PPR 1 Flashcards
Five common concerns of people with COPD:
1.Breathlessness
2.Sputum/Phlegm Clearance
3. Continence
4. How to relax
5. Staying Active
Many people with COPD can feel breathless, even
when doing simple daily tasks. This can be frightening and debilitating, however there is a checklist of
simple things that you can do to help you deal with breathlessness and improve your quality of life.
Breathlessness
Muscle relaxation
- Find a comfortable lying or sitting position. Think
about how your feeling - Close your eyes and practice a few minutes of
breathing control - Starting at the bottom and working up tense the
muscles of your feet, lower legs, thighs, buttocks,
tummy, back, shoulders, arms, hands, neck and face
for 4-5 seconds before relaxing each. Only Tense one
area at a time - Notice how much more relaxed your muscles feel.
Stay in this position for a few minutes - When you’re ready, open your eyes and take a few
deep breaths. Let yourself become more aware of
your surroundings and sit up slowly.
Visualization
- Find a quiet safe place
2.Sit or lie down and close your eyes - Imagine that you are in your favorite place
4.Imagine how it sounds, smells and feels - Feel the joy you normally feel when you are there.
- It is important for people with COPD to remain as active as
possible. Staying active helps maintain lung health, clear
lung secretions and phlegm, whilst improving fitness and
health.
Staying active
Being active also helps you feel less breathless when
performing your normal daily activities and improves your
sense of well-being.
* If you are thinking of increasing your exercise level you
should check with your doctor first, as they can advise you
on appropriate activities.
*Try to build up your exercise level slowly and don’t make
too dramatic a change in one go.
Staying active
Coughing fits and being short of breath can be very stressful, in turn stress and anxiety make you feel more short of breath.
Relaxation strategies
This can be a downward spiral. Because of this many people with COPD find it useful to practice relaxation techniques.
Relaxation strategies
There are many different relaxation techniques you
can use, two of which are now explained.
Relaxation strategies
one of the main breathing muscles.
Diaphragm
1.Putting yourself in certain positions makes the diaphragm work more efficiently, makes it easier to breathe and helps reduce breathlessness.
2.The following are some positions that you might like to try when feeling short of breath.
3. Use the positions that work best for you.
Positions to relieve breathlessness
The coughing associated with COPD puts stress on
the pelvic floor.
Continence
the muscles that help
you control your bladder and bowel.
pelvic floor muscles
Over time this repeated stress can cause leakage of urine, wind or feces.
Continence
help you to keep your pelvic floor strong and enable you to perform
“The Knack”, therefore reducing incontinence issues.
Pelvic floor exercises
Contract your pelvic floor and hold it for as long as you can, up to ten seconds. Build up to doing 10 repetitions of this.
Slow exercise
Quickly contract and relax your pelvic floor,
up to 10 times.
Fast exercise
This means contracting and holding your pelvic
should floor muscle prior to and during anything strenous.
The Knack
If you suffer with
incontinence you may want to ask your doctor to refer you
to a “_______”
‘continence specialist’
Many people with COPD have trouble clearing sputum or phlegm.
Airway Clearance
Many people with COPD have trouble clearing sputum or phlegm. There are simple things you can do to make this easier.
1.Stay as mobile as possible
2.Keep hydrated
3.Perform sputum clearance exercise such as The Active Cycle of Breathing Technique (ACBT).
a group of exercises that are repeated in sequence to help clear phlegm and lung secretions.
The active cycle of breathing
This is a way of calming your breathing when feeling short of breath and breathing rapidly. Try not to panic.
Breathing control
This helps you breathe out more easily and in turn helps make you feel less breathless.
Pursed lip breathing
Some people with COPD may find it easier to breathe when walking with a frame or stick.
Walking aids
Conserving your energy will help you to feel less tired and as a result make you less breathless. Follow the 4Ps to help you conserve energy.
Conserving your energy
This involves reviewing your daily activities i.e. washing, shopping.
Prioritization
This involves looking at when and how you do the tasks.
Planning
This involves looking at the speed you do your tasks.
