Summary
Samenvatting Cardiorespiratoire kinesitherapie (Ides & van den Eynden)
Samenvatting van cardiorespiratoire kinesitherapie, onderdeel respiratoire kinesitherapie (theorie) gegeven door K. Ides en D. van den Eynden
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December 28, 2018
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47
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2018/2019
Type
Summary
kinesia
cardiorespiratoire kine
ua
Institution
Universiteit Antwerpen (UA)
Education
Kinesitherapie en revalidatiewetenschappen
Course
Cardiorespiratoire kinesitherapie 1
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ADEMHALINGSKINESITHERAPIE
H1: Anatomie en fysiologie van het respiratoir systeem ........................................................................ 4
1. INLEIDING .................................................................................................................................... 4
2. ANATOMIE ................................................................................................................................... 4
2.1. Hogere luchtwegen ............................................................................................................. 4
2.2. Lagere luchtwegen .............................................................................................................. 5
2.3. Pleura................................................................................................................................... 6
2.4. Embryonale ontwikkeling .................................................................................................... 6
3. ADEMHALINGSFYSIOLOGIE ......................................................................................................... 6
3.1. Structuur en functie ademhalingsstelsel ............................................................................. 6
3.2. Gasuitwisseling .................................................................................................................... 6
3.3. Structuur van luchtwegen ................................................................................................... 7
3.4. Longvolumes........................................................................................................................ 7
4. MUCUSTRANSPORTMECHANISME .............................................................................................. 8
4.1. Inleiding ............................................................................................................................... 8
4.2. Mucociliair transport ........................................................................................................... 8
4.3. Tweefase-gas-vloeistofstroming ......................................................................................... 9
4.4. Andere vormen mucusklaring ........................................................................................... 11
H2: Ademhalingsmechanica .................................................................................................................. 12
1. ANATOMIE EN EMBRYOLOGIE LUCHTWEGEN .......................................................................... 12
2. BEWEGINGSMECHANICA VAN THORAX .................................................................................... 12
2.1. Pulmonale gedeelte........................................................................................................... 12
2.2. Benige thorax .................................................................................................................... 12
3. RESPIRATOIRE SPIEREN ............................................................................................................. 12
3.1. Inspiratoire spieren ........................................................................................................... 13
3.2. Expiratoire spieren ............................................................................................................ 13
3.3. Abdomen ........................................................................................................................... 13
4. INVLOEDEN OP ADEMHALINGSBEWEGING............................................................................... 13
4.1. Algemeen........................................................................................................................... 13
4.2. Lichaamshouding ............................................................................................................... 14
4.3. Pathologie.......................................................................................................................... 14
H3: Pathologie van het respiratoir systeem .......................................................................................... 15
1. STOORNISSEN IN MUCUSKLARING ............................................................................................ 15
2. CHRONIC OBSTRUCTIVE PULMONARY SYNDROME .................................................................. 15
2.1. Definitie ............................................................................................................................. 15
1
, 2.2. Klinische karakteristieken .................................................................................................. 16
2.3. Diagnose en classificatie .................................................................................................... 16
2.4. Pathofysiologie .................................................................................................................. 16
2.5. Longfuncties ...................................................................................................................... 17
2.6. Adempatroon COPD .......................................................................................................... 17
2.7. Aangrijpingspunten kinesitherapie ................................................................................... 18
3. RESTRICTIEVE STOORNISSEN ..................................................................................................... 18
3.1. Definitie ............................................................................................................................. 18
3.2. Longfunctie ........................................................................................................................ 18
3.3. Oorzaken ........................................................................................................................... 18
H4: Klinisch onderzoek .......................................................................................................................... 20
1. ANAMNESE ................................................................................................................................ 20
2. BASISONDERZOEK ..................................................................................................................... 20
2.1. Observatie ......................................................................................................................... 20
2.2. Inspectie ............................................................................................................................ 20
2.3. Palpatie .............................................................................................................................. 21
2.4. Percussie ............................................................................................................................ 22
2.5. Auscultatie ......................................................................................................................... 22
3. TOEGEVOEGD ONDERZOEK ....................................................................................................... 22
