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8/10/2019 Pulmonary Rehabilitation PP
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Pulmonary Rehabilitation
dr. Aminuddin , SpRM
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Definition of pulmonary
rehabilitation
Pulmonary rehabilitation is a
program to people with chronic
lung diseases like COPD,emphysema, and chronic
bronchitis lead full, satisfyinglives and restore them to their
highest functional capacity.
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Pulmonary rehab is aimed to improve
quality of life by:
Decreasing respiratory symptoms and
complications
Encouraging self-management and control
over daily functioning
Improving physical conditioning and exercise
performance
Improving emotional well-being
Reducing hospitalizations
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Components of Pulmonary
Rehab ProgramsMost pulmonary rehab programs include: Medical management
Exercise Breathing retraining
Education
Emotional support
Nutrition counseling
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Team Approach to Pulmonary Rehab
Most formal pulmonary rehab programs include
a team of healthcare providers working
together, like doctors, nurses, rehabilitation
therapists, psychosocial staff and dietitians. The
team evaluates each person's overall physicaland emotional status, and then develops an
individual program for him or her. The doctor, a
specially trained registered nurse, arehabilitation specialist or a respiratory care
practitioner coordinate the program.
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Exercise
Exercise is a key part of a pulmonary
rehab program. Exercise can improve the functionof your heart and lungs.
Exercise can also strengthen the muscles used forbreathing to decrease your shortness of breath. It
is common for people with lung disease to limit
physical activities because they are fearful ofbecoming short of breath - but when you are
inactive, the strength of your muscles and heart
decline.
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Exercise training can take place one to one or
in a group setting. It may include walking,
stationary bicycling, water exercise, or simple
aerobics. Breathing training, relaxation
techniques, and energy conservation for many
daily activities are also addressed.
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Education
Education is an important part of a pulmonaryrehab program for both the person and family.
Education may include one-to-one teaching,
written materials and group classes. Videos
and other visual aides may also be used.
Teaching sessions with a healthcare provider
are very important. The sessions will help
provide you with information about yourspecific medications, treatments and self-
management at home.
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Emotion Management
A number of emotions can interfere with dailyliving. These include anxiety and depression.They can also increase shortness of breath.
Studies show that depression is commonbecause of the limitations caused by the chroniclung disease. Counseling can help you and yourfamily cope with the chronic disease. Classes on
managing stress, relaxation and coping withchronic illness may be offered. Some pulmonaryrehab programs may also have a support group
for you and your family.
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Nutrition
Weight management and nutrition are importantissues for people with chronic lung disease.
Shortness of breath and fatigue can interfere with
your ability to eat a balanced diet. The amount andtype of food, as well as the timing of meals can cause
increased shortness of breath. A dietitian can offer
practical suggestions for healthy nutrition, food
selection and preparation. Individualized diet plansmay be developed when problems such as fatigue,
shortness of breath, swallowing, or poor appetite
interfere with good nutrition.
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Consequences of respiratory disease
Peripheral muscle dysfunction
Respiratory muscle dysfunction
Nutritional abnormalities Cardiac impairment
Skeletal disease
Sensory deficits Psychosocial dysfunction
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Mechanisms for these morbidities
Deconditioning
Malnutrition Effects of hypoxemia
Steroid myopathy or intensive care unit (ICU)neuropathy
Hyperinflation
Diaphragmatic fatigue
Frequent hospitalizations
Effects of various medications Psychosocial dysfunction resulting from anxiety,
depression, guilt, dependency, and sleepdisturbance
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Principal goals of pulmonary
rehabilitation Pulmonary rehabilitation aims to reduce
symptoms, decrease disability, increaseparticipation in physical and social activities, andimprove the overall quality of life (QOL) for
patients with chronic respiratory disease.1
These goals are achieved through patient and
family education, exercise training, psychosocialand behavioral intervention, and outcome
assessment. The rehabilitation intervention is geared toward
the unique problems and needs of each patientand is implemented by a multidisciplinary teamof health care professionals.
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Disease, impairment, disability, and
handicap Disease is a pathologic condition of the body with a unique set
of symptoms and signs, often resulting in impairment. Theimpairment may lead to functional deficit.
Impairment is any loss or abnormality of psychological, physical,or anatomic structure or function.
Disability is any restriction or lack of ability (as a result of animpairment) with regard to the performance of an activity in themanner or within the range that is considered normal for ahuman being. Impairment of activities of daily living (ADL) hasan impact on the capacity of the individual to liveindependently.
A handicap is a disadvantage for a given individual, resultingfrom an impairment or a disability that limits or prevents thefulfillment of a role that is normal for that individual.
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For patients with pulmonary impairment,
disability can be due to muscle dysfunction,
primary skeletal or cardiopulmonary
pathology, poor endurance, or somecombination of impairments. The patient can
be handicapped further by inadequate
finances, inadequate family support oreducation, and various public policies.
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Components of Comprehensive
Pulmonary Rehabilitation
Comprehensive pulmonary rehabilitation
programs generally have the following 4 major
components:
Exercise training
Education
Psychosocial/behavioral intervention
Outcome assessment.
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Education
1. Energy conservation and work simplification.
2. Medications and other therapies.3. End-of-life education.
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Chest physical therapy and breathing
techniques
Pursed-lip breathing
Posture techniques
Diaphragmatic breathing
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Measures of disability
Exercise testing
Walking tests
Exertion and overall dyspnea Respiratory specific functional status