When a patient has a spinal cord injury, depending on the level of injury, breathing can become the most important issue they and their family are facing. When a patient has limited use of their diaphragm, respiratory therapists assist through ventilator management or coughing assistance. Respiratory therapists keep the patient breathing and get them breathing on their own before physical recovery can begin.
Shepherd Center respiratory therapist Kelley Taylor is here today to speak about the role of respiratory therapy in the rehabilitation process.
Selected Podcast
Respiratory Therapy During Rehabilitation
Featured Speaker:
Kelley Taylor
Kelley Taylor has been a respiratory therapist for 17 years, the past nine at Shepherd Center. Her respiratory therapy team frequently provides some of the most urgent initial care to patients. Transcription:
Respiratory Therapy During Rehabilitation
Melanie Cole (Host): When a patient has a spinal cord injury, depending on the level of injury, breathing can become the most important issue they and their family are facing. When a patient has limited use of their diaphragm, respiratory therapists assist through ventilator management or coughing assistance. Respiratory therapists can keep the patient breathing and get them breathing on their own before physical recovery can begin. My guest today is Kelly Taylor. She’s a day shift respiratory supervisor at Shepherd Center. Welcome to the show, Kelly. People don’t often think of spinal cord injury and breathing as being one of the side effects or comorbidities from spinal cord injury, so speak about breathing as it relates to an injury.
Kelly Taylor (Guest): Sure. Thank you for having me, Melanie. Breathing actually can be affected no matter what level of injury that the patient may have, but the higher the level of injury the harder the breathing is. If the level of injury affects the diaphragm specifically, we have to become the diaphragm for that patient. So, it just depends on the level of injury and usually when the patient comes into Shepherd Center, if they are having breathing issues, we are the first people they’re going to see and we are going to have to get that under control before they can start their therapy.
Melanie: So, first of all, I mean, obviously, in an emergent situation if somebody is not breathing, when do you notice? Who notices that breathing becomes this big issue?
Kelly: Well, anyone can notice, to be honest with you, all the way from the top of the line to the bottom of the line here at Shepherd because we kind of train all of our employees on the signs to look for when patients are having problems breathing. When patients first come to us, a lot of times they are on a ventilator, so our goal is to get them to wean from that ventilator if the injury will allow us to so that they will not need anything anymore. But, as far as noticing it in the beginning, we kind of try to teach everyone the signs to look for; for shortness of breath which can start out with just anxiety, and then it can go as far as the patient turning blue, of course, which would be the worst case scenario. A lot of times shortness of breath just starts out as anxiety and you can kind of look at the patient and tell they’re struggling a bit.
Melanie: Okay. So, really, you all are trained to watch for this, and then what do you do if you notice that? What is an assist cough? Speak about some of the breathing treatments and things that you do as a respiratory therapist to help the patient breath on their won.
Kelly: Sure. So, assist coughing is probably one of the most important things we do here at Shepherd once the patient is weaned form the ventilator. We do it while they’re on the ventilator as well, but once they are weaned from the ventilator and they no longer have that backup of the ventilator giving them the breath, then we are the ones that have to help them with the cough. The assist cough, it’s called a “butterfly technique” that we use her at Shepherd, and it’s called a “quad cough” in some other facilities, as well. You would be surprised how many people come to work at Shepherd, even in the respiratory department, who have never done or seen an assist cough or a quad cough. So, that is one of the very first things that we teach new therapists here at Shepherd, because what we have to do is place our hands down by the abdomen and push really vigorously to help the patient cough. We become their diaphragm. So, if they have something deep into their lungs that they cannot cough up on their own, we’re going to assist them. We do that with our own hands, but we also have machines. We have an assist cough machine that is also very helpful where we just push positive air pressure into the airway and then allow the patient to cough, and we remove the secretions with that machine, as well.
Melanie: So, what are some other things that you might teach patients like deep breathing exercise? Speak about some of these kinds of things that you actually work with patients to do.
