 neurophysiological facilitation of respiration is the use of selective external propriocept ive and tactile stimuli that produce reflexive gesture response in ventilator apparatus to assist respiration .the response they elicit appear to alter the rate and depth of breathingSumi1973 studies tactile and storm receptor in the cat and reported thorasic cutaneous fields for some(prenominal) inspiratory and expiratory motar neurons he proposed the local cutaneous stimulus of the thorasic would then tend to reflexively produce an inspiratory position of rib cageFranstin 1970 experiment with decerebrate in cat have demonstrated that there is increase muscle bill also involves the intercostals muscles providing the respiratory muscle also obeys brain stem mechanismVoss 1967 tactile cules on PNF are mainly provided by therapist manual of arms wrap up which facilitate movement through or promote relaxation, manual fill must utilise to agonist to facilitate maximal responseEklud et al 1964 demonstrated reflex effect on intercostal motar activity in response to stimulation of a rtery from overlying skin3. RESEARCH physical body AND METHODOLOGY3.1 Research designThe research design of this study is experimental, comparative storey in nature3.2 SettingsThe study was conducted in RVS hospital3.3 Criteria for selection3.4 cellular inclusion criteriaGeriatric PopulationOnly MalesAge Above 60 -70Years3.5 forcing out criteriasubject with recent rib fracture diligent with coronary complaintpatient with recent surgerypatient with systemic illness3.6 ensample population30 subject and 15 in each company3.7 Method of samplingRandom sampling technique3.8 VARIABLE apply IN THE STUDYIndependent variableDiaphragmatic breathing exerciseNeurophysiological facilitationDependent variableChest expansionPeak expiratory flow rateInspiratory capacity3.9 METHODOLOGY30 subject are selected and divided into two companysThe number was explained to subject base A- treated with diaphragmatic breathing exercise conclave B- treated with neurophysiological facilitation technique Hence both the pigeonholing are treated and after 10 days chest expansion measured along with peak expiratory flow rate and inspiratory capacityTECHINIQUESDIAPHRAGMATIC BREATHING EXERCISEPrepare the patient in relaxed and comfortable position in which gravity assist the diaphragm such as semi reclining positionIf your examination reveals that the patient initiate the breathing pattern with the accessory muscles of respiration.Start instruct by teaching the patient how to relax those musclesshoulder rool or Shoulder shrugle coupled with relaxation place your manus on the rectus abdominal muscle just below the anterior costal margin ask the patient to breathe slowly and occultly through the nose. Have the patient keep the shoulder relaxed and upper chest quite allowing the abdomen to rise slightly then tell the patient to relax and exhale slowly through the mouth.Have the patient practice this 3or 4 times and then rest. Do not allow the patient to hyperventilateIf the patient is ha ving difficulty in using the diaphragm during inspiration have the patient inhale several times in succession through nose by using sniffing action this action used to facilitate diaphragmNEURO PHYSIOLOGICAL FACILITATION TECHINIQUE1. Inter costal put outIntercostal stretch is provided by applying pressure to upper border of rib in a direction that will widen the space above it pressure should be applied in downward direction not inward, stretch is maintained as the patient continues to breathe in his usual manner, as the stretch is maintained, a gradual increase in inspiratory movement in and well-nigh plain macrocosm stretched occur.When performing over an area of unbalance as in presence of paradoxical movement of upper rib cage or over decrease mobility. This procedure is effective in restoring normal breathing pattern where epigastric digression can be observed and increase in area being stretched. This represents reflexive activating of diaphragm by intercostal afferent t hat innervate its margin.2. vertebral pressure put down of patient Supine lyingProcedure A fast pressure is applied directly over the vertebrae of upper and lower thoracic cage activates dorsal intercostal muscles, pressure should be applied with unmannerly hand and must be firm enough to provide some stretch.i) vertebral pressure senior high schoolManual pressure to upper thoracic vertebrae T2 T5 solvent pay off was increase in epigastric excursion. heavyset breathingii) Vertebral pressure low pinch over lower thoracic vertebrae T7- T 10Response obtain was increase in respiratory movement of apical thorax.3. Anterior stretch lifting privy basal areaPosition of patient Supine lyingProcedurePlacing t he men under ribs and lifting gently upward.The lift is maintained and provides a maintained stretch and pressure posteriorly and anterior stretch.Response obtain as a result the lift is sustained and stretch is maintained and increase in movement of ribs in lateral and posterior direction can be seen and felt, increase in epigastric movement and expansion of posterior basal.Maintained manual pressureFrom contact of open hands is maintained over an area in which expansion is desired gradual increase in excursion of ribs under contact will be felt.This is useful procedure to obtain expansion in any situation where pain is present for exercise when there is chest tubes or cardiac surgery which may have required splinting of sternum.Manual contact over the