CHAPTER 6 Structure and Ventilation Function of the Thorax


the functional capacity and ability to perform activities and improve the quality of life in people with COPD.


Visit Kinesiology in Action and answer the posttest questions to evaluate your understanding of the chapter.


CHAPTER SUMMARY


The process of ventilation has a major mechanical com- ponent that relies on the structures of the thorax. The thoracic vertebrae, ribs, sternum, and muscles involved in respiration are interdependent as they protect vital organs and function together during ventilation. The quantities of air moving in and out of the lungs and the amount of air that maintains infl ated lung tissue represent the various lung volumes associated with ven- tilation. A combination of lung volumes is described in terms of the different lung capacities.


The kinematics of ventilation differ between quiet ventilation and forced ventilation. During quiet inspira- tion, the diaphragm is the primary muscle of inspiration, but expiration is a passive process. As metabolic demands increase with increased activity or when respiration is impaired by disease, the body recruits additional muscles for ventilation. Forced inspiration and forced expiration are active processes, and the kinematics differ from the kinematics during quiet breathing. Aging and diseases affecting the pulmonary system also play a role in altering the kinematics associated with ventilation and increase the energy required for effective ventilation.


Kinesiology in Action Case Study A


fter 25 years of smoking, Jack has been diag- nosed with COPD and displays the barrel- shaped chest that is often seen in people with this lung disease. His lungs are hyperinflated because of loss of the elastic recoil properties of his lungs and damage to his airways. These structural changes have altered the alignment and function of his dia- phragm. As he breathes in, he must rely on para- sternal and scalene muscles to expand his upper rib cage because of his ineffective diaphragm. During exhalation, Jack must recruit his abdominal muscles to assist with expiring air, even when he is at rest or doing light activities.


1.


In terms of requirements for muscle function, how much energy is Jack likely using to breathe com- pared with someone who does not have COPD?


2. Which of the four lung volumes is most likely increased because of Jack’s COPD?


3. Which of the lung volumes is most likely unchanged? DISCUSSION QUESTIONS


1. How do ribs 1 through 7 differ from ribs 8 through 10 and ribs 11 and 12 in terms of their structure and role during ventilation?


2. Define each of the following lung volumes and demonstrate each volume to a classmate. A. Tidal volume B. Inspiratory reserve volume C. Expiratory reserve volume D. Residual volume


3. What lung volumes make up each of the following lung capacities? A. Total lung capacity B. Vital capacity C. Inspiratory capacity D. Functional residual capacity


4. Describe the ventilation kinematics known as the “bucket-handle” motion and the “pump-handle” motion.


5. Which muscles are involved in quiet inspiration and in quiet expiration?


6. Which muscles are involved in forced inspiration and in forced expiration?


7. What structural changes occur in the respiratory system as a result of aging, and how do these changes affect ventilation?


8. How could the changes in ventilation and resultant changes in activity levels that occur with aging contribute to the development of secondary diseases?


9. How do the ventilation patterns of healthy people differ compared with people who have COPD?


BIBLIOGRAPHY


Bissett B, Leditschke IA, Paratz JD, Boots RJ. Respiratory dysfunction in ventilated patients: can inspiratory muscle training help? Anaesth Intensive Care. 2012;40:236–246. dos Santos Alves VL, Stirbulov R, Avanzi O. Impact of physical reha- bilitation program on respiratory function of adolescents with idio- pathic scoliosis. Chest. 2006;130:500–505. Kazuyuki T, Jun H, Hiromasa F, et al.: The relationship between skeletal muscle oxygenation and systemic oxygen uptake during exercise in subjects with COPD: a preliminary study. Respir Care. 2012;57:1602–1610. Levangie PK, Norkin CC. Joint Structure and Function: A Comprehensive Analysis. 5th ed. Philadelphia, PA: FA Davis; 2011. Lewis CB, Bottomly JM. Geriatric Rehabilitation: A Clinical Approach. 3rd ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2008. McNamara RJ, McKeough ZJ, McKenzie DK, Alison JA. Water- based exercise training for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013; 12:CD008290. Neumann DA. Kinesiology of the Musculoskeletal System Foundations for Rehabilitation. 2nd ed. St. Louis, MO: Mosby; 2010. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function tests of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am. 2005;87:1937–1946.


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