Lecture 10: Pulmonary Rehabilitation Flashcards
What are the 4 components of a rehabilitation program?
(1) assessment
(2) education
(3) physical component
(4) psychosocial component
What is the overall goal of a comprehensive rehabilitation program? (2)
(1) maximize quality of life
(2) increase independence
The PT evaluation of a pulmonary patient should include… (3)
(1) measurements of endurance capacity
(2) measurement scales to quantify dyspnea
(3) quality of life measurements
What is a common limiter in patients with a chronic pulmonary disease?
Leg fatigue.
The legs are often deconditioned in these patients.
What are the four measurement scales used to quantify dyspnea?
(1) modified RPE/Borg scale
(2) visual analog scale
(3) baseline dyspnea index (BDI)
(4) transitional dyspnea index (TDI)
Is the modified RPE or Borg scale a linear scale?
No.
What does the baseline dyspnea index do (BDI)?
Assesses dyspnea occurring outside of the clinic environment.
What does the traditional dyspnea index (TDI) measure?
The change in SOB symptoms
The 6 MWT is good for measuring endurance, what are some key factors in the testing procedure that make it reliable?
(1) be consistent in the path used
(2) indicate the distance walked and the number and characteristics of any breaks the patient took (ie. standing, sitting, braced)
(3) better if you repeat twice to achieve reliability
What are the aspects that must be monitored while doing a GXT (symptom limited) in an individual with pulmonary disease?
(1) dyspnea
(2) RPE
(3) HR
(4) ECG
(5) BP
(6) SaO2
What are the three questions to ask the patient when they are doing a GXT?
(1) BOS (breathlessness)
(2) Leg fatigue
(3) overall exertion
What are the two tests for quality of life that are specifically directed for patients with pulmonary conditions?
(1) chronic respiratory questionnaire
2) St. George’s respiratory questionnaire (SGRQ
What is the generic test for quality of life?
Questionnaire SF-36
What are the three things we need to know about the generic SF-36?
(1) physical score and mental score
(2) can be used for any condition
(3) not specific
What (4) things does the chronic respiratory questionnaire (CRQ) include?
(1) depression
(2) dyspnea
(3) fatigue
(4) mastery of domains
What are the (3) things included in the St. George’s Respiratory Questionnaire (SGRQ)?
(1) symptoms
(2) activities
(3) impact domains (impact on personal life)
What are the components of the education process for the patient?
(1) knowledge of the disease
(2) smoking cessation
(3) use of medications, supplemental oxygen, equipment (nebulizer, ventilator)
There are 8 subcategories of the physical component of the pulmonary rehabilitation, what are they?
(1) pulmonary care -maximize independence
(2) respiratory muscle training
(3) energy conservation techniques
(4) paced breathing (eg. with ADLs, exercise)
(5) flexibility
(6) strength training
(7) endurance training
(8) relaxation training
What are the three components of pulmonary care (aka pulmonary hygiene)?
(1) breathing exercises
(2) cough
(3) secretion clearance
What is the most common reason to stop a GXT?
Leg fatigue 1/2 the time this is the cause of stopping exercise
When do you not want to train the respiratory muscles in a patient?
In the midst of fatigue or acute illness (such as infection)
What is a threshold training device (w/ nose clip)?
A device that helps with training the respiratory muscles.
(1) pressure levels can be changed
(2) the patient must deliver enough force to reach the set pressure before being able to breath
Why is the threshold training device not used?
Because it is easily fooled by breathing deep and slow
When is an appropriate time for a patient to employ energy conservation techniques?
(1) during acute illness/infection
What is paced breathing?
Coordination of inhalation and exhalation (ie. inhalation for 2 steps and exhalation for 3 steps)
Why is flexibility important in pulmonary patients?
Head, neck, trunk, UE, scapula, and pelvic motion Is all involved in breathing.
Why is strength training important in pulmonary patients?
Adequate muscle strength is required for correct breathing
What are the guidelines for developing an endurance training program for any individual?
(1) long duration, low intensity
(2) 4x/wk
(3) large muscle groups
What are the 4 considerations when doing respiratory endurance training?
(1) temperature controlled
(2) avoid sudden changes in intensity (be sure to warm up&cool down)
(3) pulmonary medications may increase resting HR
(4) watch SaO2
What are the three relaxation training techniques?
(1) Bensons relaxation exercise - meditation: repeat word
(2) Jacobsen’s relaxation exercise - contract muscle and then relax to encourage maximal muscle relaxation
(3) mental imagery - using mental images to calm the body
Why is a psychosocial intervention done on pulmonary patients?
Depression and anxiety are the two highest concerns for patients being treated for pulmonary dysfunction
How much time can improvements be expected after a comprehensive pulmonary rehabilitation program?
4 weeks
What improvements can be expected after a comprehensive pulmonary rehabilitation program?
(1) symptom-limited exercise capacity
(2) functional level
(3) respiratory symptoms
(4) respiratory muscle function
(5) psychological status
(6) quality of life
(7) frequency of hospitalalizations
What four things do not have accepted improvements with a comprehensive rehabilitation program?
(1) lung function
(2) heart function
(3) maximal aerobic capacity
(4) mortality rate