Kelly: Sure. So, we try to teach patients, especially, again, once they are breathing on their own this becomes more important, on teaching them how to slow their breathing down when they get short of breath. We teach them a thing called “pursed lip breathing” where we have them breathe in through the nose, out through the mouth, and kind of purse your lips like you’re blowing out candles. That really helps in getting the patient to be able to catch their breath and make it a lot easier for the patient, but also calming down that anxiety. So, we teach them those techniques. We also teach them, believe it or not, to assist cough themselves. So, some of our patients, unfortunately, may have to go home and not have a lot of help at home so we teach them how to place their hands on their stomach and abdomen and assist cough themselves. You can do that in a couple of ways, and we teach them all of those things before leaving Shepherd.
Melanie: You mentioned the pursed lip breathing and this Valsalva maneuver. So, is this intended to help increase that oxygen saturation and help them with that shortness of breath? Just speak about that. It’s a little bit of holding your breath, isn’t it?
Kelly: Absolutely. It’s all about increasing the oxygen level. With a spinal cord injury patient, we’re not as concerned about the oxygen levels being at 98 or 99% which is the highest you can go. We’re okay here at Shepherd with them having even lower saturations as long as they’re 92 or above, we are usually okay with that. Once they kind of start dropping lower than that, that’s when we do that deep breathing exercise, because what we have them do is take the biggest, deepest breath in that they can and blow all of it out through their mouth until they’ve blown all of their air out and, again, have them do it slow and easy, in and out, and that helps increase the saturation, as well.
Melanie: We think of weight training and things that people do for other rehabilitation exercises, and what about for the lungs and for breathing and a spirometer or some of the equipment that you might use to help them strengthen up their breathing capabilities?
Kelly: So, we use incentive spirometry here a lot, and a lot of times people think of incentive spirometers as you something you would only use pre- or post-surgery to help keep your airways open. But, what people tend to forget sometimes is an incentive spirometer also helps to strengthen your muscles--those muscles that we use to breathe, that we’re not used to having to use all the time. So, it recruits those muscles and helps those breathing muscles get stronger so that when we need them, they’re strong enough for us to use them, so we do use those. We do spirometry on our patents here. The pulmonary team likes to order those just to kind of get a baseline. We also do baseline ABGs when a patient first gets to Shepherd so that we know what their arterial blood gases look like and we know exactly where their breathing is at that point in time.
Melanie: And, what do you tell them as they are intending to go back home about using a ventilator and doing these exercises, and even getting the family involved so that they can help them, Kelly, work on these breathing exercises when you’re not there all the time?
Kelly: So, that is one of the things that I love most about the Shepherd Center. You will never see a family member leave Shepherd without knowing exactly how to take care of their patient and, not just in respiratory, but in all aspects of what needs to be done. We have a very vigorous family training program, and our department has their own family trainer for respiratory; that is her only job--not her only job, she has many jobs--but that is what she does is she trains every family that’s leaving Shepherd Center, whether they’re on a ventilator, whether they’re off the ventilator, they may just have a trach, whatever that family is going home with, she trains them how to do it, how to use it, what every button means on that ventilator, what you should do if you get into trouble. She tells them from beginning to end and she gives them lots of literature. Once she does her initial training then the therapists come behind and let the families practice until they feel 100% comfortable, and then we sign them off that they are ready to go.
Melanie: So, wrap it up for us, Kelly, in explaining what a respiratory therapist does in terms of spinal cord injury with patients and their families at Shepherd Center and what’s your best advice for working on these breathing techniques for families?
Kelly: Well, to sum it up, I just think that Shepherd Center in itself is such a teaching facility. I think that we start teaching the family as respiratory day one. We have patients who are ventilated or non-ventilated who may have trachs. On day one, we start teaching the family how to bag their family member. And that’s day one. Every single day we’re teaching them how to do those breathing techniques, how to handle their patient or their family member if they were to get into trouble, and we do that every single day that they’re here until the time that they leave. We want them to feel 100% comfortable doing exactly what we do for their family member while they’re here at Shepherd.
