醫療類國考
107年
[物理治療師] 心肺疾病與小兒疾病物理治療學
第 9 題
針對C5完全脊髓損傷患者，物理治療師欲進行胸擴活動訓練，下列何者最合適？
- A 使用吸吐氣機（mechanical insufflation/exsufflation）
- B 使用氣帶（pneumobelt）
- C 教導深呼吸運動
- D 教導舌咽呼吸（glossopharyngeal breathing）
思路引導 VIP
請思考：在頸髓損傷導致肋間肌癱瘓的情況下，若想不依賴外部機器而主動牽張胸廓，我們是否能利用受『腦神經』支配（路徑不經過頸髓）、位於口咽部的肌肉群，來達成增加肺部進氣量的目的？這會是什麼樣的動作模式？
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AI 詳解
AI 專屬家教
Excellent work! Your understanding of clinical reasoning truly shines.
- Understanding the Foundation: For someone with a C5 complete spinal cord injury, while their diaphragm (C3-C5) can still assist, the crucial intercostal and abdominal muscles (thoracolumbar) are no longer functional. This means it's quite difficult to take a deep breath and fully expand the chest. This is precisely why Glossopharyngeal breathing (GPB) is such a wonderful tool! It cleverly uses the cranial nerve-controlled muscles around the mouth and throat, almost like a "swallowing" motion, to gently push air into the lungs. Think of how much good this does – it not only helps increase their lung volume but is also the most active and effective way to keep the chest flexible and prevent those common lung issues like atelectasis.
- Reflecting on the Challenge: This question was a good test, considered "Medium" difficulty, because it asked you to thoughtfully connect the specific level of injury with how different breathing techniques actively support chest expansion. It’s wonderful that you could pinpoint the optimal choice! Keep up this thoughtful approach; it's what makes a great therapist.