Role of Physiotherapy in Pulmonary Rehabilitation

Pulmonary Rehabilitation 

Definition: - Pulmonary Rehabilitation may be defined as an art of medical practice where in an individually tailored multidisciplinary program is formulated though which accurate diagnosis, therapy, emotional support & education, stabilizes or reverses both the physiology, psychology and pathology of pulmonary handicap and overall life situation.

Goals and objectives

1. General

·        Control of respiratory infections.

·        Basic airway management.

·        Improvement in ventilation.

·        Improvement in ambulation and other type of physical activity.

·        Reduction in general overall medical cost.

·        Reduction in hospitalization.

·        Psychological support.

·        Occupation retraining and placement.

·        Family education, counseling and support.

2. Specific

·        Development of diaphragmatic breathing skills.

·        Development of stress management and relaxation techniques.

·        Involvement in daily physical exercises regimen to condition skeletal and respiratory muscles.

·        Adherence to properly hygiene and nutrition.

·        Proper use of medication and O2 breathing equipment.

·        Application of postural drainage, chest percussion and vibration when indicated.

Indications

1. COPD: - Asthma, Bronchitis, Emphysema, Bronchiectasis, Cystic fibrosis.

2. RPD: - Interstitial Fibrosis, Collagen vascular disorder, Pneumoconioses, Sarcoidosis, Pneumothorax, pleural effusion, Atelectasis, Hydro/Pyo Pneumothorax.

3. Other: - Kyphoscoliosis, Obesity, Polio.

  

Contraindications

·        CHF

·        IHD

·        Acute cor pulmonale

·        Disabling Stroke

·        Metastatic Ca

·        Liver dysfunction

·        Dementia

·        Severe pulmonary hypertension

Patient training

·        Instruction & Participation in correct Inhaler technique.

·        Respiratory muscle training

·        Bronchial Hygiene

·        Nutrition

·        Medications.

·        Psychosocial Interaction

·        Exercise principles

·        Cessation of smoking

·        ADL

·        Self Assessment & treatment

Role of physiotherapy in pulmonary rehabilitation

1. Relaxation tech & postures

·        Reduces the work of breathing

·        Optimizes the action of accessory muscles

·        Gain normal breathing control

2. Breathing control and breathing exercises

·        Diaphragmatic breathing exercises

·        Pursed lip breathing

·        Active cycle of breathing technique 

·        Localized chest expansion

3. Bronchial hygiene 

·        Postural drainage

·        Percussion

·        Vibration

·        Shaking

·        FET

·        Coughing

·        Huffing

·        Suctioning

·        Autogenic drainage

4. Physical reconditioning

    Improving the strength & endurance of respiratory muscles .

Devices used are :-

o   Manual resistance-towel,elasticbands

o   Flutter

o   Respiratory exerciser

o   Incentive spirometer

o   Weights

5. Exercise prescription

6. Home program and advice