Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Establishing the need for a surgical intervention
Confirmation of relevant physical findings and review of the clinical history and laboratory investigations that support the need of surgical intervention
Type of approach- Benefits & Risks of surgical procedure
The incision site- ease of surgery as well as cosmetic considerations
Type of anesthesia
The goal in patients with primary lung disease is to teach them to relax the neck and chest accessory muscles and use more diaphragmatic breathing to reduce the work of breathing.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Establishing the need for a surgical intervention
Confirmation of relevant physical findings and review of the clinical history and laboratory investigations that support the need of surgical intervention
Type of approach- Benefits & Risks of surgical procedure
The incision site- ease of surgery as well as cosmetic considerations
Type of anesthesia
The goal in patients with primary lung disease is to teach them to relax the neck and chest accessory muscles and use more diaphragmatic breathing to reduce the work of breathing.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
The process that moves air in and out of the lungs called breathing or pulmonary ventilation.
Breathing is only one of the processes that deliver oxygen to where it is needed in the body and remove carbon dioxide.
Breathing exercise enhance the respiratory system.
Improper breathing can upset the oxygen and carbon dioxide exchange.
Standard treatments with bronchodilator for chronic obstructive Pulmonary Disease (COPD)
though reduce the degree of airway obstruction to a certain extent is totally insufficient to relieve completely
the symptom and their physical capacity.COPD patients have reduced respiratory muscle endurance and so are
not able to tolerate the respiratory work loads. Pranayama practiced as a specific training programme for
respiratory muscles traditionally in olden days of India has been ignored by the present generation due to
negligence and ignorance. An attempt was made to reintroduce the same to COPD patients in this study and the
effects of improvement in ventilator capacity and exercise tolerance in these patients were documented. The
present study support the findings that pranayamic breathing strengthen the respiratory muscles and increases
the naturally occurring endurance power of these muscles. The aim of the study is to bring about the
importance of this spirotherapy in public and acceptance of this technique in the management of COPD
universally. The article describes the technique of pranayama and its rehabilitatory effect on COPD.
Breathing exercise are indicated in any pathological state, which cauuse the patient to use his muscles of respiration insufficiently resulting in an impotent of pulmonary function. Generally any patient with an abdominal pattern of breathing or increased work of breathing. Breathing exercise are form of exercise that can be used for a variety of health related reasons. improper breathing can upset the oxygen and carbon dioxide exchange and contribute to anxiety, panic attacks, fatigue, and other physical and emotion disturbance. diaphragmatic breathing is a type of breathing
Types of techniques:
Airway clearance techniques
Facilitating airway clearance technique with effective coughing techniques
Technique to facilitate ventilation pattern
Mobilization and Exercises
Airway clearance technique:
Postural drainage
Percussion
Vibration/shaking
Manual hyperinflation
Active cycle of breathing technique
Autogenic drainage
Positive expiratory pressure
High frequency chest compression
Exercises for airway clearance
Indications and cautions:
Cystic fibrosis
Atelectasis
Asthama
Respiratpry muscle weakness
Bronchiectasis
Mechanical ventilation
Neonatal respiratory distress syndrome
Contraindications:
Intracranial pressure (ICP) > 20 mm Hg
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery (e.g .• laminectomy) or acute spinal injury
Active hemoptysis Empyema
Bronchopleural fistula
Large pleural effusions
Pulmonary embolism
Aged, confused, or anxious patients
Rib fracture. with or without flail chest
Surgical wound or healing tissue
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. There are several that fall into type of
therapy used to Airway Clearance Therapy,
remove secretions and breathing exercise to
improve gas exchange.
includes
manual secretion removal technique
(postural drainage, percussion, shaking)
Airway clearance technique (cough or huff)
Independent secretion removal technique
(active cycle of breathing, autogenic
drainage )
breathing exercises/breathing training.
pre and post-surgical care.
Activities for increase functional ability
but this guide is specifically focused on
breathing exercises.
3. BREATHING EXERCISE
are exercises that work on to improve pulmonary status & to improve endurance and function in ADLs
& prevention for acute and chronic pulmonary disease mainly for chronic lung diseases.
Efficacy breathing exercises(1)
To re-training of patients to use primary respiratory muscles efficiently.
Strengthen the diaphragm, allowing it to assist with lung expansion and improve air reaching
the base of the lung
Take the burden off accessory muscles in the neck, back and chest that are used. and
Strengthening when become weak with patient in ICU.
