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8/10/2019 17. Chest Physical Therapy.pptx
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CHEST PHYSICAL THERAPY
Dr. MOCH. RIDWAN, Sp.KFR
DEPARTEMENT OF PHYSICAL MEDICINE AND
REHABILITATION
SCHOOL OF MEDICINE
BRAWIJAYA UNIVERSITY / Dr. SAIFUL ANWAR
GENERAL HOSPITAL
M A L A N G
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CHEST PHYSICAL THERAPY
PURSED-LIP BREATHING
DIAPHRAGMATIC BREATHING
POSTURAL TECHNIQUES
COUGH CONTROL
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RELAXATIONTECHNIQUE
Purpose:
1. To reduce tension of breathing muscle
2. To reduce anxiety.
3.
To improve sense of well being
Position:- Semifowler
- Side lying
- Manual strain on neck, shoulder and upper
extremity
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BREATHINGEXERCISE:
PURSED LIP BREATHING
DIAGPHRAGMATIC BREATHING
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THEADVANTAGESOF BREATHING
EXERCISE:
1. To put off the sticky bronchial secrete
2. To help remove of secrete
3. To help inflation of lung
4. To mobilize thoracic cage
5. To restore ventilation-perfusion relationship
6. To exercise breathing muscle
7. To help patient to overcome short of breath
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PURSED-LIP BREATHING
Patients exhale slowly for 4-6 seconds through pursed lips
held in a whistling position. This technique relieves dyspnea
by increasing expiratory airway pressure, thereby inhibiting
dynamic expiratory airway collapse.
Patients also shift their breathing pattern from a rapidrespiratory rate, which is under involuntary respiratory
center control, to a slower, more controlled pattern governed
by voluntary cortical function. The overall work of breathing
does not change and, in fact, may increase slightly.
The pursed-lip breathing shifts a major portion of
the inspiratory work of breathing from the diaphragm to the
ribcage muscles, resting the diaphragm and reducing
dyspnea.
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PURSED-LIP BREATHING
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DIAPHRAGMATIC BREATHING
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DIAPHRAGMATIC BREATHINGAdvantages:
1. To reduce work of breathing
2. To reduce short of breath
3. To restore basal ventilation
4. To help normal breathing
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POSTURALDRAINAGE
Definite position, so the gravitational effectcan help to expel secrete from lung region(according to broncial anatomy)
Contraindication:1.Hemoptoe2.Severe Hypertension3.Edema Cerebri4.Aneurism aorta and cerebral aneurismal5.Cor Aritmia6.Lung Edema7.Defect in esophagus diaphragm
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POSTURAL DRAINAGE
Posterior Apical Segments of the Right and Left Upper Lobes
Position the patient sitting and leaning forward at about a 45-degree angle
Area for percussion is just above the scapula with the fingers extending up
onto the shoulders
Anterior Apical Segments of the Right and Left Upper Lobes
Position the patient sitting and leaning back at about a 45-degree angle
Area for percussion is just below the clavicle
Anterior Segments of the Right and Left Upper Lobes
Position the patient supine with the bed flat
Area for percussion is just above the nipple
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MANUALTECHNIQUEUsed with postural drainage for mobilization of secretions
1.Percussion :
Clapping
Tapping2. Shaking : rhythmical movement down ward on chest with
gentle push
3. Vibration : Soft vibration on chest with ligth push
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COUGHCONTROL
Removal of secretions from the larger airways
Steps:(1) Inspiratory gasp;
(2) Closing of the glottis;
(3) Contraction of expiratory muscles;
(4) Opening of the glottis
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TECHNIQUE
1. Slow deep breathing with diaphragm
2. Hold for 2 seconds
3. Do coughing twice, with slightly open mouth
4. Pause
5. Inhale slowly
6. Take a breath
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The following sequence and procedures are used when
teaching an effective cough.
1. Assess the patients voluntary or reflexive cough.
2. Have the patient assume a relaxed, comfortable
position for deep breathing and coughing. Sitting orleaning forward usually is the best position for
coughing. The patients neck should be slightly
flexed to make coughing more comfortable.
3. Teach the patient controlled diaphragmatic
breathing emphasizing deep inspirations.
4. Demonstrate a sharp, deep, double cough.
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5. Demonstrate the proper muscle action of coughing
(contraction of the abdominals). Have the patient place the
hands on the abdomen and make three huf fs with expiration
to feel the contraction of the abdominals
6. Have the patient practice making a K sound to experience
tightening the vocal cords, closing the glottis, and contracting
the abdominals.
7. When the patient has put these actions together, instruct thepatient to take a deep but relaxed inspiration, followed by a
sharp double cough. The second cough during a single
expiration is usually more productive.
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EDUCATION
Patients can become more skilled at
collaborative self-management and have
improved compliance
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PSYCHOSOCIALANDBEHAVIORALINTERVENTION
Psychosocial and behavioral interventions in the
form of regular patient education sessions or
support groups focusing on specific problems are
very helpful. Instructions in progressive muscle
relaxation, stress reduction, and panic control may
help to reduce dyspnea and anxiety
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OUTCOMEASSESSMENT
The assessment of the following measures of the
patient's recovery before and after rehabilitation:
DyspneaExercise ability
Health status
Activity levels
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SUMMARY
Pulmonary Rehabilitation programs usually
consistof exercise training, education, and
psychosocial/behavioralcomponents. Chest
physical therapy such as : pursed-lipsbreathing, diaphragmatic breathing, postural
drainage and cough control are included in
most rehabilitation programs,.
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THANK YOU