Related Experiment Video
Updated: Jan 24, 2026
12:43
A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS
Published on: February 21, 2011
35.9K
Considerations for chest clearance and cough augmentation in severe bulbar dysfunction: a case study.
Jodi Elizabeth Allen1, Ellen Louise O'Leary1
1Department of Therapy and Rehabilitation, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Summary
Mechanical insufflation-exsufflation (MI-E) worsened secretions in a congenital myotonic dystrophy patient. Multidisciplinary assessment revealed dysphagia, leading to an individualized airway clearance program.
Area of Science:
- Neurology
- Respiratory Medicine
- Physiotherapy
Background:
- Congenital myotonic dystrophy (CDM) presents with progressive muscle weakness, impacting respiratory function and airway clearance.
- Effective management of respiratory complications, including weak cough and secretions, is crucial for patients with CDM.
Observation:
- A 21-year-old male with CDM experienced increased secretions and respiratory infections after initiating mechanical insufflation-exsufflation (MI-E).
- The patient also reported speech difficulties post-MI-E use.
- This suggested potential complications beyond the intended respiratory support.
Findings:
- Multidisciplinary assessment identified oro-pharyngeal dysphagia and a weak cough as primary issues.
- MI-E, a single-discipline intervention, appeared to exacerbate the patient's condition.
Implications:
- This case underscores the risks of single-discipline interventions in neuromuscular disorders.
- Comprehensive, multidisciplinary assessment is vital for accurate diagnosis and tailored treatment in patients with CDM.
- Alternative airway clearance techniques, like active cycle of breathing and manually assisted cough, improved patient comfort and secretion management.
Related Concept Videos
01:24Flail Chest-I
641
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
641
01:26Flail Chest-II
559
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
559
01:24Chest Physiotherapy
1.7K
Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
1.7K
01:09Hepatic Drug Clearance: Restrictive and Nonrestrictive Clearance
496
Hepatic clearance refers to the volume of blood cleared of a drug by the liver per unit of time. It plays a crucial role in drug metabolism and elimination. While hepatic clearance is commonly estimated by subtracting renal clearance from total body clearance, other pathways, such as pulmonary or biliary clearance, may also contribute. However, these pathways are generally less significant than hepatic and renal clearance.
Most drugs undergo restrictive clearance, which is proportional to the...
Most drugs undergo restrictive clearance, which is proportional to the...
496
01:22Design Consideration
559
Designing a structure involves a series of considerations, primarily the material's ultimate strength, calculated through tests that measure changes under increased force until the material reaches its breaking point or limit. The ultimate load, where the material breaks, is divided by its original cross-sectional area, resulting in the ultimate normal stress or strength. The ultimate shearing stress is another significant factor taken into account.
The factor of safety is another key...
The factor of safety is another key...
559
01:23Renal Clearance
2.4K
The glomerular filtration rate (GFR) is a critical marker of kidney function, reflecting the efficiency of filtration by the glomeruli. Renal clearance of specific substances, such as inulin or creatinine, is commonly used to measure GFR.
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
2.4K