Physical Therapy Intervention For Pulmonary Diseases
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Transcript of Physical Therapy Intervention For Pulmonary Diseases
Physical Therapy Intervention For Pulmonary Diseases
Dr. Mohamed Seyam PhD. PT. Assistant professor of physical therapy
Physical Therapy Intervention for Pulmonary diseases
Breathing Exercise Thoracic Mobilization Techniques Inspiratory
Muscle Training Airway Clearance Techniques Mechanical Ventilators
1. BREATHING EXERCISES Prevent postoperative pulmonary
complications.
GOALS: Improve or redistribute ventilation. Prevent postoperative
pulmonary complications. Improve the strength, endurance, and
coordination of themuscles of ventilation. Correct inefficient or
abnormal breathing patterns anddecrease the work ofbreathing.
Promote relaxation and relieve stress. Teach the patient how to
deal with episodes of Dyspnea. Types of Breathing Exercises
a. Diaphragmatic breathing exercise b. Segmental breathing exercise
c. Pursed- lip Breathing exercise d. Glossopharyngeal breathing e.
Preventing and Relieving Episodes of Dyspnea a. Diaphragmatic
breathing exercise
These are designed to improve the efficiency of ventilation,
decreasethe work of breathing, increase the excursion (descent or
ascent) of thediaphragm, and improve gas exchange and Oxygenation.
Position: Semi-Fowlers position (in which gravityassists the
diaphragm), long sitting or supine. Procedure Of Diaphragmatic
breathing exercise
Start instruction by teaching the patient how to relax the
accessory muscles of inspiration those muscles (shoulder rolls or
shoulder shrugscoupled with relaxation). Place your handon the
rectus abdominals just below the anterior costalmargin on the
epigastric angle. Ask the patient to breathe in slowly and deeply
through the nose. Have the patientkeep the shoulders relaxed and
upper chest quiet,allowing the abdomen to rise slightly. Then tell
the patient to relax and exhale slowly through the mouth. After the
patient understands and is able to control breathing using a
diaphragmatic pattern, practice diaphragmatic breathing in a
variety of positions (sitting, standing)and during
activity(walking, climbing stairs). b. Segmental breathing
exercise
Segmental breathing techniques may need to be directed to the lobes
ifthere is accumulation of secretions or insufficient lung
expansionin theseareas. 1.Lateral Costal Expansion called lateral
basal expansion, can be carried out unilaterally or bilaterally.
Position: Hook-lying position; later progress to a sitting
position. Procedure Place your hands along the lateral aspect of
the lower ribs todirect the patients attention to the areas where
movement is to occur. 1)Lateral Costal Expansion
Ask the patient to breathe out, and feel the rib cage move downward
and inward. As the patient breathes out, place pressure into the
ribs with the palms of yourhands. Just prior to inspiration, apply
a quick downward and inward stretch to thechest. This places a
quick stretch on the external intercostals to facilitate
theircontraction. Apply light manual resistance to the lower ribs
to increase sensory awarenessas the patient breathes in deeply and
the chest expands. Teach the patient how to perform the maneuver
independently by placing his or her hand(s) over the ribs or
applying resistance with a towel or beltaround the lower ribs 2)
Posterior Basal Expansion
Deep breathing emphasizing posterior basal expansion is
importantfor the postsurgical patient who is confined to bed in
asemi recliningposition for an extended period of time
becausesecretions oftenaccumulate in the posterior segments of the
lower lobes. Procedure Have the patient sit and lean forward on a
pillow, slightly bending thehips. Place your hands over the
posterior aspect of thelower ribs. Follow the same procedure just
described for lateral costal expansion. c. Pursed-Lip
Breathing
Pursed-lip breathing is a strategy that involves lightly pursing
the lips together duringcontrolledexhalation. p r e c a u t i o n :
The use of forceful expiration during pursed-lip breathing must
beavoided because this can causefurther restriction of the small
bronchioles. PositionAny comfortable position Procedure: Have the
patient breathe in slowly and deeply through the nose and then
breathe outgentlythrough lightly pursed lips as if blowing on and
bendingthe flame of a candle butnot blowing it out. Explain to the
patient that expiration must be relaxed and that contractionof
theabdominals must be avoided. Place your hand over the patients
abdominal muscles to detect any contraction of theabdominals. d.