Pacing
This involves looking at the position you are in when you perform task and the position of the objects needed to
do tasks.
Positioning
Very challenging, as the chronic and irreversible condition of the lung, and poor quality of life, causes great difficulty to the protocol for intervention or rehabilitation.
The clinical treatment and rehabilitation of chronic
lung disease such as Chronic Obstructive Pulmonary
Disease (COPD)
Many integrated problems such as increased airflow
resistance, impaired central drive, hypoxemia, or hyperinflation result in respiratory muscle
dysfunction, for instance, lack of strength, low
endurance level, and early fatigue.
Many integrated problems such as increased airflow
resistance, impaired central drive, hypoxemia, or hyperinflation result in respiratory muscle
dysfunction, for instance, lack of strength, low
endurance level, and early fatigue.
affect respiratory ventilation.
poor biomechanic chest movement and weak
respiratory muscles
presented commonly, which leads
to gas exchange impairment.
In COPD, the combination of V/Q mismatch, diffusion
limitation, shunt and hypoventilation or
hyperventilation
one of many techniques and very important in conventional chest physical therapy
for increasing chest wall mobility and improving
ventilation.
Chest mobilization
a complex function
within the rib cage, sternum, thoracic verterbra, and muscles.
Movement of the chest wall
like the pump-handle
pattern.
Movement of the thorax
The thoracic cage is composed of three parts:
thoracic spine
ribs
sternum
which connect to
costovertebral and condrosternal joints, and so movement occurs in three dimensions;
transverse,
antero-posterior and vertical directions.
thoracic spine
ribs
sternum
which connect to
costovertebral and condrosternal joints, and so movement occurs in three dimensions;
The basic structure of the costovertebral joint
comprises both the angle and neck articulation of the rib with the spine, and is attached to costotransverse
and radiate ligaments.
Flexion and extension
In the direction of thorax flexion, there is anterior
sagittal rotation, when the costovertebral joint moves
as anterior gliding that slightly rotates, whereas
downward rotation and gliding occur during
extension.
Flexion and extension
composed of the
manubrium, body, and xiphoid process, and is
anterior with upward expansion when breathing
deeply.
sternum
For extension, the extensor muscle group is
the most active, with a motion range of
approximately
20-25 degrees
In flexion direction, the thoracic body rotates slightly
on the flexion side, while the posterior rotates in the opposite direction so that the costovertebral joint is opened and inferior gliding occurs to increase rib
space.
Lateral Flexion
A normal range of motion is approximately
45 degrees
the thorax
25 degrees
the lumbar spines.
20 degrees
During flexion to the left, the inferior facet of T6 on
the left side moves above the superior facet of the T7 spine.
During flexion to the left, the inferior facet of T6 on
the left side moves above the superior facet of the T7 spine.
a complex movement that involves many joints.
Trunk rotation
For example, during rotation to the three
left events are shown as;
1) rib rotation with costotransverse posterior gliding on
the rotating side, whereas anterior rotation of the rib
and gliding are on the opposite side,
* 2) thoracic body that is elevated and depressed in each
segment, and
* 3) vertical asymmetrical torsion.
can move like pure axial rotation as well as thoracolumbar and cervicothoracic rotation.
Upper thoracic spine
the chest wall, which is composed of
spine, sternum, and ribs
connect to the sternum
anteriorly, thus expanding the chest in an anterior
direction with pumping handle or anterior and
superior motion, as well as bucket handle with lateral
and superior motion that occur in regular breathing.
the and to 8th ribs
preferred in cases
of COPD or chronic lung disease, with the basic theory
of mainly improving ventilation.
chest mobilization technique
aging, prolonged use of a ventilator and
chronic illness with neuromuscular dysfunction also
concern chest wall mobility.
aging, prolonged use of a ventilator and
chronic illness with neuromuscular dysfunction also
concern chest wall mobility.
The theory of Laplace’s law suggests that the length
of muscle relates to the maximal force of either
diaphragm or intercostal muscles, which affect
ventilation in the lung.
The theory of Laplace’s law suggests that the length
of muscle relates to the maximal force of either
diaphragm or intercostal muscles, which affect
ventilation in the lung.