Clear the airway of excess sputum (If the patient suffers from a effusion in both lungs,
breathing exercises can only be used after fluid drainage, but if it is in unilateral lung,
Postural drainage can be used with breathing exercises(2)
Improve lung function
Removal of spasms that occur with a severe cough
Reduce the risk of developing respiratory infections or atelectasis (alveoli collapse) & Speed
up the healing process.
4. Control of the respiratory system in the medulla oblongata is involuntary but can be
overridden by voluntary action such as breathing exercises or reflexes such as speech,
laughter, emotion, pain, sudden cold and some pathological states (2).
studies indicate that breathing exercise and ventilatory training have affect and alter a
patient’s rate and depth of ventilation, so this technique is used to improve the pulmonary
status and increase patient’s overall endurance. (3)
If sputum builds up in the lungs, it may become infected and increase the risk of pneumonia
& impedes the ability of the lungs to expansion (My Health Alberta 2019; Penn Medicine
2016), so breathing and coughing exercises are necessary to aid breathing and remove
excess secretion in the recovery phase.
A study by the University of Melbourne found that preoperative education and teaching
of respiratory exercises halves the rate of post-surgery complications for major
abdominal surgery patients (Boden & Denehy 2018).(4)
Research study
5. Type of breathing exercise:
There are many breathing exercises used in the rehabilitation of many health problems,
such as
respiratory diseases (obstructive or restrictive lung disease)
spinal injuries (effect on diaphragm muscle)
post-trauma or surgery, or in ICU
pregnant women.
Before starting breathing exercises for lungs, you need to decide what purpose you intend to
do. Most of the time, people choose one pool or another to get these results.(5)
to improve the efficiency of ventilation
decrease the work of breathing
increase the excursion of the diaphragm
improve gas exchange and oxygenation.
facilitate relaxation
maintain or improve mobility of chest wall
prevent pulmonary compromise
6. is also called ( Deep, belly breathing or abdominal breathing).
that helps strengthen your diaphragm muscle.
Indication
Post-operative pain or surgical procedure such as
thoracic or abdominal surgeries.
Pulmonary disease (primary or secondary)
obstructive lung diseases. (not lungs expansion)
COPD (improves their breathing during activities they find strenuous in
ADLs.)(6)
Asthma (A 2013 review of three randomized controlled trials investigated the
effects of diaphragmatic breathing on quality of life ( QOL) among people with
asthma. It found moderate evidence of short- and long-term improvements in
QOL following diaphragmatic breathing exercises.) (7)
Cystic fibrosis
Lung abscess
Diaphragmatic breathing exercise:
7. Restriction of breathing due to musculoskeletal abnormality
Central nervous system deficit
ICU
Stress and anxiety (A 2017 study notes that diaphragmatic breathing reduces
levels of the stress hormone cortisol in the body. Because of this, it may help
alleviate symptoms of stress and anxiety.) (8)
8. Contraindication
increase PaCO2
marked hyperinflation of the lungs with diaphragmatic movement
Diaphragmatic breathing is not always beneficial as a standalone treatment. People should not
rely on diaphragmatic breathing alone to treat conditions such as asthma or chronic obstructive
pulmonary disease, as a 2018 study indicates that in the literature there are reports of some
harmful effects of diaphragmatic breathing in COPD patients when used as a standalone therapy.
(10)
9. 1) Explain procedure to patient. (should focus on the breathing
technique & teach the patient relaxation techniques, relax the muscles
of upper thorax neck and shoulder to minimize the use of accessory muscle work)
1) Position the patient long-sitting position, upright position or Semi-Fowler's position.
2) Place the therapist's hand gently over the subcostal angle and abdominal to feel to expansion
3) during exhalation, apply gentle pressure on the subcostal angle
4) Increase to firm pressure at the end of exhalation.
5) Release pressure allowing a full inhalation.
6) Allow the patient to perform deep breathing only for 3-4 times, to avoid Hyperventilation.
PROCEDURE
10. 8) When checking the quality of the diaphragm, we put resistance during
inhalation
9) Observe the patients spontaneous breathing pattern and rhythm while at rest
and during activity to determine whether Patient is indicated or not
10) Doing diaphragm breathing exercise within activities of daily life during upright
sitting, standing, walking, and stair climbing precaution
clinical signs of respiratory muscle fatigue(inspiratory muscle)
tachypnea or dyspnea with cyanosis
patient with paradoxical breathing patterns vertical rib cage movement with excessive accessory
muscles activity. Abdominal hollowing without distension)
In cases of severe hyperinflation or poor diaphragmatic movement during inhalation, placing the
patient in a semi-Fowler's position may increase symptoms, increase the work of breathing, and
dyspnea in some persons.(9)
11. SELF-CARE PROCEDURE
1) Sit in a comfortable position on flat surface.
