PULMONARY REHABILITATION TRI DAMIATI.P, Dr.Sp RM PHYSICAL MEDICINE AND REHABILITATION FKUP/RSHS 2011

DEFINITION COMPREHENSIVE TEAM APPROACH THAT PROVIDE PATIENTS WITH THE ABILITY TO ADOPT TO THEIR CHRONIC LUNG DISEASE, IT INCLUDES MEDICAL MANAGEMENT, TRAINING AND COPING SKILLS AND EXERCISE RECONDITIONING AGUSTA ALBA ;CONCEPT IN PULMONARY REHABILITATION, BRADDOM

DEFINITION OF RESPIRATION 1.PROCESS OF MOVING OXYGEN FROM THE AIR TO ALVEOLI OF THE LUNGS BY A MASS MOVEMENT OF AIR AND REMOVING CARBON DIOXYDE FROM ALVEOLI BY THE SAME MOVEMENT 2.THE CIRCULATORY SYSTEM PROVIDE THE TRANSPORT OF OXYGEN BETWEEN LUNG AND THE TISSUE H.FREDERIC HELMHOZ,JR, HENRY H.STONNINGTON PULMONARY REHABILITATION, KRUSEN

PHYSIOLOGICAL BASIC OF DISORDERS OF RESPIRATION 1.INADEQUATE TRANSPORT OF OXYGEN IN AND CARBON DIOXYDE OUT OF THE LUNG 2.RETENTION OF CARBON DIOXYDE 3.LACK OF OXYGEN

THE CAUSE OF THE RESPIRATORY DISORDERS 1.MUSCLE WEAKNESS OR INEFFICIENCY OR INCREASING OF ELASTIC COMPONEN 2.INCREASE RESISTANCE TO AIRFLOW THROUGH THE TRACHEOBRONCHIAL TREE

ELASTIC COMPONENTS ARE LUNGS THORACIC CAGE DIAPHRAGM ABDOMINAL COMPLEX ACCESSORY MUSCLES

THE RESPIRATORY DISORDERS ARE CLASSIFIED AS 1.RESTRICTIVE DISORDER 2.OBSTRUCTIVE DISORDER

RESTRICTIVE DISORDERS ARE CHARACTERIZED BY 1.AN INCREASE IN ENERGY REQUIREMENT TO OVERCOME ELASTIC RECOIL OF LUNG OR CHEST STRUCTURES AT ANY GIVEN VENTILATION 2.REDUCED VITAL CAPACITY

OBSTRUCTIVE DISORDER CHARACTERIZED BY 1.RESISTANCE TO AIRFLOW ---  AIRFLOW STOP BEFORE EMPTYING IS COMPLETE ---  AIR TRAPPING 2.FIXATION THE CHEST IN A POSITION LARGER THAN THE NORMAL END-EXPIRATION LEVEL 3.INCREASE IN THE FUNCTIONAL RESIDUAL CAPACITY AND RESIDUAL VOLUME

OBSTRUCTIVE DISORDER CHARACTERIZED BY 4. FLATTENING OF THE DIAPHRAGM 5. LESSEN THE USE FULLNESS OF THIS MUSCLE IN INSPIRATION

PULMONARY REHABILITATION GOALS 1. IMPROVEMENT IN CARDIOPULMONARY FUNCTION 2. PREVENTION AND TREATMENT OF COMPLICATION 3. RECOGNITION AND TREATMENT OF STRESS AND DEPRESSION, WHICH CAN INTERFERE WITH COPING MECHANISM AND INDEPENDANCE

PULMONARY REHABILITATION GOALS 4. FACILITATION OF COPING MECHANISM TO OVERCOME ANY SENSE OF LOSS, LOSS OF CONTROL OF PERSONAL AND SOCIAL RELATIONSHIP, SELF ESTEEM, OR SENSE OF SELF WORTH 5. PROMOTION OF INCREASING PATIENT RESPONSIBILITY FOR HIS OR HER OWN CARE AND WELL-BEING

6.DECREASE NUMBER OF EXACERBATION, EMERGENCY ROOM VISIT AND HOSPITALIZATION 7.TO UNDERSTANDING THE DISEASE SO THAT PATIENTS AND FAMILLY CAN CONFRONT IT REALISTICALLY

PULMONARY REHABILITATION GOALS 8. RETURN TO WORK AND/OR A MORE ACTIVE, PRODUCTIVE, AND EMOTIONALLY SATISFYING LIFE FOR THE PATIENT AND HIS FAMILY

