Rehabilitation Approaches for Patients with Tracheostomies and Ventilators – Sheila Clark

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Trachesostomy and ventilator patients face a number of added challenges that often impact therapy outcomes. While working on compensatory strategies, functional mobility, and ADLs in therapy, they’re also developing communication skills, learning swallowing techniques, and adjusting to medical equipment.

This recording explores the latest solutions to these and other challenges of tracheostomy and ventilator management. Examine current tracheostomy benefits, considerations, and best practices by reviewing the anatomy and physiology of respiration, as well as the many different types and combinations of tracheostomy tubes, speaking valves, and ventilators. Discuss how tracheostomies and ventilators impact physical, occupational, and speech therapies, and take home evidence-based tools and rehab strategies the whole team can use to improve rehab outcomes with pediatric and adult populations.

1. Describe the basic neuroanatomy and physiology of respiration
2. Identify the invasive and non-invasive ventilation techniques
3. Articulate the positive and negative effects of tracheostomy and areas of function it impacts
4. Describe tracheostomy tubes and speaking valve options and the benefits/contraindications for use
5. Develop assessment and treatment strategies of speaking valves with tracheostomies
6. Analyze common differences in pediatric and adult management of tracheostomies and speaking valves
7. Recognize the importance of a team approach and the goals of the Global Tracheostomy Collaborative

NEUROANATOMY AND PHYSIOLOGY OF RESPIRATION

• Definitions and terminology
• Diseases of the respiratory system

TYPES OF VENTILATION

• Invasive
• Noninvasive
• Goals and differences from natural respiration
• Sutt articles

TRACHEOSTOMY CONSIDERATIONS

• Purpose
• Percutaneous vs. surgical
• Types of tracheostomy tubes
• Changes in function due to tracheostomy
• Rehab team approach to treating patients with new tracheostomy
  • PT/OT therapeutic exercise to maximize respiratory function
  • Functional transfers/gait while intubated
• Changes in subglottic pressure and its effect on PT, OT, and ST treatments

SPEAKING VALVES AND IMPACT ON REHAB OUTCOMES 

• Commercial speaking valves
  • Types
  • Functions
• Speaking valves benefits
  • Phonation
  • Swallowing
  • Secretion management
• Assessment and treatment considerations
  • ICU
  • LTACH
  • TCU
  • Outpatient
  • Home health
• Speaking valves contraindications and concerns
  • Determining use during rehab interventions
  • Using speaking valves to progress PT/OT/ST goals
  • Donning/doffing valves during PT/OT/ST treatments

PEDIATRIC VS. ADULT CONSIDERATIONS

• Vital signs
• Cuffed vs. cuffless trachs
• Treatment strategies

TEAM APPROACH TO TRACH AND VENT MANAGEMENT

• Global Tracheostomy Collaborative
• Purpose of a team approach
• Members of the tracheostomy team and their roles
  • Benefits of rehab professionals as part of the team
• Outcome statistics when team is in place