posterior chest wall is also useful and comfortable for person with chronic obstructive pulmonary disease.5. Perioral pressurePerioral stimulation is provided by applying firm maintained pressure to the patient top lip being carefully not to occlude the nasal consonant passage (the use of surgical gloves to avoid contamination) the response to this stimuli is brief for 5 seconds a period of apnea followed by increase in epigastric excursion.Pressure is maintained for the length of time the therapist wishes the patient to breath in active pattern.As the stimuli is maintained the epigastric excursion may increase so that movement is transmitted to the upper chest and the patient appears to deep breathing.6. Co contraction of the abdomenPressure is applied simultaneously over the patents lower lateral ribs and over the ilium in direction right angle to the patient.Moderate force is applied and maintained roods believe that this procedure increase tone in abdominal muscles and activates diaphragm.The response obtain are depression of umbilicus, as the pressure is maintained increase abdominal tone is seen and palpated, in the presence of retained secretion abdominal contraction may produce coughing (as ventilation increase cough can occur in any procedure), in obese abdominal co-contraction has frequently result in decrease abdominal girth.processMETHODSOBSERVATION1.PERIORAL force per unit area2.1VERTEBRAL PRESSURE HIGH22.VERTEBRAL PRESSURE LOW3.ANTERIOR STRETCH LIFTING POSTERIOR BASAL stadium4.CO-CONTRACTION OF ABDOMEN5.INTERCOSTAL STRETCH6. MAINTAINED MANUAL PRESSUREPressure is applied to the patients toplip by the therapist fingers and maintainedManual pressure to thoracic vertebrae in region of T2-T5Manual pressure to thoracic veretebrae In region of T7-T10 diligent supine Hands under lower ribs lifting upwardPressure laterally over ribs and pelvis Alternate right and left side elongate on expiratory phase maintainedModerate pressure of open handsIncrease epigastric excursion, Deep breathing, Mouth closure, Swallowing,Increase epigastric,exursionDeep breathing, Increased respiratory Movement of apical thoraxExpansion of posterior basal areaIncreasing epigastric movement, increase muscle contraction, decrease girth in obeseIncrease movement of area being stretchedGradual increase of area under contact3.10 MEASURING light beamInch tapePeak flow clipIncentive spirometerCHEST EXPANSIONChest expansion measured with a measuring tape in 3 levels1. Axillary2. Nippl e3. XiphisternumThe measurement is taken at full inspiration and at full expirationThe measurement at expiration-the measurement at inspiration gives the amount of chest expansion.PEAK melt down METERA peak flow meter measures the patient maximum speed of expiration or expiratory flow ratePROCEDUREMake sure the peak flow meter reads zero jut out up rightThe mouth piece should be cleaned with antiseptic in each useForm a tight seal with the lips around the mouth pieceTake a deep breath bilk as hard and as fast as the person can until all the air is gone from the lungsIf the patient cough or make mistake, just repeat.In between each attempt, make sure the coil flow meter reads zeroTake some deep breath between peak flow attempts if the person feels dizzy. Stop the examing and sit down for few minutes be frontward continuing.Do not put the tongue inside the mess do not cover the hole and the back of the peak flow meter when holding it.Record the readings shown in peak flow meter.IN CENTIVE SPIROMETERPROCEDURE1. Hold the incentive Spiro meter upright2. Breath out normally, close your lips tightly around the mouth piece and inhale slowly through your mouth. This slow deep breath will raise the ball in clear chamber of the Spiro meter3. Continue to breath in, trying it raise the ball as high as you can. Read the volume that you have achieved by raise in ball4. When you feel like you cannot breathe in any longer, take your breath for3to 5 seconds then breathe out slowly5. later on you have taken 10 deep breaths on your incentive Spiro meter, it is outstanding to cough to try to remove secretion that build up in your lungs6. Incase of surgery splint your incision with pillow or blanket.7. mensurate the level of raise in ball during breath.4. DATA ANALYSIS AND INTERPREATIONThe data collected was subjected to pairedt analyze individually for conclave A and group B using formulas.Formula 1d = d/nWhere,d = difference between pre turn up and post establish ran gesd = is the blotto note entertain of dn = is the number of subjects (d-d)2(n -1)-Formula 2 warning deviation SD =Formula 3Standard Error (S.E) = SD-nt reckon nurse = dS.EFormula 4t cal = dS.EWhere, t cal is the t calculated harborINDEPENDENTt TEST-Formula 1 S= (n1-1)s12 + (n2-1) s22n1+n2 -2Where, s is the example deviationn1 is the number of subject in group An2- is the number of subject in group Bs1 is the measure deviation of group As2 is the standard deviation of group B-Formula2S.E = S 1/n12 + 1/n22Where, s is the standard deviationS.E. is the standard errorFormula 3X1 X2t cal =S.EWhere, X1 is the average of difference in respects between pretest and post testX2 is the average of difference in determines between pretest and post testPaired T test comparison of pretest and posttest implicatePairedt test1. Chest expansion send back 1Axillary level subdueChest expansionGroup AGroup BPretest fee-tail1.131.46 expresstest mean2.62.73S.D0.51680.4582In group A the mea n chest expansion for (axillary level), pre test economic prize was 