Lecture 10: Pulmonary Rehabilitation

Question 0

What are the 4 components of a rehabilitation program?

Answer 0

(1) assessment
(2) education
(3) physical component
(4) psychosocial component

Question 1

What is the overall goal of a comprehensive rehabilitation program? (2)

Answer 1

(1) maximize quality of life

(2) increase independence

Question 2

The PT evaluation of a pulmonary patient should include… (3)

Answer 2

(1) measurements of endurance capacity
(2) measurement scales to quantify dyspnea
(3) quality of life measurements

Question 3

What is a common limiter in patients with a chronic pulmonary disease?

Answer 3

Leg fatigue.

The legs are often deconditioned in these patients.

Question 4

What are the four measurement scales used to quantify dyspnea?

Answer 4

(1) modified RPE/Borg scale
(2) visual analog scale
(3) baseline dyspnea index (BDI)
(4) transitional dyspnea index (TDI)

Question 5

Is the modified RPE or Borg scale a linear scale?

Answer 5

No.

Question 6

What does the baseline dyspnea index do (BDI)?

Answer 6

Assesses dyspnea occurring outside of the clinic environment.

Question 7

What does the traditional dyspnea index (TDI) measure?

Answer 7

The change in SOB symptoms

Question 8

The 6 MWT is good for measuring endurance, what are some key factors in the testing procedure that make it reliable?

Answer 8

(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

Question 9

What are the aspects that must be monitored while doing a GXT (symptom limited) in an individual with pulmonary disease?

Answer 9

(1) dyspnea
(2) RPE
(3) HR
(4) ECG
(5) BP
(6) SaO2

Question 10

What are the three questions to ask the patient when they are doing a GXT?

Answer 10

(1) BOS (breathlessness)
(2) Leg fatigue
(3) overall exertion

Question 11

What are the two tests for quality of life that are specifically directed for patients with pulmonary conditions?

Answer 11

(1) chronic respiratory questionnaire

2) St. George’s respiratory questionnaire (SGRQ

Question 12

What is the generic test for quality of life?

Answer 12

Questionnaire SF-36

Question 13

What are the three things we need to know about the generic SF-36?

Answer 13

(1) physical score and mental score
(2) can be used for any condition
(3) not specific

Question 14

What (4) things does the chronic respiratory questionnaire (CRQ) include?

Answer 14

(1) depression
(2) dyspnea
(3) fatigue
(4) mastery of domains

Question 15

What are the (3) things included in the St. George’s Respiratory Questionnaire (SGRQ)?

Answer 15

(1) symptoms
(2) activities
(3) impact domains (impact on personal life)

Question 16

What are the components of the education process for the patient?

Answer 16

(1) knowledge of the disease
(2) smoking cessation
(3) use of medications, supplemental oxygen, equipment (nebulizer, ventilator)

Question 17

There are 8 subcategories of the physical component of the pulmonary rehabilitation, what are they?

Answer 17

(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

Question 18

What are the three components of pulmonary care (aka pulmonary hygiene)?

Answer 18

(1) breathing exercises
(2) cough
(3) secretion clearance

Question 19

What is the most common reason to stop a GXT?

Answer 19

Leg fatigue 1/2 the time this is the cause of stopping exercise

Question 20

When do you not want to train the respiratory muscles in a patient?

Answer 20

In the midst of fatigue or acute illness (such as infection)

Question 21

What is a threshold training device (w/ nose clip)?

Answer 21

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

Question 22

Why is the threshold training device not used?

Answer 22

Because it is easily fooled by breathing deep and slow

Question 23

When is an appropriate time for a patient to employ energy conservation techniques?

Answer 23

(1) during acute illness/infection

Question 24

What is paced breathing?

Answer 24

Coordination of inhalation and exhalation (ie. inhalation for 2 steps and exhalation for 3 steps)

Question 25

Why is flexibility important in pulmonary patients?

Answer 25

Head, neck, trunk, UE, scapula, and pelvic motion Is all involved in breathing.

Question 26

Why is strength training important in pulmonary patients?

Answer 26

Adequate muscle strength is required for correct breathing

Question 27

What are the guidelines for developing an endurance training program for any individual?

Answer 27

(1) long duration, low intensity
(2) 4x/wk
(3) large muscle groups

Question 28

What are the 4 considerations when doing respiratory endurance training?

Answer 28

(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

Question 29

What are the three relaxation training techniques?

Answer 29

(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

Question 30

Why is a psychosocial intervention done on pulmonary patients?

Answer 30

Depression and anxiety are the two highest concerns for patients being treated for pulmonary dysfunction

Question 31

How much time can improvements be expected after a comprehensive pulmonary rehabilitation program?

Answer 31

4 weeks

Question 32

What improvements can be expected after a comprehensive pulmonary rehabilitation program?

Answer 32

(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

Question 33

What four things do not have accepted improvements with a comprehensive rehabilitation program?

Answer 33

(1) lung function
(2) heart function
(3) maximal aerobic capacity
(4) mortality rate