4. RESPIRATOIR BILAN ................................................................................................................... 22
H5: Behandeling .................................................................................................................................... 23
1. ANALYTISCHE ADEMHALINGSOEFENINGEN .............................................................................. 23
1.1. Soorten ademhaling .......................................................................................................... 23
1.2. Ademhaling (re)-educatie .................................................................................................. 23
2. VRIJMAKEN BOVENSTE LUCHTWEGEN ..................................................................................... 23
2.1. Bovenste luchtwegen ........................................................................................................ 23
2.2. Algemene technieken ........................................................................................................ 24
3. INHALATIETHERAPIE .................................................................................................................. 24
3.1. Inleiding ............................................................................................................................. 24
3.2. Principes inhalatietherapie................................................................................................ 25
3.3. Reinigen lagere luchtwegen .............................................................................................. 27
3.4. Soorten inhalatiesystemen................................................................................................ 27
3.5. Farmacologie ..................................................................................................................... 31
4. SPONTANE DRAINAGETECHNIEKEN .......................................................................................... 31
4.1. Hoesten ............................................................................................................................. 31
4.2. Fysieke activiteit ................................................................................................................ 33
2
, 5. ACTIEVE DRAINAGETECHNIEKEN............................................................................................... 33
5.1. Forced expiration techniques (FET) ................................................................................... 33
5.2. Active Cycle of Breathing Techniques (ACBT) ................................................................... 34
5.3. Autogene drainage ............................................................................................................ 34
5.4. Respiratoire kinesitherapie bij baby’s ............................................................................... 36
6. PASSIEVE DRAINAGETECHNIEKEN ............................................................................................. 38
6.1. Posturale drainage............................................................................................................. 38
6.2. Tapotage & mechanische vibratie ..................................................................................... 40
7. HULPMIDDELEN ......................................................................................................................... 40
7.1. PEP ..................................................................................................................................... 40
7.2. Sustained Maximal Inspiration (SMI) ................................................................................ 41
7.3. Manuele hulp therapeut ................................................................................................... 41
7.4. Elastofix ............................................................................................................................. 42
7.5. Bouncing & trampoline ..................................................................................................... 42
H7: Behandeling van specifieke patiëntengroepen en symptomen ..................................................... 43
1. MOBILISATIE VAN DE THORAX .................................................................................................. 43
1.1. Dekyfoseren....................................................................................................................... 43
1.2. Lateroflexie ........................................................................................................................ 44
1.3. Afrollen wervels................................................................................................................. 44
2. INSPIRATOIRE SPIERTRAINING .................................................................................................. 44
2.1. Indicatie ............................................................................................................................. 44
2.2. Trainingsvormen ................................................................................................................ 44
3. PRE- EN POSTOPERATIEVE ADEMHALINGSKINESITHERAPIE ..................................................... 45
3.1. Complicaties ...................................................................................................................... 45
3.2. Risico analyse..................................................................................................................... 45
3.3. Peri-operatieve ademhalingskinesitherapie ..................................................................... 46
3.4. Vergelijking IMT en incentive spirometrie ........................................................................ 47
3.5. Evidence based .................................................................................................................. 47
H8: Hyperventilatiesyndroom ............................................................................................................... 47
1. NIET KENNEN ☺......................................................................................................................... 47
3
, Respiratoire kinesitherapie (Ides + Van Den Eynden)
H1: Anatomie en fysiologie van het respiratoir systeem
1. INLEIDING
• Ademhalingsstelsel
o Geleidend gedeelte
▪ Bescherming: reinigen + bevochtigen + op temperatuur brengen lucht
▪ Doel: in contact brengen van zuurstof met circulair systeem voor gasuitwisseling
▪ Bedekking: trilhaar epitheel + slijmbekercellen
• Rokers meer slijmbekercellen en minder trilhaar epitheel rokershoest
o Respiratoir gedeelte
2. ANATOMIE
• Functies ademhalingsstelsel
o Voorzien in diffusie oppervlak voor gasuitwisseling
o Verplaatsing van lucht naar dat oppervlak
o Bescherming van dat oppervlak neus: haartjes + slijm
o Spraak
o Reuk
2.1. Hogere luchtwegen
• Neusholte:
o Vooraan: kraakbeen
o Achteraan: os vomer + os ethmoïdale
o Toegang = apertura piriformis: ossa nasi + os maxillares
o Uitgang: choana
o Bodem: proc. palatinus os maxilla = verhemelte
o Dak:
▪ Lamina cribrosa: deel van os ethmoïdale
waardoor vezels reukzenuw lopen
o Zijwanden: os maxilla + os palatum
• Sinussen = neusbijholten
o Maxillaire sinussen onder oogkassen
o Frontale sinussen in voorhoofd
o Etmoïdale sinussen hoog in neusholte
o Sfenoïdale sinussen voor hypofyse
• Pharynx = slokdarmhoofd
o Opening voor mond – neusholte – larynx – luchtwegen – slokdarm
o Hangt op aan schedelbasis
o Slikbeweging: reflex van Mm. constrictores pharyngis
▪ Epiglottis van larynx sluit luchtweg af
▪ Huig + weke verhemelte sluit neusholte af
▪ Buis van Eustachius naar middenoor opent
➔ Luchtweg kruist hier met spijsvertering
4