Melanie: Thank you so much, Kelly, for being with us today. It’s great information. You're listening to Shepherd Center Radio and for more information, you can go to www.Shepherd.org. That's www.Shepherd.org. This is Melanie Cole. Thanks so much for listening.
Respiratory Therapy During Rehabilitation
Melanie Cole (Host): When a patient has a spinal cord injury, depending on the level of injury, breathing can become the most important issue they and their family are facing. When a patient has limited use of their diaphragm, respiratory therapists assist through ventilator management or coughing assistance. Respiratory therapists can keep the patient breathing and get them breathing on their own before physical recovery can begin. My guest today is Kelly Taylor. She’s a day shift respiratory supervisor at Shepherd Center. Welcome to the show, Kelly. People don’t often think of spinal cord injury and breathing as being one of the side effects or comorbidities from spinal cord injury, so speak about breathing as it relates to an injury.
Kelly Taylor (Guest): Sure. Thank you for having me, Melanie. Breathing actually can be affected no matter what level of injury that the patient may have, but the higher the level of injury the harder the breathing is. If the level of injury affects the diaphragm specifically, we have to become the diaphragm for that patient. So, it just depends on the level of injury and usually when the patient comes into Shepherd Center, if they are having breathing issues, we are the first people they’re going to see and we are going to have to get that under control before they can start their therapy.
Melanie: So, first of all, I mean, obviously, in an emergent situation if somebody is not breathing, when do you notice? Who notices that breathing becomes this big issue?
Kelly: Well, anyone can notice, to be honest with you, all the way from the top of the line to the bottom of the line here at Shepherd because we kind of train all of our employees on the signs to look for when patients are having problems breathing. When patients first come to us, a lot of times they are on a ventilator, so our goal is to get them to wean from that ventilator if the injury will allow us to so that they will not need anything anymore. But, as far as noticing it in the beginning, we kind of try to teach everyone the signs to look for; for shortness of breath which can start out with just anxiety, and then it can go as far as the patient turning blue, of course, which would be the worst case scenario. A lot of times shortness of breath just starts out as anxiety and you can kind of look at the patient and tell they’re struggling a bit.
Melanie: Okay. So, really, you all are trained to watch for this, and then what do you do if you notice that? What is an assist cough? Speak about some of the breathing treatments and things that you do as a respiratory therapist to help the patient breath on their won.
Kelly: Sure. So, assist coughing is probably one of the most important things we do here at Shepherd once the patient is weaned form the ventilator. We do it while they’re on the ventilator as well, but once they are weaned from the ventilator and they no longer have that backup of the ventilator giving them the breath, then we are the ones that have to help them with the cough. The assist cough, it’s called a “butterfly technique” that we use her at Shepherd, and it’s called a “quad cough” in some other facilities, as well. You would be surprised how many people come to work at Shepherd, even in the respiratory department, who have never done or seen an assist cough or a quad cough. So, that is one of the very first things that we teach new therapists here at Shepherd, because what we have to do is place our hands down by the abdomen and push really vigorously to help the patient cough. We become their diaphragm. So, if they have something deep into their lungs that they cannot cough up on their own, we’re going to assist them. We do that with our own hands, but we also have machines. We have an assist cough machine that is also very helpful where we just push positive air pressure into the airway and then allow the patient to cough, and we remove the secretions with that machine, as well.
Melanie: So, what are some other things that you might teach patients like deep breathing exercise? Speak about some of these kinds of things that you actually work with patients to do.
