Pulmonary Rehabilitation

• Pulmonary Rehabilitation


  Multidisciplinary program that provides persons with the ability to adapt to their chronic lung disease
• Pulmonary Rehabilitation


  1. Physical conditioning

  2. Ongoing medical management

  3. Training in coping skills

  4. Psychosocial support
• Goal of Pulmonary Rehabilitation


  Stabilize or reverse the disease process and return the patient's function and participation in activity/occupation to the highest capacity

  
• Modalities of Pulmonary Rehabilitation

  • General medical management
  • Oxygen therapy
  • Chest physical therapy
  • Occupational therapy
  • Respiratory therapy
  • Exercise training
  • Nutritional and psychosocial support
• Long-term oxygen therapy (LTOT)


  Provided more than 15 h per day, improves survival and quality of life in COPD if hypoxemia is present with arterial oxygen saturation of 88%, also needed if patient has evidence of pulmonary HTN, peripheral edema suggesting congestive heart failure
• Chest Physical Therapy


  1. Breathing exercises begin with relaxation techniques, which then become the foundation for breathing retraining

  2. Retraining techniques for persons with COPD include: pursed lips breathing, head down and bending forward postures, slow deep breathing, localized expansion exercises, respiratory muscle endurance training

  3. Techniques for clearing secretions (e.g. postural drainage)

  
• Exercise conditioning


  Aerobic exercise is the cornerstone of any pulmonary rehabilitation program, cardiopulmonary exercise testing is necessary for the selection and evaluation of individuals in several circumstances prior to exercise conditioning, includes lower limb training on a treadmill, bicycle ergometer, unsupported or supported arm exercise (arm ergometer)
• Signs and Symptoms of Respiratory Distress

  • Dyspnea
  • Extreme fatigue
  • Confusion
  • Impaired judgment
  • Cyanosis – bluish skin color caused by insufficient oxygen in the blood
• Psychosocial Considerations - Barriers preventing engagement in occupation for people with COPD


  • Uncertainty about progression of the disease
  • Attributing the cause of the disease to external factors
  • Progressing restriction in activity and isolation
  • Anxiety and depression
  • Passive acceptance
• Progressive muscle relaxation


  Can be a successful tool for controlling the dyspnea and anxiety for lowering BP

  
• Dyspnea Control Postures


  1. In a seated position - patient bends forward slightly at the waist while supporting the upper part of the body by leaning the FA on a table or the thighs (Forward-leaning position)

  2. In a standing position - Relief may be obtained by leaning forward and propping oneself on a counter or shopping cart
• Pursed-Lip Breathing (PLB)


  1. Breathing technique designed to make your breaths more effective by making them slower and more intentional, increase use of the diaphragm and decrease accessory muscle recruitment

  2. Technique: 1. Purse the lips as if to whistle, 2. Slowly exhales through purse lips. Some resistance should be felt, 3. Inhale deeply through the nose, 4. It should take twice as long to exhale as it does to inhale
• Diaphragmatic Breathing


  1. Increased use of the diaphragm to improve chest volume

  2. Technique: 1. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed, 2. Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible, 3. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe, 4. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible

  
• Progressive Muscular Relaxation


  1. Involves tensing and releasing of muscle groups at a time from top to bottom or vice versa; may also begin in the most tense area, Teaches the difference between muscle tension and relaxation by exaggerating the sensation between the two tone states, Requires mental discipline and practice, Takes months to learn completely

  2. Jacobson's PMR (Original steps): 1. The progression of muscle groups should start with LE and move up to the head, 2. Muscle groups should be isolated during the contraction phase, leaving all remaining muscles relaxed, 3. The same muscle groups on both sides of the body should be contracted simultaneously, 4. The contraction should be held for 5 to 10 seconds, with a corresponding relaxation phase of about 45 seconds, 5. The individual should focus attention on the intensity of contraction, sensing the tension level produced

  
• Other intervention strategies


  • Progression and Energy Costs/ Energy Conservation Techniques
  • Lifestyle Modification
  • Patient and Family Education
• Occupational Therapy(SAMPLE FOR COPD)


  1. Assess UE mobility, strength, and endurance

  2. Evaluate basic and advanced self-care activities, and provide adaptive aids to improve independence with dressing, hygiene, bathing, cooking

  3. Train the patient in energy conservation and work simplification techniques

  4. Evaluate home environment and make recommendations for workspace modifications to improve safety, efficiency, and independence

  5. Provide relaxation exercise training with visual imagery techniques