Transcript PULMONARY REHABILITATION

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.
2.
INADEQUATE TRANSPORT OF OXYGEN IN AND
CARBON DIOXYDE OUT OF THE LUNG
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
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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.
2.
3.
4.
5.
6.
MEDICATION (MOST OF THEM ARE DONE BY
PULMONOLOGIST)
EDUCATION
CHEST PHYSICAL THERAPY
UPPER EXTREMITY EXERCISES
RECONDITIONING
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 CONTROL BREATHLESSNESS
B. IMPROVE VENTILATORY PATTERN
C. PREVENT DYNAMIC AIRWAY
COMPRESSION
D. IMPROVE GAS EXCHANGE
The aim of Pursed-lips and Diaphragmatic
Breathing:
A.
B.
C.
D.
SLOW EXPIRATORY PHASE
MAINTAIN THE AIRWAY PRESSURE
DECREASE THE RR
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 SHOULDERGIRDLE 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.
2.
3.
4.
PATIENTS WITH DIFFICULTY IN CLEARING SECRETION
PATIENTS WITH DYSPNEA AND HYPOXIC PANNIC
PATIENT WITH PULMONARY CHRONIC DISEASE
PRE AND POST THORACIC SURGERY
DON’T PANIC :
CONTROL YOUR
BREATHING
DON’T PANIC :RELAX YOURSELF
CONTROLED BREATHING ACTIVITY
ACCESSORIES MUSCLES RELAXATION
1.
2.
3.
Neck muscles
Shoulder muscles
Chest flexibility
Abdominal Muscles Exercises
Upper Extremity Exercises
Postural Drainage