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 1.MEDICATION (MOST OF THEM ARE DONE BY PULMONOLOGIST) 2.EDUCATION 3.CHEST PHYSICAL THERAPY 4.UPPER EXTREMITY EXERCISES 5.RECONDITIONING 6.PSYCHOSOCIAL SUPPORT

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 2. EDUCATION - THE MOST IMPORTANT IS SMOKING CESSATION - CHANGING IN LIFESTYLE TO ADAPT THE DISEASE - UNDERSTAND THE DISEASE - UNDERSTAND THE GOALS AND THE BENEFIT OF THE REHABILITATION PROGRAM

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 3. CHEST PHYSICAL THERAPY A. APPLICATION OF PHYSICAL METHOD TO THE RESPIRATORY CARE OF PATIENS WITH PULMONARY DISEASE B. THE COMPONENTS ARE 1. CONTROL BREATHING - RELAX POSITION - BREATHING EXERCISE PURSEDLIPS BREATHING SLOW DEEP BREATHING DIAPHRAGMATIC BREATHING SEGMENTAL BREATHING

The Aim of Control Breathing: A. HELP THE PATIENTS RELIEVE AND CON- TROL BREATHLESSNESS B. IMPROVE VENTILATORY PATTERN C. PREVENT DYNAMIC AIRWAY COMPRESSION D. IMPROVE GAS EXCHANGE

The aim of Pursed-lips and Diaphragmatic Breathing: A. SLOW EXPIRATORY PHASE B. MAINTAIN THE AIRWAY PRESSURE C. DECREASE THE RR D. INCREASE TIDAL VOL

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 2. CLEARENCE OF SECRETION - POSTURAL DRAINAGE - CHEST PERCUSION AND VIBRATION - CONTROL COUGHING 3. TRUNK FLEXIBILITY - NECK - COMPONENT SHOULDER GIRDLE - TRUNK

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 4. UPPER EXTRIMITY EXERCISES A. STRENGTHENING OF THE UPPER BACK MUSCLES B. STRENGTHENING OF THE UPPER EXTRIMITY MUSCLES C. RANGE OF MOTION EXERCISE OF THE SHOULDER- GIRDLE COMPLEX

COMPONENT OF PULMONARY REHABILITATION FOR OBSTRUCTIVE DISORDERS 5. RECONDITIONING AEROBIC EXERCISES 1.INTENSITY DEPENDS ON THE EXERCISE TESTING 2.DURATION 20 – 30 MINUTES 3.FREQUENCY 3 – 4 TIMES AWEEK WALKING, JOGGING, CYCLING, ERGOCYCLE,TREADMEAL,SWIMMING, ETC

6.PSYCHOSOCIAL SUPPORT 1.IS PROVIDED BY WARM AND ENTHUSIASTIC STAFF WHO CAN COMMUNICATE EFFECTIVELY WITH PATIENTS AND DEVOTE THE TIME AND EFFORT NECESSARY TO UNDERSTAND AND MOTIVATED THEM

FAMILY MEMBER SHOULD ALSO BE INCLUDE SO THAT THEY CAN UNDERSTAND THE DISEASE AND HELP THE PATIENT TO COPE

PATIENT SELECTION 1.SYMPTOMATIC LUNG DISEASE 2.STABLE ON STANDARD THERAPY 3.FUNCTION LIMITATION BECAUSE OF DISEASE 4.MOTIVATED TO BE ACTIVELY INVOLVED IN AND TAKE RESPONSIBILITY FOR OWN HEALTH CARE

1.NO OTHER INTERFERING ON UNSTABLE MEDICAL CONDITION 2.NO ARBITRARY LUNG FUNCTION OR AGE CRITERIA

WHEN ARE THE PATIENTS REFERED TO THE PULMONARY REHABILITATION? MOSTLY: 1.PATIENTS WITH DIFFICULTY IN CLEARING SECRETION 2.PATIENTS WITH DYSPNEA AND HYPOXIC PANNIC 3.PATIENT WITH PULMONARY CHRONIC DISEASE 4.PRE AND POST THORACIC SURGERY

DON’T PANIC : CONTROL YOUR BREATHING

DON’T PANIC : RELAX YOURSELF

CONTROLED BREATHING ACTIVITY

ACCESSORIES MUSCLES RELAXATION 1.Neck muscles 2.Shoulder muscles 3.Chest flexibility

Abdominal Muscles Exercises

Upper Extremity Exercises

Postural Drainage