Kelly: Sure. So, we try to teach patients, especially, again, once they are breathing on their own this becomes more important, on teaching them how to slow their breathing down when they get short of breath. We teach them a thing called “pursed lip breathing” where we have them breathe in through the nose, out through the mouth, and kind of purse your lips like you’re blowing out candles. That really helps in getting the patient to be able to catch their breath and make it a lot easier for the patient, but also calming down that anxiety. So, we teach them those techniques. We also teach them, believe it or not, to assist cough themselves. So, some of our patients, unfortunately, may have to go home and not have a lot of help at home so we teach them how to place their hands on their stomach and abdomen and assist cough themselves. You can do that in a couple of ways, and we teach them all of those things before leaving Shepherd.
Melanie: You mentioned the pursed lip breathing and this Valsalva maneuver. So, is this intended to help increase that oxygen saturation and help them with that shortness of breath? Just speak about that. It’s a little bit of holding your breath, isn’t it?
Kelly: Absolutely. It’s all about increasing the oxygen level. With a spinal cord injury patient, we’re not as concerned about the oxygen levels being at 98 or 99% which is the highest you can go. We’re okay here at Shepherd with them having even lower saturations as long as they’re 92 or above, we are usually okay with that. Once they kind of start dropping lower than that, that’s when we do that deep breathing exercise, because what we have them do is take the biggest, deepest breath in that they can and blow all of it out through their mouth until they’ve blown all of their air out and, again, have them do it slow and easy, in and out, and that helps increase the saturation, as well.
Melanie: We think of weight training and things that people do for other rehabilitation exercises, and what about for the lungs and for breathing and a spirometer or some of the equipment that you might use to help them strengthen up their breathing capabilities?
Kelly: So, we use incentive spirometry here a lot, and a lot of times people think of incentive spirometers as you something you would only use pre- or post-surgery to help keep your airways open. But, what people tend to forget sometimes is an incentive spirometer also helps to strengthen your muscles--those muscles that we use to breathe, that we’re not used to having to use all the time. So, it recruits those muscles and helps those breathing muscles get stronger so that when we need them, they’re strong enough for us to use them, so we do use those. We do spirometry on our patents here. The pulmonary team likes to order those just to kind of get a baseline. We also do baseline ABGs when a patient first gets to Shepherd so that we know what their arterial blood gases look like and we know exactly where their breathing is at that point in time.
Melanie: And, what do you tell them as they are intending to go back home about using a ventilator and doing these exercises, and even getting the family involved so that they can help them, Kelly, work on these breathing exercises when you’re not there all the time?
Kelly: So, that is one of the things that I love most about the Shepherd Center. You will never see a family member leave Shepherd without knowing exactly how to take care of their patient and, not just in respiratory, but in all aspects of what needs to be done. We have a very vigorous family training program, and our department has their own family trainer for respiratory; that is her only job--not her only job, she has many jobs--but that is what she does is she trains every family that’s leaving Shepherd Center, whether they’re on a ventilator, whether they’re off the ventilator, they may just have a trach, whatever that family is going home with, she trains them how to do it, how to use it, what every button means on that ventilator, what you should do if you get into trouble. She tells them from beginning to end and she gives them lots of literature. Once she does her initial training then the therapists come behind and let the families practice until they feel 100% comfortable, and then we sign them off that they are ready to go.
Melanie: So, wrap it up for us, Kelly, in explaining what a respiratory therapist does in terms of spinal cord injury with patients and their families at Shepherd Center and what’s your best advice for working on these breathing techniques for families?
Kelly: Well, to sum it up, I just think that Shepherd Center in itself is such a teaching facility. I think that we start teaching the family as respiratory day one. We have patients who are ventilated or non-ventilated who may have trachs. On day one, we start teaching the family how to bag their family member. And that’s day one. Every single day we’re teaching them how to do those breathing techniques, how to handle their patient or their family member if they were to get into trouble, and we do that every single day that they’re here until the time that they leave. We want them to feel 100% comfortable doing exactly what we do for their family member while they’re here at Shepherd.
Melanie: Thank you so much, Kelly, for being with us today. It’s great information. You're listening to Shepherd Center Radio and for more information, you can go to www.Shepherd.org. That's www.Shepherd.org. This is Melanie Cole. Thanks so much for listening.