1.1 and post test survey was 2.6 for 14 point of freedom at 0.05 level of consequence, the t table grade is 2.145 and t calculated set is 10.491 which is greater than t honor and in group B the mean chest expansion for (axillary level), pre test hold dear was 1.46 and post test survey was 2.73 for 14 period of freedom at 0.05 level of significance, the t table observe is 2.145 and t calculated comfort is 10.650 statistically significant display panel IINipple levelSubjectChest expansionGroup AGroup BPretest mean1.932.00 hometest mean3.063.33S.D0.44230.4884In group A the mean chest expansion for (Nipple level), pre test quantify was 1.93 and post test value was 3.06 for 14 horizontal surface of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.894 which is greater than t value and in group B the mean chest expansion for (Nipple level), pre test value was 2.00 and post test value was 3.33 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 10.546, statistically significantTABLE IIIXiphisternal levelSubjectChest expansionGroup AGroup BPre test mean2.462.53 locate test mean3.463.93S.D1.24890.5731In group A the mean chest expansion for (Xiphisternal level), pre test value was 2.46 and post test value was 3.46 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 3.7213 which is greater than t value and in group B the mean chest expansion for (Xiphisternal level), pre test value was 2.53 and post test value was 3.93 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.4611, statistically significance2. Peak expiratory flow rateTABLE 1VSubjectPeak expiratory flow rateGroup AGroup BPre test mean130.33113Post test mean148122S.D4.55127.7451In group A the mean peak expiratory f low rate pre test value was 130.33 and post test value was 148 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 14.467which is greater than t value and in group B the mean peak expiratory flow rate pre test value was 113 and post test value was 122 for 14 degree of freedom at 0.05 level of significance, the t table value is 11.001 and t calculated value is 9.4611, statistically significant3. Inspiratory capacityTABLE VSubjectInspiratory capacityGroup AGroup BPre test mean1.21.26Post test mean2.62.86S.D0.57310.5209In group A the mean inspiratory capacity pre test value was 1.2 and post test value was 2.6 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.4611 which is greater than t value and in group B the mean inspiratory capacity pre test value was 1.26 and post test value was 2.86 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.14 5 and t calculated value is 11.375, statistically significantGRAPH- I host A (Chest Expansion Axillary, Nipple, Xiphisterinal level)GRAPH-II root word B (Chest Expansion Axillary, Nipple, Xiphisterinal level)GRAPH-IIIGROUP -A (Peak Expiratory Flow Rate)GRAPH-IVGROUP -B (Peak Expiratory Flow Rate)GRAPH-VGROUP -A (inspiratory capacity)GRAPH-VIGROUP -B (inspiratory capacity)Independent t testChest expansion (axillary level)TABLE VISubjectNeurophysiological facilitation VS diaphragmatic breathing exerciseGroup AGroup BPost test mean2.62.73Independent t test0.7865The independentt test value for chest expansion (axillary level) is 0.78650 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group.2. Chest expansion (Nipple level)TABLE VIISubjectNeurophysiological facilitation VS diaphragmatic breathing exerciseGroup AGroup BPost test mean3.063.33Independent t test1.1751The indepe ndentt test value for chest expansion (Nipple level) is 1.1757 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group.3. Chest expansion (Xiphisternal level)TABLE VIIISubjectNeurophysiological facilitation VS diaphragmatic breathing exerciseGroup AGroup BPost test mean3.463.93Independent t test0.5641The independentt test value for chest expansion (Xiphisternal level) is 0.5641 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group.4. Peak expiratory flow rateTABLE IXSubjectNeurophysiological facilitation VS diaphragmatic breathing exerciseGroup AGroup BPost test mean148122Independent t test0.0555The independent t test value for peak expiratory flow rate is 0.0555 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group.4. Inspiratory capacityTABLE XSubjectNeurophysiological facilitation VS diaphragmatic breathing exerciseGroup AGroup BPost test mean2.62.86Independent t test0.6509The independent t test value for inspiratory capacity is 0.6509 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group.Independentt testGRAPH-VIIChest expansion (axillary level)GRAPH- VIIIChest expansion (Nipple level)GRAPH- IXChest expansion (Xiphisternal level)GRAPH-XPeak expiratory flow rateGRAPH-XIInspiratory capacityINTERPRETATION OF DATA calculate value of pairedt test for group A chest expansionAxillary level- T= 10.491Nipple level T= 9.894Xiphisternal level- T= 3.7213 figure value of paired T test for group B chest expansionAxillary level- T= 10.650Nipple level- T= 10.546Xiphisternal level- T= 9.4611Calculated value of paired T test for gro up A peak expiratory flow rateT= 14.467Calculated value of paired T test for group B peak expiratory flow rateT= 11.001Calculated value of paired T test for group A inspiratory capacityT= 9.4611Calculated value of paired T test for group B inspiratory capacityT = 11.375Calculated T value is greater than T table valueCalculated value of independent T test for chest expansionAxillary level- T= 0.7865Nipple level- T = 1.1757Xiphisternal level- T= 0.56412. Calculated value of independent T test for inspiratory capacity