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rehabilitative medicine
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Rehabilitation of Pulmonary Diseases Dept. Physical Medicine and Rehabilitation Dr. Saiful Anwar Hospital/ FK UB Malang
Medical Rehabilitation of Pulmonary DiseasesTo restore or prevent the remain of disabled lung function due to obstructive or restrictive disorder
EtiologyRestrictive pulmonary disorder, especially due to thorax cage abnormality.
Obstructive pulmonary disorder,such as chronic obstructive lung disease and asthma
Type of Lung DisorderRestrictive Pulmonary DisorderPulmonary disorder with defect of function because the lung does not inflate so there is derangement of tidal volume, vital capacity, tachypneu, difficullity in deep breathing
Obstructive Pulmonary Disorder
Restrictive Pulmonary DisorderExtrapulmonal Type:Pleural EffusionInflexible thoracic cage: pain in thoracic cage, scoliosis, weakness of muscle breathing, decreasing of diaphragm movement
Pulmonal TypeLung tumor, Atelektase, Pneumonia, Heart disease.
Atelectasis
Chronic Obstructive Lung DiseaseChronic Lung Disease that cause narrowing of airways, alter the structure of alveoli and accumulation of secret.
Type : Chronic Bronchitis; Empysema Pulmonum; Bronchiectasis.
Medical ProblemDue to obstructive lung disease: Decrease FEV1 Short of breath/dyspneu Chronic accumulation of secreta Prolonged expiration Posture deformity Decrease of endurance Triad symptoms: short of breath, cough, easy weak
Medical Problem2. Due to Restrictive Lung Disorder : Decreasing of vital capacity Difficulty in deep breathingDecreasing of thoracic cage mobility Deviation of posture and shoulderDecreasing of Endurance Deconditioning Syndrome : decreasing of fitness, cardiopulmonal and working capacity
Medical ProblemsSitting mobilization, walking and standing are affected.Problem in communication due to cough and short of breathProblem in ADL due to short of breath and weaknessProblem in Vocational Problem in Psychosocial
Protocol Team Work Chest Physical Therapy : 1. Relaxation Technique2. Breathing Control 3. Breathing Exercise 4. Postural Drainage 5. Manual Technique6. Cough Control
Patients with advanced COPD can develop an increased anteroposteriorchest diametera barrel shaped chest
Indication for Chest Physical Therapy:COPD2. Post Op. Thorax, Cardiovascular system3. Long standing lying down 4. Neuromuscular disease with decrease of cough5. Depend on ventilator machine
Relaxation TechniquePurpose: To reduce tension of breathing muscle To reduce anxiety. To improve sense of well being
Position: - Semifowler- Side lying- Manual strain on neck, shoulder and upper extremity
Breathing ControlBreating Lower part of the chest- Lower power - Decrease short of breath
Advantages: To reduce work of breathing To reduce short of breathTo restore basal ventilation To help normal breathing
Breathing ExercisePatient is active during inspiration and expiration asPurpose : To achieve normal lung function
The advantages of Breathing Exercise:1. To put off the sticky bronchial secrete2. To help remove of secrete 3. To help inflation of lung 4. To mobilize thoracic cage 5. To restore ventilation-perfusion relationship6. To exercise breathing muscle 7. To help patient to overcome short of breath
Postural DrainageDefinite position, so the gravitational effect can help to expel secrete from lung region (according to broncial anatomy)
Contraindication:Hemoptoe Severe Hypertension Edema CerebriAneurism aorta and cerebral aneurismalCor Aritmia Lung EdemaDefect in esophagus diaphragm
Time and How Long?In the excessive sputum condition , do four times a day Usually do twice a day, when wake up in the morning, or before taking a bed Do before eatingNebulizer can be given before the treatment is done Do for 1 hour
Manual Technique1.Percussion :ClappingTapping2. Shaking : rhythmical movement down ward on chest with gentle push3. Vibration : Soft vibration on chest with ligth push
CONTRAINDICATION OF CLAPPINGTuberculosisLung AbscessBroncogenic CarcinomaBronchiectasis with new bleeding Newly post operation Acute lung inflammation
Cough Control TechiniqueSlow deep breathing with diaphragm Hold for 2 secondsDo coughing twice, with slightly open mouth PauseInhale slowlyTake a breath
Endurance