Pulmonary Rehab Management PT 2: Breathing Exercises & Pathology-Based Rehab Management

Question 1

pursed lip breathing:
– ______ symptoms of dyspnea
– _____ RR and ____ wheezing
– prevents:

Answer 1

– decreases
– slows ; reduces
– alveolar collapse at end exhalation

Question 2

when is paced breathing indicated?

Answer 2

for patients with very low endurance, anxiety, dyspnea on exertion

Question 3

when does inhalation and exhalation take place during paced breathing?

Answer 3

inhalation = beginning of activity
exhalation = during activity

Question 4

when is inspiratory hold technique indicated?

Answer 4

for hypoventilation, atelectasis, and poor V/Q matching

Question 5

what does inspiratory hold technique improve?

Answer 5

air flow into poor ventilated lung regions

Question 6

inspiratory hold technique:
– what is it?
– can be used in conjunction with:

Answer 6

– prolonged breath holding for 2-3 seconds at max inspiration
– vibration techniques to aid in secretion clearance

Question 7

when is stacked breathing indicated for?

Answer 7

hypoventilation
atelectasis
poor V/Q matching
uncoordinated breathing

Question 8

what is stacked breathing?

Answer 8

series of deep breaths that build on top of the previous breath without exhalation until max volume tolerated is reached
- inspiratory hold in between each inhalation

Question 9

what does thoracic mobilization techniques improve?

Answer 9

ability of the thorax to expand via optimized biomechanics

Question 10

what are some ways you can accomplish thoracic mobilization techniques?

Answer 10

– towel roll or bolster along thoracic spine in supine to improve anterior chest wall mobility
– sidelying over towel roll or bolster will increase lateral chest wall mobility

Question 11

who is counter rotation effective in?

Answer 11

patients with high neuromuscular tone that affects normal chest wall mechanics

Question 12

what is the position of the body in counter rotation?

Answer 12

sidelying with knees bent and arms in front
upper trunk rotates outward with inhalation, inward with exhalation
pelvis and lower trunk can stay still or rotated opposite of trunk

Question 13

what is the butterfly rotation technique?

Answer 13

upright version of counter rotation

Question 14

what is inspiratory muscle training?

Answer 14

strength training for the diaphragm in patients with decreased strength and endurance of inspiratory muscles

Question 15

what does increased ventilatory capacity improve from inspiratory muscle training?

Answer 15

improved lung volumes
better V/Q matching
improved SpO2 and PaO2

Question 16

what does decreased dyspnea improve from inspiratory muscle training?

Answer 16

improved functional activity tolerance
higher QOL

Question 17

what are the two characteristics of inspiratory muscle training?

Answer 17

1. overload – low load applied over a long time
2. specificity – resistance needs to be applied to inspiratory muscles, rather than expiratory

Question 18

diaphragm muscle types:
slow twitch oxidative:
– _____ contraction
– uses ____ metabolism
– _____ resistant

Answer 18

– slow
– aerobic
– fatigue

Question 19

diaphragm muscle types:
fast twitch oxidative-glycolytic:
– _____ contraction
– uses ____ metabolism initially
– can switch to ____ metabolism, then fatigues faster

Answer 19

– fast
– aerobic
– anaerobic

Question 20

diaphragm muscle types:
fast twitch glycolytic:
– _____ contraction
– uses ____ metabolism
– fatigues ____

Answer 20

– fast
– anaerobic
– quickly

Question 21

what percentage of adult diaphragm is slow twitch muscle fibers?

Answer 21

55%

Question 22

fatigue is correlated to:
a. slow twitch fibers
b. fast twitch oxidative glycolytic
c. fast twitch glycolytic
d. b and c

Answer 22

a.

Question 23

weakness of diaphragm is correlated to:
a. slow twitch fibers
b. fast twitch oxidative glycolytic
c. fast twitch glycolytic
d. b and c

Answer 23

d - fast twitch fibers

Question 24

endurance training of the diaphragm increases:

Answer 24

capillary density
myoglobin
glycogen concentration

Question 25

what improves with endurance training of the diaphragm?

Answer 25

proportion of fatigue-resistant slow twitch muscle fibers

Question 26

what is the exercise recommendation for inspiratory muscle training targeting endurance training?

Answer 26

30-60 minutes continuous deep diaphragmatic breathing 2-3x/day

Question 27

strength training with inspiratory muscle training:
– involves :
– if tidal volume is far below 500 mL, start with:

Answer 27

– resisted inhalation
– active breathing exercises before adding any resistance or weight

Question 28

what is the early IMT technique to engage focused diaphragm use?
– technique for this?

