Respiratory Management of ALS: Amyotrophic

The Respiratory Management of Motor Neuron Disease brings together the latest research, expert opinions, and treatment options for respiratory symptom management. It provides a detailed, step-by-step approach to assessment of upper and lower airway structures and how motor neuron loss impairs function. Treatment options emphasize symptom management and enhanced quality of life. Palliative care, end-of-life decision making, and long term mechanical ventilation in patients with MND/ALS are included.This textbook encourages critical thinking through 1) inclusion of researchable questions at the end of chapters, and 2) discussion of different approaches to patient assessment and symptom management when medical evidence is lacking. Students will be encouraged to use their understanding of anatomy, physiology, pharmacology, lung expansion and secretion mobilization techniques to review, support or challenge current practices in MND/ALS.Respiratory therapy students, respiratory care practitioners, nurses in neurology clinics, primary care physicians, and pulmonologists whose practice includes patients with motor neuron disease will all benefit from the detailed review of bulbar and thoracic muscles, loss of function, and treatment recommendations.

Preface	p. ix
Acknowledgments	p. xiii
Amyotrophic Lateral Sclerosis Overview: Definition, Epidemiology, History	p. 1
Introduction	p. 2
Definition	p. 2
Clinical Subtypes of MND	p. 3
Classification	p. 3
Diagnostic Criteria	p. 4
Clinical Rating Scales	p. 4
Epidemiology	p. 4
Public Figures with ALS	p. 7
Clinical Presentation	p. 8
Clinical Diagnosis	p. 9
Stages of Functional Decline in ALS	p. 9
Clinical Markers of Respiratory Decline in ALS	p. 11
Drug Treatment	p. 12
Symptom Management	p. 15
Multidisciplinary Care	p. 15
Topics for Research	p. 21
Summary	p. 22
References	p. 22
Neuroanatomy and Respiratory Physiology	p. 27
Introduction	p. 28
Functional Neurorespiratory Anatomy	p. 28
Pathobiology	p. 30
Neurodegenerative Action	p. 31
Cognitive Impairment in ALS	p. 32
Neurochemistry of the Pulmonary System	p. 34
Innervation of the Respiratory Muscles	p. 36
Summary	p. 39
References	p. 39
Questions for Research	p. 41
The Upper Airway	p. 43
Introduction to the Upper Airway	p. 47
Anatomy and Physiology	p. 48
Structures of the Upper Airway	p. 48
Clinical Implications of Impaired Upper Airway	p. 52
Assessment Techniques	p. 54
Symptom Management	p. 56
Communication Augmentation for Patients	p. 58
Communication Techniques for Caregivers and Medical Personnel	p. 59
Summary	p. 60
References	p. 60
Questions for Research	p. 62
The Lower Airway	p. 63
The Normal Lung	p. 64
Larynx-The Dividing Line	p. 64
Conducting Airways	p. 66
Respiratory Units	p. 67
Lower-Airway Defense Systems	p. 68
Bronchial Mucus	p. 72
Lower Respiratory Tract Infections	p. 76
Summary	p. 77
References	p. 78
Questions for Research	p. 80
Clinical Respiratory Assessment of ALS	p. 81
Introduction	p. 81
ALS Functional Rating Score	p. 85
Respiratory Insufficiency: Signs, Symptoms, and Significance	p. 85
Co-morbidities	p. 96
Summary	p. 97
References	p. 97
Questions for Future Research	p. 99
Respiratory Assessment	p. 101
ALSFRS-R	p. 105
Measures of Dyspnea	p. 107
Pulmonary Function and Respiratory Assessment of Neuromuscular Patients: Objective Measures of Lung Function	p. 111
Introduction	p. 113
Measures of Lung Mechanics and Strength	p. 113
Spirometry	p. 114
Vital Capacity (VC)	p. 114
Expiratory Volume	p. 116
Clinical Uses of PFT	p. 117
MIP	p. 117
MEP	p. 119
PCF	p. 120
Sniff Nasal Inspiratory Pressure Test	p. 121
Other Measures of Pulmonary Function	p. 122
Noninvasive Measures of Pulmonary Function	p. 123
Monitoring of Respiratory Function During Sleep	p. 125
Laboratory Measures	p. 126
Summary	p. 128
References	p. 128
Questions for Research	p. 130
Volume Expansion, Secretion Mobilization, and Cough Assistance in Amyotrophic Lateral Sclerosis	p. 131
Introduction	p. 132
Patient Assessment	p. 133
Lung Volume Recruitment	p. 134
Airway Secretion Management	p. 139
High-Frequency Chest Wall Compression	p. 142
Cough Techniques	p. 144
New Therapies	p. 148
Summary	p. 148
References	p. 149
Questions for Research	p. 152
Noninvasive Positive Pressure Ventilation	p. 153
Introduction	p. 154
History	p. 154
Definition	p. 155
Physiological Effects of NPPV	p. 156
Benefits of NPPV	p. 157
Timing of NPPV	p. 160
Acceptance of NPPV	p. 160
Acclimatization	p. 161
Adherence	p. 162
NPPV and Cognitive Impairment	p. 162
Nutrition and NPPV	p. 163
NPPV in Neuromuscular Disease	p. 163
NPPV Setting Guidelines	p. 165
Monitoring NPPV Settings	p. 166
Initiating NPPV in Advanced ALS	p. 166
Challenges to NPPV	p. 167
The Bulbar Patient	p. 170
Summary	p. 171
References	p. 172
Questions for Research	p. 175
Tracheostomy and Mechanical Ventilation	p. 177
Introduction	p. 181
Indications for Tracheostomy and MV	p. 181
Advantages of Tracheostomy and MV	p. 182
Drawbacks to Tracheostomy and MV	p. 183
Making the Decision for MV	p. 184
Characteristics of Patients Who Choose MV	p. 185
Measuring QoL	p. 185
Challenges of MV	p. 186
Mechanical Ventilators for Home Use	p. 189
Preparing for Hospital Discharge Following Tracheostomy and MV	p. 192
Summary	p. 192
References	p. 193
Home Care of the Amyotrophic Lateral Sclerosis Patient	p. 197
Introduction	p. 198
Goals of Respiratory Care in the Home	p. 200
Types of Respiratory Support	p. 201
NPPV	p. 201
Tracheostomy and Mechanical Ventilation	p. 204
Challenges of Managing Mechanically Ventilated Patients in the Home	p. 207
References	p. 209
Palliative Care and End-of-Life Care	p. 211
Introduction	p. 212
End-of-Life Choices	p. 213
Respiratory Failure	p. 222
RCP Attitudes Toward Terminating Life Support	p. 230
Respiratory Controversies at End of Life	p. 231
Summary	p. 234
References	p. 234
A Values History Questionaire	p. 239
Resources	p. 241
Professional Associations for Respiratory Care Practitioners	p. 241
Organizations for People with ALS, Their Families, and Medical Professionals	p. 242
Resources for People with ALS	p. 244
Respiratory Assistive Devices and Supplies	p. 244
Advanced Directives	p. 245
Resources for Respiratory Care Practitioners	p. 246
Resources for Home Care Providers	p. 247
Ethical Considerations in Health Care	p. 247
General Resources About ALS	p. 248
Index	p. 251
Table of Contents provided by Ingram. All Rights Reserved.

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Respiratory Management of ALS: Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis

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