Glossopharyngeal breathing
It is a means of increasing the inspiratory capacity when there is
severe weakness of therespiration muscles. It is used primarily by
patients who areventilator-dependent because of absent orIncomplete
innervations of the diaphragm as the result of a high
cervical-level spinalcord lesion or other neuromuscular disorders
Procedure Glossopharyngeal breathing involves taking several gulps
of air, usually 6 to 10gulpsin series, to pull air into the lungs
when action of the inspiratory muscles isinadequate. After the
patient takes several gulps of air, the mouth is closed, and the
tonguepushes the air back and traps it in the pharynx. The air is
then forced into the lungswhen the glottis is opened. This
increases the depth of the inspiration and thepatients inspiratory
and vital capacities e. Preventing and Relieving Episodes of
Dyspnea
If the patient becomes slightly short of breath, he must learn to
stop anactivity and use controlled, pursed-lip breathing until the
dyspneasubsides. Procedure 1. Have the patient assume a relaxed,
forward-bent posture. A forwardbent positionstimulates
diaphragmatic breathing (the viscera drop forward and the
diaphragmdescends more easily). 2. Have the patient gain control of
his or her breathing and reduce therespiratory rateby using
pursed-lip breathing during expiration. 3. After each pursed-lip
expiration, teach the patient to use diaphragmaticbreathingand
minimize use of accessory muscles during each inspiration. 2.
Thoracic Mobilization Techniques
Chest mobilization exercises are any exercises thatcombine active
movements of the trunk or extremitieswith deep breathing. They are
designed to maintain or improve mobility of thechest wall, trunk,
and shoulder girdles when it affectsventilation or postural
alignment. Exercises that combine stretching of these muscles
withdeep breathing improve ventilation on that side of thechest. a.
Specific Techniques To Mobilize One Side of the Chest 1. While
sitting, have the patient bend away from the tight side to lengthen
hypo mobile structures and expand that side of the chest during
inspiration 2. Then, have the patient push the fisted hand into the
lateral aspect of the chest, bend toward the tight side, and
breathe out 3. Progress by having the patient raise the arm
overhead on the tight side of the chest and side-bend away from the
tight side. This places an additional stretch on hypo mobile
tissues. b. To Mobilize the Upper Chest and Stretch the pectoralis
muscle
While the patient is sitting in a chair with hands elongatingthe
clasped behind the head, horizontally abduct thearms have him or
her Pectoralis major) during a deepinspiration. Then instruct the
patient to bring the elbows together andbend forward during
expiration. c. To Mobilize the Upper Chest and Shoulder
While sitting in a chair, have the patient reach with botharms
overhead (180 bilateral shoulder flexion and slightabduction)
during inspiration. Then bend forward at the hips and reach for the
floorduring expiration 3.Respiratory muscle Training (RRT)
RRT is advocated to improve ventilation in patients with
pulmonarydysfunction associated with weakness, atrophy, or
inefficiency ofthe muscles of inspiration or to improve the
effectiveness of thecoughmechanism in patients with weakness of the
abdominalmuscles or other expiratory muscles. Types of Training a.
Inspiratory Muscle Training (IMT) b. Incentive Spirometer a.