Answer 28

sniffing
– quickly 3x with slow exhalation helps increase awareness of correct diaphragmatic engagement

Question 29

what is a way to accomplish strength training with IMT?
– dosage?

Answer 29

place weights on lower chest
– 2-3 sets of 10 reps, 1-2x/day
no recommendations on starting weight

Question 30

what do IMT devices provide resistance against?

Answer 30

inhalation

Question 31

what is maximal inspiratory pressure (MIP)?

Answer 31

measurement of the max force inspiratory muscles can generate against resistance

Question 32

how long should you use a IMT device?

Answer 32

15-30 minutes 2x/day
start with level of resistance that is comfortable to perform the frequency

Question 33

what is the IMT recommendations using MIP percentages for heart failure population?

Answer 33

</= 30 minutes/day if using higher training intensity of > 60% MIP

> 30% MIP sets or intervals performed to fatigue
5-7 days/week for 8-12 weeks

Question 34

thoracotomy post-op precautions:
– in place for ____ weeks
– no: (3)
– ROM:

Answer 34

– 6-8 weeks
– no lifting > 5 lbs, no twisting or rotational activities, no strenuous activity with surgical side
– encouraged as tolerated below 90-90

Question 35

what is the primary thing we are intervening on in cystic fibrosis?

Answer 35

secretion clearance techniques
– postural drainage with manual airway clearance techniques, oscillation vest, acapella, flutter valve devices, active cycle of breathing, forced expiratory technique

Question 36

during periods of SOB with cystic fibrosis, what techniques can be used?

Answer 36

controlled breathing techniques

Question 37

in order to avoid worsening posture in those with cystic fibrosis, what should we do?

Answer 37

thoracic stretching
postural re-education to avoid kyphotic posture

Question 38

your patient has asthma and has just showed up to the clinic with uncontrolled asthma. should you work with them today?

Answer 38

no - activity shouldnt begin unless appropriate medications initiated to reduce bronchospasm and inflammation

Question 39

what secretion clearance technqiues would be good for pts with asthma?

Answer 39

active cycle of breathing
vibration techniques

Question 40

in patients with asthma, what should you avoid when exercising?

Answer 40

any situation that may trigger bronchoconstriction (temperature, environmental, smells, etc)

Question 41

transplanted lungs lose their ______
what does it result in?

Answer 41

autonomic innervation
results in decreased mucociliary clearance, V/Q imbalance, ineffective cough, slowed receptor responses

Question 42

what two important structures are NOT cut during lung transplant surgery?

Answer 42

phrenic nerve
diaphragm

Question 43

your patient just had a lung transplant. what should you focus your initial interventions on?

Answer 43

pulmonary toilet
mobilization
positioning for optimal breathing/coughing
postural drainage
airway clearance techniques
decreased accessory breathing

Question 44

what two interventions are very effective in early stages post-lung transplant?

Answer 44

active cycle of breathing
vibration –> percussions will be too harsh

Question 45

what medications should be used post-lung transplant for immunosuppression?

Answer 45

oral and inhaled steroids
60-90% require HTN medications

Question 46

what pathologies are very common after a lung transplant?

Answer 46

steroid myopathy in proximal muscles and osteoporosis

Question 47

when should resistance exercise be performed in a patient with a lung transplant?

Answer 47

prior to transplant
continued at the highest level that is safe following transplant

Question 48

what is required if you perform aerobic exercise in lung transplant patients?

Answer 48

adequate warm up and cool down - to compensate for the lack of autonomic innervation

Question 49

true or false. you never treat HF along with pulmonary dysfunction

Answer 49

false. very challenging to fully separate HF from pulmonary dysfunction because of overlap of symptoms

Question 50

in general, when treating patients with pulmonary dysfunction, always start with _______ intensity (___/10)

Answer 50

low intensity (3-4/10)

Question 51

when performing endurance training with a pulmonary patient, you feel they can be challenged more. you should first increase ______ before increasing _______

Answer 51

duration
intensity

Question 52

what’s the duration of endurance training for a pulmonary patient?

Answer 52

start with the length of time a patient can exercise until fatigued
– increase by 1-2 minutes/day

Question 53

true or false. interval training is very effective in initial phases of treatment for pulmonary dysfunction

Answer 53

true