CHEST PHYSIOTHERAPY Pulmonary Rehabilitation Pulmonary rehabilitation is a holistic therapy provided to patients with respiratory disease which aims

to address both the physical and psychological problems associated with chronic respiratory disease. The Role of the Physiotherapist in Pulmonary Rehabilitation Physiotherapists are involved in all processes of the rehabilitation programmed from recruitment of patients, assessment and identification of problems, delivery of the rehabilitation and liaison with community services to enhance life long behavioral change. The role of physiotherapy in rehabilitation will be different depending upon the programmed delivery, the patients and other personnel involved. GOALS OF CHEST PHYSIOTHERAPY

Reduse airway obstruction Prevent the accumulation of secretions Improve the mobilization of secretions Improve the distribution of ventilation Enhance gas exchange Promote more efficient breathing patterns Reduce the work of breathing Improve cardiopulmonary exercise tolerance

TREATMENT TECHNIQUES Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, breathing exercises, coughing, and incentive spirometry etc.CPT is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs. 1) 2) 3) 4) Relaxation Positions Normal pattren of breathing Breathing control Breathing exercise (a) Incentive spirometry (b) Diaphragmatic (c) Pursed-Lip Breathing 5) Coughing & huffing 6) Manual techniques (a) Chest percussion (b) Chest vibration
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7) Forced Expiration Technique ( FET )

8) Active Cycle of Breathing Technique (ACBT) 9) Postural drainage 10) Suctioning CHEST PHYSIOTHERAPY (BREATHING EXERCISE) Breathing Exercises: Breathing exercises may help strengthen the muscles that inflate and deflate the lungs, but they do not directly improve lung function. Still, breathing exercises decrease the likelihood of lung complications after surgery in heavy smokers and others with lung disease. Such exercises are particularly helpful for sedentary people who have chronic obstructive pulmonary disease or those who have just been taken off of a ventilator. BREATHING EXERCISE Exhale deeply, contracting the belly. Continue inhaling as you expand the chest. Continue inhaling as you raise the shoulders up towards your ears. Hold for a few comfortable seconds Exhale in reverse pattern, slowly. Release shoulders, relax chest, contract the belly. Repeat. Inhale slowly as you expand the abdomen. DEEP BREATHING EXERCISES There are two types of deep breathing exercises. 1. Diaphragmatic Breathing Exercise 2. Pursed-lip breathing 3. Segmental breathing exercise 4. Incentive spirometry 5. Breathing exercise with movement DIAPHRAGMATIC Diaphragmatic breathing can relax muscles, improve oxygen levels and provide a feeling of release from tension. Place one hand on the abdomen, the other on the chest; Inhale concentrating on pushing the abdominal hand outward while the chest hand remains still; Hold air in your lungs for five counts; Exhale slowly, while the abdomen hand moves inward and the chest hand remains still. Let all the air out slowly through your mouth; PURSED-LIP BREATHING Help maintain open airways by maintaining positive pressure longer during exhalation; Inhale through nose with mouth closed; Exhale slowly through nurse-lips, as through whistling or blowing out a candle, making exhalation twice as ling as inhalation.
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BENEFITS OF EXERCISE These exercises facilitate a wide exchange of gases. They maximise the amount of oxygen available to the cells. They prevent orthostatic pneumonia. They make you relaxed. They help you cope with pain. They help reduce the chances of chest complications after surgery. How Frequently Should These Exercises be Performed? Deep breathing should be performed every hour while awake. Patients who have had abdominal or chest surgery need to perform deep breathing at least three to four times daily. Each session should include a minimum of five deep breaths. Deep breathing exercise may be performed every hour, specially by patients who are prone to pulmonary problems. GOALS OF BREATHING EXERCISES Improve ventilation. Increase the effectiveness of the cough mechanism. Prevent pulmonary impairments. Improve the strength, endurance, and coordination of respiratory muscles. Maintain or improve chest and thoracic spine mobility. Correct inefficient or abnormal breathing patterns. Promote relaxation. Teach the patient how to deal with shortness of breath attacks. Improve a patients overall functional capacity. PHYSIOTHERAPY TECHNIQUIES COUGH A cough consists of a deep inspiration followed by a forced expiratory manoeuvre performed against a closed glottis. HUFF A huff is a forced expiratory manoeuvre performed with an open glottis, resulting in lower intra thoracic pressures than a cough. Forced Expiration Technique ( FET ) The forced expiration technique is defined as 1-2 huffs from mid to low lung volume followed by a period of relaxed controlled breathing. The forced expiration technique utilizes the physiology of the huff combined with a recovery phase to reduce the possibility of airway closure, de saturation or fatigue. Active Cycle of Breathing Technique (ACBT) The FET is an integral part of the Active Cycle of Breathing Technique described by Pryor and Webber in 1992. The Active Cycle of Breathing Technique comprises; relaxed breathing control, thoracic expansion exercises, forced expiration technique.
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Vibration and Shaking Vibration and shaking are techniques that consist of intermittent chest wall compression performed throughout the expiratory phase of breathing. Both techniques are performed immediately over the area of secretions. Vibration is a less intense form of chest shaking. Vibrations are performed using the therapist's hands and arms to create oscillations of small amplitude and high frequency while shaking utilises the therapist's, arms and body to create oscillations of large amplitude and lower frequency.

PERCUSSION (CHEST CLAPPING) Percussion is the rhythmic "clapping" of cupped hands over the area of retained secretions. It may be performed by an assistant or independently by the patient. This technique is thought to produce an energy wave which is transmitted through the chest wall causing turbulence and compression of air within the airways. This in turn causes vibration and consequent loosening of secretions which may be cleared by additional techniques.

Dr. Abdul Ghafoor Sajjad Senior Physiotherapist AFIRM

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