2) Relax your shoulders and focus on the diaphragm muscle.
3) Put a hand on your chest and a hand on your stomach.
4) Breathe in through your nose for about two seconds. Breathe,
until you feel your stomach is expanding.
1) Purse your lips (as if you’re about to drink through
2) a straw), press gently on your stomach, and exhale slowly for about two seconds.
3) Repeat these steps several times for best results (to 5-10times)
12. Pursed lip breathing
is a breathing technique designed to make your breaths more effective by making them slower and
more control over your breathing, which is particularly important for people with lung conditions
such as COPD.
In a 2018 study, effectiveness of pursed lip exercises for COPD patients demonstrated the an
important part of rehabilitation programs for these patients.(11)
13. Efficacy(12)
increase tidal volume and reduce the work of breathing.
reduce dyspnea by slowing the respiratory rate.
improve gas exchange (both oxygen and carbon dioxide).
decrease mechanical disadvantage of an impaired ventilatory pump.
increasing exercise tolerance.
Decrease the respiratory rate and minute ventilation.
Improve gas mixing at rest for patients with COPD .
facilitate relaxation by taking deep breaths.
14. indications
Primarily used for patients with obstructive disease with experience dyspnea at rest or
with minimal activity/exercise
tachypnea (abnormally rapid breathing.)
who use an ineffective breathing pattern during activity/exercise
Precautions:
The use of forceful exhalation during lip breathing should be avoided so as not to increase
the pressure of inter-thorasic as this can cause further restrictions on the small
bronchioles
Contraindications
Bronchiectasis
Diabetic (hypoglycemia)
Clinical depression (Breathing with longer exhalations stimulates the parasympathetic
nervous system, as this can worsen it because you put the body in a state of relaxation
with increased lack of motivation.)
Age
Severe Personality Disorders
Psychoactive Substances
(13)
15. 1) Have the patient breathe slowly and deeply through the nose.
2) Then gently exhale through gently pointed lips as if blowing out a candle.
Intra-bronchial pressure increases.(Like O-shape)
3) Press gently on the patient's abdomen during the exhalation period
4) The contraction of the abdominal muscles can be used wisely to increase the volume of exhalation.
5) Practice this technique 4-5 times a day at first so you can get the correct breathing pattern.
reminders
Do not force the air out.
Always breathe out for longer than you breathe in.
Breathe slowly, easily, and relaxed ... in and out ... until you are in complete control.
Procedure:
16. may be defined as localized respiration consciously directed to one segment of the chest
while the other segments remain relaxed.(13)
Four types of segmental breathing exercise are: (13)
Lateral costal expansion
Posterior basal expansion
Right middle or lingulae expansion
Apical expansion
Segmental Breathing
17. Utilization of segmental breathing exercises accomplishes many objectives
the most important of which is to promote the expansion or expansion of an
anatomical segment, lobe or lung
improved aeration and expansibility, thus reducing the possibility of collapsed lung
stimulation of the cough reflex mechanism, thus preventing excessive accumulation
of secretions in the bronchial tree & pleural fluid and secretions.
maintain or restore functional residual capacity,
maintain or improve mobility of chest wall and prevent pulmonary compromise.
18. alter regional distribution of gas,
prevention of panic response in the patient through development of a Chief
sense of confidence derived from a feeling of controlled breathing.
development of normal motion.
decrease paradoxical breathing (deflation of a lung or portion of a lung during
the phase of inspiration and the inflation of the lung during the phase of
expiration)
Contraindication :
prevent to use in hypoventilation until the medical condition permits it
19. Indications
patients who have Pleurisy, pneumonia, incision, or post trauma pain that cause a decreased
movement in a portion of the thorax (splinting)
at risk for developing atelectasis (lung collapse).
post thoracotomy, post mastectomy scar or post chest radiation-fibrosis.
Inappropriate in cases of intractable hypoventilation until the medical situation is resolved
(palliative therapy to reduce bronchogenic tumor size or a chest tube to reduce pneumothorax).
