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