17. Chest Physical Therapy.pptx

8/10/2019 17. Chest Physical Therapy.pptx

1/25

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


2/25

CHEST PHYSICAL THERAPY

PURSED-LIP BREATHING

DIAPHRAGMATIC BREATHING

POSTURAL TECHNIQUES

COUGH CONTROL


3/25

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


4/25

BREATHINGEXERCISE:

PURSED LIP BREATHING

DIAGPHRAGMATIC BREATHING


5/25

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


6/25


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.


7/25



8/25


9/25

DIAPHRAGMATIC BREATHING


10/25

DIAPHRAGMATIC BREATHINGAdvantages:

1. To reduce work of breathing

2. To reduce short of breath

3. To restore basal ventilation

4. To help normal breathing


11/25

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


12/25

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


13/25


14/25

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


15/25

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


16/25

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


17/25

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.


18/25

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.


19/25

EDUCATION

Patients can become more skilled at

collaborative self-management and have

improved compliance


20/25

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


21/25

OUTCOMEASSESSMENT

The assessment of the following measures of the

patient's recovery before and after rehabilitation:

DyspneaExercise ability

Health status

Activity levels


22/25


23/25

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,.


24/25


25/25

THANK YOU

17. Chest Physical Therapy.pptx

Documents

Transcript of 17. Chest Physical Therapy.pptx