In relationship to COVID-19, segmental breathing can be utilized to target specific lung
segments that have been affected by alveolar collapse or damage.
pulmonary hygiene purposes for all diagnoses that experience consolidation including COPD,
Pneumonia, and CHF.
20. Procedure
Explain procedure to the patient.
Position the patient to facilitate inhalation to a certain segment, such as
postural drainage positions. upright sitting.
Apply gentle pressure to the thorax over the area of hypoventilation during
exhalation.
increase to firm pressure just prior to inspiration.
Asks the patient to breathe in against the resistance of the therapist's hands.
release resistance allowing a toll inhalation
21.
22. The basis of incentive spirometry involves having the patient take a sustained maximal
inspiration (SMI).
Benefit
to increase tidal volume (inhaled,)
sustain or improve alveolar inflation
maintain or restore functional residual capacity.
In a 2019 study, the effect of Sustained maximal inspiration was found to be similar to
that of incentive spirometers (15)
Incentive spirometry may be more effective than Intermittent positive pressure
breathing (IPPB) because it maximizes the amount of air inhaled while maintaining
relatively low airway pressures.
sustained maximal inspiration
23. Indications(17)
Pre-operative screening of patients at risk of postoperative complications.
Lack of pain control as post- operative pain, especially thoracic and abdominal
surgery or post-trauma pain or acute lobar collapse
to prevent or treat atelectasis.
Restrictive lung disease associated with a dysfunctional diaphragm or accessory
respiratory musculature
alternative for clinical use in cases where incentive spirometers equipment
acquisition is not possible (16)
24. Contraindications (17 )
patients with COPD or Asthma
Very young patients or pediatrics with developmental delay
Hyperventilation
Fatigue & Hypoxemia secondary to interruption of oxygen
therapy
Patients unable to take deep breathe effectively due to pain,
diaphragmatic dysfunction, or opiate analgesia.
Patients who are heavily sedated or comatose
25. explain the procedure to patient
(Advise patient to take approximately ten incentive spirometry breaths per waking
hour (use clinical reasoning to prescribe using Frequency, Intensity, Time and Type
principles).
Inspire slowly through nose or pursed lips to maximal inspiration.
Hold maximal inspiration for three seconds.
Passively exhale the volume.
Incentive spirometers (devices used to measure and encourage deep spiration) can assist
the patient in achieving maximal inspiration during
Deep breathing offers a similar effect. However, using an incentive device as feedback
may create greater inhaled volumes, greater control of flow and more motivation to
participate in therapy
Procedure.
26. GPB is also known as frog breathing or air gulping
The major purpose is Assist coughing.
is a means of increasing a patient’s inspiratory capacity when there is severe weakness of
the muscles of inspiration.
Originally developed to help polio patients with severe muscle weakness, this type of
breathing pattern is used today, and taught to patients with high spinal cord injuries
who can easily develop respiratory problems.
The use of GPB has been shown to be sufficient to maintain arterial blood gases within
normal range(18)
GPB may prove useful in improving cough effectiveness in patients with tetraplegia or
neuromuscular disorders, impaired tracheobronchial clearance
Glossopharyngeal Breathing
27. indication(19)
The most common use of GPB is
in patients who are able to breathe spontaneously but whose power to cough and clear secretions is
inadequate
Patients with high-level quadriplegia.
patients with poliomyelitis
patient who is unable to voluntarily alter tidal breathing.
Use of GPB continuously, during the day, but during sleep he returns to mechanical ventilation in the
patients with a reduced vital capacity owing to respiratory muscle paralysis
28. Contraindication(19)
patients with a tracheostomy when the cuff is inflated.
patients with airflow obstruction or pulmonary disease, due to the risk of air trapping.
GPB should not be attempted in patients with neuromuscular disorders affecting swallowing
and in patients with a progressive disorder, intermittent positive pressure breathing (IPPB)
may be more appropriate than GPB(20)
Precautions:
This sequence should be practiced slowly at first and then gradually speeded up until the movement flows.
A leak of air may occur through the nose and, until it is prevented by the soft palate, a Close the nose may be
required.
29. mouth opened to draw in air
The mouth and pharynx are filled with air by depressing the cricoid cartilage and tongue
While maintaining this position the jaw are closed, trapping the air
air pushed back with tongue into trachea
vocal folds closed to prevent passive air leaks.
Entire maneuver is then repeated
Precautions:
This sequence should be practiced slowly at first and then gradually speeded up until the movement
flows.