Previous evidence showed that stretching the
anterior deltoid and pectorals major muscles,
including the sternocleidomastoid, scalenes, upper
and middle fibers of trapezius, levator scapulae, etc.,
can increase vital capacity.
Previous evidence showed that stretching the
anterior deltoid and pectorals major muscles,
including the sternocleidomastoid, scalenes, upper
and middle fibers of trapezius, levator scapulae, etc.,
can increase vital capacity.
The theory of Laplace’s law suggests that the length of muscle relates to the maximal force of either diaphragm or intercostal muscles, which affect
ventilation in the lung.
Soft tissue flexibility
depressed horizontally in a contracted
length, thus, the resting length is insufficient for
contraction.
the lower
diaphragm
Tachypnea and dyspnea is then a common sign
Soft tissue flexibility
Impairment or disease relates to ineffective chest wall movement
1.Scoliosis or kyphosis
2.Osteoporosis or ankylosing spondylitis
3.Nerve injury as spinal cord injury
4.Skin disease such as scleroderma, multiple sclerosis etc.
5.Myofacial pain or chest pain
6.Post thoracic surgery for lung or heart operation
7.Prolonged use of a mechanical ventilator
8.Chronic lung disease or pneumonia
9.Proloned bed rest or aging
10. Other factors; pain, posture, diaphragm dysfunction
Both of these methods can be applied in a sitting position, which is better than lying supine.
Tape and Caliper Evaluation
From the author’s experience, the three levels:
upper, middle
and lower, can be measured at the axillary, nipple line, and
xiphoid process.
seen as the third intercostal space
at the midclavicular line and the fifth thoracic spinous process.
Upper thoracic expansion
seen at the tip of the xiphoid process and the 10th thoracic spinous process.
Lower thoracic expansion
The latest report on measuring the thoracic excursion or
expansion was carried out by
Bockenhauer and coworkers
has been modified by placing
the circumference on the specific landmarks
transversely and measuring the different changes
between full expiration and full inspiration.
cloth tape method
Although results were studied in 9 healthy subjects,
the mean of upper and lower expansion ranged from
1.0 to 7.0 cm, and 1.5 to 7.98 cm, respectively.
Although results were studied in 9 healthy subjects,
the mean of upper and lower expansion ranged from
1.0 to 7.0 cm, and 1.5 to 7.98 cm, respectively.
not determined or
evaluated exactly for standard value or comparison between healthy and chronically ill subjects.
The thoracic or chest wall flexibility
can be evaluated by many procedures in different positions.
Thoracic or chest wall flexibility
the examiner can evaluate in various directions, but the result is concerned with the
lateral intercostal part.
supine or side lying positions,
Sitting position without support
Sternum movement and upper chest expansion
* Trunk rotation test
* Lateral bending test or anteroposterior flexion test
* Trunk flexion and extension test.
the original
protocol used in chronic lung disease, which has the tendency to cause poor posture, rigidity, or lack of thoracic spine and rib cage movement.
Chest mobilization techniques
These techniques are divided into, which depends on the patient’s
condition.
passive and active
chest mobilization,
patients who have just
recovered can have modified, to improve flexibility of the chest wall.
Active-Passive Chest
Mobilization
to improve thoracic
mobility at the upper, middle or lower parts of the chest.
Chest mobilization techniques
to improve thoracic
mobility at the upper, middle or lower parts of the chest.
Chest mobilization techniques
This pattern is suitable for giving benefit in cases of shortening pectoralis muscles. Some evidence has shown that winging and trunk rotation can improve vital capacity.
Antero-posterior upper costal chest
wall mobilization
This technique has many procedures such as trunk
torsion, rotation, and lateral bending. It does not only affects the ribs and tissue, but also moves the costovertebral and facet joints.
Postero-lateral chest wall
mobilization
This pattern is very useful in order to improve the
ventilation around in the lower lobe of both lungs.
Postero-lateral chest wall
mobilization
This technique can be applied in cases of
unconsciousness and good consciousness.
