Respiratory Physiotherapy Support in Disability Care

Our Physiotherapist Danielle discusses the conditions that require respiratory assessment and treatment in the NDIS!

In the disability sector, Physiotherapists focus not only on supporting mobility, exercise, strength, and community participation, but respiratory care as well.

If you are a practicing or aspiring Physiotherapist keen to train in respiratory care, Danielle also provides practical tips to get you started on your learning journey. (Hint: Better Rehab has a Respiratory Physiotherapy upskilling pathway!)

What are the biomechanics of healthy respiration?

Danielle: Spontaneous breathing occurs due to intrapulmonary pressure changes. Air moves into the lungs when intrapulmonary pressure is lower than atmospheric pressure and moves out when the intrapulmonary pressure is greater.

Inspiration is the phase of ventilation where air enters the lungs which requires muscular contraction, and expiration is the phase of ventilation in which air is passively expelled. In normal spontaneous breathing, the inspiratory time to expiratory time (I:E) ratio is about 1:2 (“one to two”). This means expiratory time is twice as long as the inspiratory time.

This ratio changes with breathing disorders.

Asthma

With asthma, it becomes 1:3 or 1:4. This means participants must put a lot more effort into breathing to overcome the resistance experienced within the airways. This can lead to turbulent flow within the airways, causing the characteristic wheeze of an asthma attack.

COPD

With chronic obstructive pulmonary disease or COPD, the ratio is 1:4 or 1:5. The biomechanics of respiration for participants with COPD are affected by increased airway resistance. Narrow airways due to inflammation and poor elastic recoil of the alveoli prevents the normal emptying of the lungs during expiration. This causes air to become trapped in the lungs – ‘’air trapping’’. Constantly having trapped air in the lungs combined with the extra effort needed to breathe results in a person feeling short of breath and requiring an increased expiration time to empty the lungs adequately.

Neuromuscular disorders

The phrenic nerve provides motor innervation to the diaphragm and plays a crucial role in breathing. Damage of the phrenic nerve can result in paralysis of the diaphragm. Phrenic nerve palsy is often seen in neuromuscular conditions such as multiple sclerosis and motor neurone disease where the affected side of the diaphragm moves upwards during inspiration, and downwards during expiration. Participants with phrenic nerve palsy experience weakness of the diaphragm, have reduced breathing control and lung volume and often have difficulty maintaining adequate gas exchange.

Participants may require ventilatory support such as non-invasive ventilation, oxygen or augmented cough assistance particularly during periods of increased respiratory load e.g. during a chest infection or post-physical exertion.

What are the most common conditions seen in the NDIS that require respiratory intervention and why is that support important?

Danielle: The following often require respiratory support:

  • Neurodegenerative conditions such as multiple sclerosis, motor neurone disease, Guillain-Barre syndrome, muscular dystrophy, spinal cord injuries.
  • COPD, asthma, recurrent aspiration pneumonia, emphysema.
  • Stroke – particularly with impaired swallow.
  • Acquired brain injury, cerebellar ataxia, or Parkinson’s disease with bulbar symptoms.
  • Sleep apnoea.

“Respiratory support” is a broad term for different treatment techniques, ranging from non-invasive ventilation, cough assist to positive expiratory pressure devices as well as manual techniques.

Participants with neuro-degenerative diagnoses, either with or without pre-existing respiratory conditions, are at a significantly increased risk of developing respiratory complications. These may be caused by community acquired pneumonia, other respiratory tract infections or aspiration pneumonia. These complications result in a decreased quality of life that can be prevented with early respiratory identification and intervention in the community.

Respiratory management for participants in the community is under-serviced and requires a multidisciplinary team with particular emphasis for Speech Pathologists and respiratory-trained Physiotherapists to work together to support and improve participant’s functional capacity.

Danielle with Mark, who is trialling the Cough Assist with Danielle’s support.

Do you have any practical tips for Physios?

Danielle: I have a few!

  • Respiratory Physiotherapy assessment and intervention should occur early for community participants with neuro-degenerative conditions to prevent complications and respond to deteriorations quickly.
  • Practice basic auscultation and review cough effectiveness on everyone! Get used to hearing different lung sounds and implementing basic respiratory techniques e.g. ACBT, positioning, PEP devices or manual techniques.
  • Pay attention to lung volumes and refresh the pathophysiology of restrictive and obstructive respiratory conditions.
  • If you have the opportunity, learn about prone positioning of mechanically ventilated patients, particularly significant during these COVID-19 times.

How can Physios get training in respiratory support?

Come and join Better Rehab! We have developed a Respiratory Physiotherapy upskilling pathway and service that covers respiratory assessment and treatment fundamentals all the way to suctioning, cough assist and NIV competencies including assistive technology prescription within an NDIS context.

Further resources include the Australian Physiotherapy Association (APA) Cardiorespiratory Level 1 and Level 2 Courses, and Clinical Skills Development Service – Cardiorespiratory Physiotherapy and Intensive Care Physiotherapy.

Are you a Physiotherapist wanting to learn more about respiratory support? Join our team and we will provide a clear and structured learning and development plan to help you help others. Leave your details with us and let’s get your career MOVIN’!

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