Basic techniques of pulmonary physical therapy (I) 100/04/24

Size: px

Start display at page:

Download "Basic techniques of pulmonary physical therapy (I) 100/04/24"

Beryl Johns
10 years ago
Views:

1 Basic techniques of pulmonary physical therapy (I) 100/04/24

2 Evaluation of breathing function Chart review History Chest X ray Blood test Observation/palpation Chest mobility Shape of chest wall Accessory muscle firing Respiratory rate Posture Physical examination Breathe sound Dyspnea index Cough ability Functional capacity

wall Accessory muscle firing Respiratory rate Posture Physical

3 Evaluation of breathing pattern Breathing pattern (I) 2C2D 3C1D Breathing pattern (II) Upper chest paradox Abdominal paradox Excessive accessory muscle use Breathing pattern (III) Paradoxical Rapid and shallow Prolong expiration, and etc.

paradox Excessive accessory muscle use Breathing pattern

4 Breathing retraining Active expiration Pursed lips breathing Specific body positions Diaphragmatic breathing Accessory muscle stretch Breathing control Relaxation breathing Incentive spirometry (IS)

5 Active expiration Contraction of the abdominal muscles during expiration Lengthens the diaphragm Improve the length tension relationship or geometry of the respiratory muscle (diaphragm) Assist the next inspiration transdiaphragmatic pressure The efficacy of the contraction in moving the rib cage improves strength and endurance of inspiratory muscle

(diaphragm) Assist the next inspiration transdiaphragmatic pressure The efficacy of the

6 Length tension relationship In same neural input, length, output of muscle

7 Pursed lips breathing Effects Improves ventilation Releases trapped air in the lungs Keeps the airways open longer and decreases the work of breathing Prolongs exhalation to slow the breathing rate Improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs Relieves shortness of breath Causes general relaxation

slow the breathing rate Improves breathing patterns by moving old air out of the lungs

8 Pursed lips breathing Active and prolonged expiration through half opened lips

9 Body position Upright position Oxygen transport is optimized to the greatest degree (ventilation vs perfusion) Maximize lung volume and capacities (Fig) Anteroposterior dimension of chest wall is the greatest, and compression of the heart and lung is minimized Maximal expiratory pressure is greatest (cough, huffing, etc.)

Anteroposterior dimension of chest wall is the greatest, and compression of the

13 To optimize thoraco abdominal Segmental breathing movements

14 Segmental breathing

15 Diaphragm breathing Move the abdominal wall predominantly during inspiration and to reduce upper rib cage motion Improve chest wall motion Improve distribution of ventilation the energy cost of breathing the contribution of rib cage muscle dyspnoea exercise performance

motion Improve distribution of ventilation the energy cost of

16 Diaphragm breathing

17 Accessory muscle stretch Accessory muscle sternocleidomastoid (elevated sternum) scalene muscles (anterior, middle and posterior scalene) serratus anterior, pectoralis major & minor, upper trapezius, latissimus dorsi, erector spinae (thoracic), iliocostalis lumborum, quadratus lumborum, serratus posterior superior and inferior, levatores costarum, transversus thoracis, subclavius

upper trapezius, latissimus dorsi, erector spinae (thoracic), iliocostalis lumborum, quadratus

18 Accessory muscle stretch

19 Accessory muscle stretch

20 Manual therapy techniques Sidelying, with the upper arm elevated to stretch the intercostal muscles or in sitting, using active shoulder abduction combined with lateral flexion Active or passive bilateral arm flexion and spine extension may be combined with deep inspiration

abduction combined with lateral flexion Active or passive bilateral

21 21

22 Respiratory ratio Breathing control Inhalation: exhalation= 1:2

23 Relaxation breathing When hyperinflation caused by an activity of the inspiratory muscles during expiration Hyperinflation is due to altered lung mechanics (COPD) Loss of elastic recoil pressure air trapping Forward leaning COPD Relief hyperinflation and paradoxical abdominal movement EMG activity of the scalene and sternomastoid muscles transdiaphragmatic pressure, thoracoabdominal movements

24 Relaxation breathing 24

26 26

27 Incentive spirometry Mechanical devices introduced in surgical patients Attempt to reduce postoperative complications by increasing inspiratory capacity Activated by the patient s inspiratory effort Slow, deep inspiration Mouthpiece Visual feedback Preset volume and hold at full inspiration for 2 3 secs 27

28 Incentive spirometry 28

29 Manual therapy techniques Subjective assessment Musculoskeletal dysfunction Postural and skeletal changes over time Overuse of upper chest breathing patterns Lack of lower rib expansion Chronic hyperinflation typically leads to the development of a barrel shaped chest Physical assessment: posture The relaxed posture of the pelvis, lumbar, thoracic and cervical spines The position of the scapulae and the location of the humeral head within the glenoid The posture of the neck and head and alignment with the trunk and pelvis The point of maximal curve of each of these segments Whether the spinal posture is fixed or able to be corrected 29

30 30

31 Manual therapy techniques Physiotherapy management Postural correction and motor control training Educating awareness Use visual, auditory and sensory feedback Motor learning with training the holding ability of the postural stabilizers frequent gentle repetitions of the corrected movement or position Initial focus: correct any posterior pelvic rotation in sitting and on reducing the lumbar and thoracic kyphosis 31

32 Manual therapy techniques Mobilization techniques Focus: improving the range and quality of thoracic extension and rotation Increasing the mobility of the ribs Muscle lengthening techniques Taping Muscle retraining 32

34 Neurophysiological facilitation Intercostal stretch Stretch on expiration phase maintained Observation of respiration Increased movement of area being stretched Suggested mechanism Intercostal stretch receptors

36 Neurophysiological facilitation of respiration Anterior stretch lifting posterior basal area Patient supine Hands under lower ribs Ribs lifted upward Observation Expansion of posterior basal area epigastric movements Suggested mechanism Dorsal root mediated intersegmental reflex Stretch receptors in intercostals, back muscles

I tro r duct c io i n t o Exercise Technique

I tro r duct c io i n t o Exercise Technique Introduction to Exercise Technique Is Exercise Technique Important? It is the actual technique used for a resistance training exercise that determines; The precise movement pattern the body will be attempting