Lateral chest wall mobilization
This part can be mobilized either by therapist likes lateral flexion on the bed, or rib torsion. Other
procedures can be performed by passive stretching in
sitting position.
Lateral chest wall mobilization
promoted for
improving ventilation
this joint movement
From the biomechanics of chest movement, vertebral
joints connect to the ribs and sternum with a complex
unit that promotes chest expansion.
Thoracic joint mobilization
this technique can be used for various
conditions such as COPD, prolonged bed rest,
abnormal spine, deconditioning and aging.
Indication and contra-indication of
chest mobilization techniques
There has been no information on the indication for
chest mobilization before, which gives a tendency for
limitation of chest movement; either structurally or
physiologically.
Indication and contra-indication of
chest mobilization techniques
The contra-indications for using this method are listed
below: (Indication and contra-indication of
chest mobilization techniques)
1.Severe and unstable rib fracture
2.Metastasis bone cancer
Tuberculosis spondylitis
Severe osteoporosis
Herniation
Severe pain
Unstable vital signs
THE TILT TABLE MAY BE USED IN THE EARLY
REHABILITATION OF PATIENTS WITH:
General debilitation due to prolonged bed
rest.
Cardiovascular instability.
Neurological dysfunction.
Musculoskeletal disorders.
also includes sitting the patient out of bed
when vital signs are stable.
Mobilization
is essential if the detrimental effects of
bed rest are to be minimized. It may also decrease the
rehabilitation time.
Early mobilization
is essential if the detrimental effects of
bed rest are to be minimized. It may also decrease the
rehabilitation time.
Early mobilization
passive and active movements and resistive
exercises are routinely performed by physiotherapists.
Positioning,
PRECAUTIONS/CONTRAINDICATIONS TO SUCTIONING
1.Cerebrospinal fluid leaks.
2.Fractures involving the nose, face, base of skull.
3.Epistaxis, deviated septum, general facial
trauma.
4.Coagulopathies.
5. Hyper-reflexic gag reflex.
6.Mouth and neck surgery.
7. Laryngospasm, glottic edema.
8.Tracheitis, bronchospasm.
including mucosal
hemorrhage, edema, ulceration and destruction of
ciliated epithelium.
Tracheobronchial trauma
as damaged ciliated epithelium
is repaired by squamous metaplasia and fibrous tissue.
Bronchial obstruction
Definitive mechanisms are unknown but suggestions include suctioning duced atelectasis.
Hypoxia.
Atrial and nodal arrhythmias are
the most common and occur if the patient is breathing
air while suctioned. Pre-oxygenation with 100% oxygen
abolishes these arrhythmias. Vagal stimulation,
however, can occur and may result in significant
bradycardia or even cardiac and respiratory arrest.
Cardiac arrhylhmias.
COMPLICATIONS OF
SUCTIONING ARE:
Tracheobronchial trauma
Bronchial obstruction
Hypoxia.
Cardiac arrhylhmias.
THE FOLLOWING GUIDELINES
PROMOTE A CORRECT
TECHNIQUE:
1Select flow rate to achieve required fractional inspired
oxygen (FIO2).
2Check operation of bag prior to connection to the
patient.
3Hyperventilate following connection.
4Consider bag volume, patient’s size and airway
pressure when determining volume
5Hyperventilate prior to suction and reconnection to
ventilator.
The potential complications of bagging include:
1Barotrauma due to high airway pressure.
2Hypotension and decrease in cardiac output
3Raised intracranial pressure (ICP).
4Hypoventilation due to poor technique or patient
“fighting” the bagging.
5Hyperventilation and loss of respiratory drive due to a
fast rate.
an effective, safe technique provided the
operator continually adjusts the rate, tidal volume and
pressure, in response to changes in the patient’s lung
compliance or airway resistance.
Bagging
technique using a four-to-five litre
anaesthetic bag is generally not used due to
complications of barotrauma and significant decreases
in venous return
“bag-squeezing”
can be used as an adjunct to other physiotherapy techniques to improve lung expansion.
Manual bagging
Bagging is used to:
1Hyperoxygenate pre and post suctioning.