Inspiratory muscle training
Procedur The patient inhales through a resistive training device
placed in themouth. These devices are narrow tubes of varying
diameters or amouthpiece and adapter with an adjustable aperture
that provideresistance to airflow during inspiration and therefore
place resistanceon inspiratory muscles. The smaller the diameter of
the tube and, the greater istheresistance. The patient inhales
through the device for a specified period of timeseveral times each
day. b. Incentive spirometer
Incentive spirometer is a form of ventilatory training that
emphasizes sustainedmaximum inspirations. The purpose of incentive
spirometer is to increase the volume of air inspired. It is used
primarily to prevent alveolar collapse and atelectasis in post
operativepatients. Procedure. Have the patient assume a comfortable
position (semi reclining, if possible) andinhale and exhale three
to four times and then exhale maximally with the fourthbreath Then
have the patient place the spirometer in the mouth, inhale
maximally throughthemouthpiece to a target setting and hold the
inspiration for several seconds. This sequence is repeated five to
ten times several times per day. 4. Airway Clearance
Techniques
Sputum in perspective Hydration and humidification Exercise
Postural drainage Manual techniques modified Postural drainage
Breathing techniques Mechanical aids Cough Pharyngeal suction
Nasopharyngeal airway Minitracheostomy 4. Airway Clearance
Techniques
An effective cough is necessary to eliminate respiratory
obstructionsandkeep the lungs clear. A cough may be reflexive or
voluntary. The Cough Mechanism 1. Deep inspiration occurs. 2.
Glottis closes, and vocal cords tighten. 3. Abdominal muscles
contract and the diaphragm elevates, causingan increase in intra
thoracic and intra-abdominal pressures. 4. Glottis opens. 5.
Explosive expiration of air occurs. Factors that Decrease the
Effectiveness of the Cough Mechanism and Cough Pump:
1. Decreased inspiratory capacity. 2. Inability to forcibly expel
air. 3. Decreased action of the cilia in the bronchial tree. 4.
Increase in the amount or thickness of mucus. Teaching an Effective
Cough
1. Assess the patients voluntary or reflexive cough. 2. Have the
patient assume a relaxed, comfortable position - Sitting or leaning
forward 3. Teach the patient controlled diaphragmatic breathing,
emphasizing deep inspirations. 4. Demonstrate a sharp, deep, double
cough. 5. Demonstrate the proper muscle action of coughing
(contraction of the abdominals). 6. Take a deep but relaxed
inspiration, followed by a sharp double cough. The second cough
during a single expiration is usually more productive. Additional
Techniques to Facilitate a Cough
1.Manual-Assisted Cough If a patient has abdominal weakness manual
pressure on theabdominal area assistsin developing greater
intra-abdominal pressure for a more forceful cough. a.
Therapist-Assisted Techniques b. Self-Assisted Technique 2.
Splinting If chest wall pain from recent surgery or trauma is
restricting the cough, teach thepatient to splint over the painful
area during coughing. 3. Tracheal Stimulation The therapist places
two fingers at the sternal notch andapplies a circular motionwith
pressure downward into the trachea to facilitate areflexive cough
5. Aerosol therapy Indications
A therapeutic administration of a drug in the form of an aerosol.
Indications Bronchospasm Inflammation Mucosal edema Copious
secretion For mobilization of secretion Aerosol drug delivery
systems
Delivery systems: a) Nebulizer b)MDI (Metered dose-inhalers) a)
Nebulizer It is a device used to converting a liquid drug into a
fine mist which can then beinhaled easily. Types: a) Jet Nebulizer
b) Ultrasonic Nebulizer Purposes: To administer medication directly
into the respiratory tract to induce sputumexpectoration in case of
sputum induction To reduce the difficulty in bringing out the
secretions To increase Vital capacity metered-dose inhaler
(MDI)
Ametered-dose inhaler (MDI)is a device that delivers a specific
amount ofmedication to thelungs, in the form of a short burst of
aerosolized medicinethat is inhaled by the patient. It is the most
commonly used delivery system for treatingasthma,chronicobstructive
pulmonary disease (COPD) and other respiratory diseases. The
medication in a metered dose inhaler is most
commonlyabronchodilator,corticosteroidor a combination of both for
thetreatment of asthma and COPD. Thank you