A leak of air may occur through the nose and, until it is prevented by the soft palate, a Close the nose
may be required.
procedure
30.
31. In the case of weak abdominal muscles, the force of intra-abdomen pressure is weak. It
cannot provide an effective cough to expel secretions in the lung or the air accumulated
inside it.
It can benefit from some methods to strengthen the abdomen muscles, by
Abdominal strengthening exercises such as core and global muscle (in case the patient is
able to do exercises)
The use of the abdomen corset in the event of inability to perform exercises
can facilitate relaxation
decrease breathlessness
increase inspiratory muscle strength
Abdominal strengthen
32. They are exercises that are used especially for athletes and who
suffer from short breathing
It is one of the exercises used in ADLs, and it is multiple
exercises such as:
Rib Breathing
shoulder shrugging
Elbow Touch
Windmill
Seated Kicks
Coordination breathing exercises :
33. Reference
1. https://www.ausmed.com/cpd/articles/breathing-exercises
2. Physiotherapy in Respiratory Care: An Evidence-based Approach to RespiratoryBMJ.
2018;360:j5916. Published 2018 Jan 24. doi:10.1136/bmj.j5916
3. https://www.slideshare.net/rahulapcvtp/breathing-exercise-rahul-ap-mpt
4. Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of
respiratory complications after upper abdominal surgery: pragmatic, double blinded,
multicentre randomised controlled trial [published correction appears in BMJ. 2019 Apr
25;365:l1862].
5. https://www.ausmed.com/cpd/articles/breathing-exercises
6. https://www.medicalnewstoday.com/articles/diaphragmatic-breathing#conditions-it-can-help-with
7. Prem V, Sahoo RC, Adhikari P. Effect of diaphragmatic breathing exercise on quality of life
in subjects with asthma: A systematic review. Physiother Theory Pract. 2013;29(4):271-277.
8. Ma X, Yue ZQ, Gong ZQ, et al. The Effect of Diaphragmatic Breathing on Attention,
Negative Affect and Stress in Healthy Adults. Front Psychol. 2017;8:874. Published 2017
Jun 6. doi:10.3389/fpsyg.2017.00874
34. Reference
9. Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of deep diaphragmatic
breathing in COPD patients with chronic respiratory insufficiency. Eur Respir J.
1998;11(2):408-415. doi:10.1183/09031936.98.11020408
10. Mendes LP, Moraes KS, Hoffman M, et al. Effects of Diaphragmatic Breathing With
and Without Pursed-Lips Breathing in Subjects With COPD. Respir Care. 2019;64(2):136-
144. doi:10.4187/respcare.06319
11. Sakhaei S, Sadagheyani HE, Zinalpoor S, Markani AK, Motaarefi H. The Impact of
Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in
COPD Patients. Open Access Maced J Med Sci. 2018;6(10):1851-1856. Published 2018 Oct
20. doi:10.3889/oamjms.2018.407
12. https://www.healthline.com/health/pursed-lip-breathing
13. https://www.breathinglabs.com/clinical-use/postoperative-care/
14.Wilma-Nell Harmony, B.S., Segmental Breathing, PhysicalTherapy,Volume 36, Issue 2, 1 February
1956, Pages 106–107, https://doi.org/10.1093/ptj/36.2.106
35. Reference
15. Mendes LPS, Teixeira LS, da Cruz LJ, Vieira DSR, Parreira VF. Sustained maximal inspiration has
similar effects compared to incentive spirometers. Respir Physiol Neurobiol. 2019;261:67-74.
doi:10.1016/j.resp.2019.01.006
16. (https://erj.ersjournals.com/content/52/suppl_62/PA1705) Maximal sustained inspiration promotes similar
changes on breathing pattern and chest wall motion compared to Incentive spirometry. Liliane Mendes, Luana
Teixeira, Layza Cruz, Danielle Vieira, Veronica Parreira. European Respiratory Journal Sep 2018, 52 (suppl
62) PA1705; DOI: 10.1183/13993003.congress-2018.PA1705
17. https://www.physio-pedia.com/Incentive_Spirometry
18. (M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002)
19. https://www.physio-pedia.com/Glossopharyngeal_Breathing
20. Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition.
Churchill Livingstone. 1998
https://smartvest.com/top-2-breathing-techniques-for-copd/
https://www.aarogya.com/specialties/physiotherapy/segmental-breathing.html
YouTube links
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