2.Improve V/Q matching by increasing lung volumes,
CONDITIONS REQUIRING
MODIFICATION OF PERCUSSION
1Fractured ribs, vertebrae or sternum
2Acute myocardial Infarctlon and arrhythmlas
3Hemoptysis
Osteoporosis
Osteomyelltis of the rib cage
Bronchospasm
Incislons/burns/grafts
Severe surgical emphyseme
CONDITIONS REQUIRING
MODIFICATION OF PERCUSSION
1Fractured ribs, vertebrae or sternum
2Acute myocardial Infarctlon and arrhythmlas
3Hemoptysis
Osteoporosis
Osteomyelltis of the rib cage
Bronchospasm
Incislons/burns/grafts
Severe surgical emphyseme
are manual techniques that
can be used in conjunction with posturing, postural
drainage, manual bagging and controlled breathing
exercises to assist the mobilization of secretions from
peripheral to central airways,
Percussion and vibration
CONDITIONS REQUIRING
SPECIAL CONSIDERATION WHEN
POSITIONING
Sever hypertension
Asciles
Dyspnea
Abdominal distension
Pneumonectomy
6.cerebral or aortic aneurysms
THE AIM OF
PHYSIOTHERAPY ARE TO
- Improve V/Q relationships, thereby decreasing the risk
of alveolar collapse and pulmonary infection. - Maintain joint and soft tissue range.
- Encourage active movements, thereby diminishing the
risk of deep vein thrombosis, and promoting normal
musculoskeletal and neurological function. - Encourage mobilization to minimize the detrimental
effects of bed rest. - Inifiate rehabilitation programs focusing on major
problems.
Designed to
minimize the effects of any disease state and
promote normal function.
Physiotherapeutic techniques
Involved directly with the prevention of pulmonary complications
Physiotherapist
Determined by its local distensibility and airway resistance
Uneven distribution of ventilation
Ventilation is
preferentially distributed to nondependent lung
regions in the paralyzed, mechanically ventilated patient.
Ventilation-perfusion (V/Q) mismatch
FACTORS FOR CPT IN THE
ICU
1.Decreased mucocilliary clearance.
2.Colonization of the lower respiratory tract with upper
respiratory tract organisms.
The presence of an
artificial airway increases mucus production and
decreases ciliary activity. Inadequate humidification
further impairs this mechanism.
Decreased mucocilliary clearance.
Contamination of the lower respiratory tract occurs during intubation and with intermittent cuff leaks.
Colonization of the lower respiratory tract with upper
respiratory tract organisms.
COPING WITH BEING
SHORT OF BREATH
1.Find a relaxation position that is most comfortable for you. Do not worry about how fast you are breathing.
2. Breathe in through your mouth and out through your mouth.
3.Begin to lengthen the time you breathe out
4. Try to breathe in through your mouth and out through pursed lips.
5. Breathe in through your nose and out through pursed lips.
6.Start diaphragmatic breathing and continue to breathe out through pursed lips,
7. Continue until you feel more relaxed.
RELAXATION POSITIONS TO
REDUCE SHORTNESS OF BREATH
Practice
Sitting
are two other symptoms of your disease.
Cough and sputum
is important because it
helps remove sputum from your lungs.
Coughing
The diaphragm is made up of two large,
domeshapedmuscles located just below the lungs.
When they are tightened (contracted), there is more
room in the chest cavity for your lungs to expand.
DIAPHRAGMATIC
BREATHING
a technique that helps to control your breathing rate and improve your shortness of breath
Pursed lip breathing
BENEFITS OF DEEP
BREATHING
Reduction of hot flashes in menopausal women
2. Relaxation of facial muscles
3. Reduction of pain and stress signals
4.Improve effectiveness of aerobic exercises and
workouts
5. Lower blood pressure
6.Reduction of chances to have a second heart attack
In order for the deep breathing exercise to be beneficial, we must
understand the proper technique for deep breathing. We must
understand how the diaphragm works in the body and the mechanics
of deep breathing. The following link does a very good
PROPER DEEP BREATHING
BELLY BREATHING
