Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
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
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.
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
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.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
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
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
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
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
An incentive Spirometer is a device that increases pulmonary function, and also clears Secretions of the air pathway.
It reduces Postoperative Pulmonary Complications.
It also stimulates cough.
It will give Visual Feedback to the Patient and encourages the Patient.
Rapid sequence intubation (RSI) is a technique that is used when rapid control of the airway is needed as a precaution for patients that may have a 'full stomach' or other risks of pulmonary aspiration. A short description about RSI procedure according to IQARUS guideline.
Dr. Ummay Sumaiya
ICU DOCTOR
| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh |
Mail: Ummay.Sumaiya@iqarus.com
Proprioceptive Neuromuscular Facilitation techniques are facilitation techniques to initiate muscle contraction and movement in Neuro-muscular conditions. Basic techniques improve contraction and correct imbalances.
segmental breathing exercise is one of the deep breathing exercises, which improve individual lobe function.
It reduces post-surgical Pulmonary complications and improves Chest wall mobility
Diaphragmatic Breathing is a deep breathing exercise, with two methods.
One method of ‘diaphragmatic’ breathing that concentrates on the forwarding movement of the whole abdominal wall.
Another technique combines the forward movement of the upper abdominal wall with some lateral movement of the lower ribs.
The diaphragm is the main muscle of respiration, but it must be remembered that the diaphragm also plays an important part in lower costal breathing exercises.
It is vital to remember that the expiratory phase is completely passive; any forced or prolonged expiration may increase airway obstruction.
coronary artery bypass graft surgery CABGSunil kumar
coronary artery bypass graft surgery, explanation of CABG on-pump and off-pump procedures, physiotherapy management after surgery. indications of CABG. description of the procedure, investigations before surgery, per operative and post operative management
introduction, causes, risk factors, symptoms, examination, investigations and management of peripheral arterial disease.
how to assess the patient and what will be the complications of PAD, physiotherapy treatment for PAD
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
definition, types, pathophysiology, clinical features, investigations, diagnosis and treatment of COPD,
Explanation about blue bloaters and pink puffers
complication and pulmonary rehabilitation.
indications, uses and types of cardiac catheterization, about intra cardiac pressure, about angiography and its technique, digital substraction angiography and its technique.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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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
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. • INSPIRATORY MUSCLE TRAINING (IMT) IS
INDICATED FOR PATIENTS WHO EXHIBIT SIGNS
AND SYMPTOMS OF DECREASED STRENGTH OR
ENDURANCE OF THE DIAPHRAGM AND
INTERCOSTAL MUSCLES.
• SIGNS AND SYMPTOMS INCLUDE, BUT ARE NOT
LIMITED TO, DECREASED CHEST EXPANSION,
DECREASED BREATH SOUNDS, SHORTNESS OF
BREATH, UNCOORDINATED BREATHING
PATTERNS, BRADYPNEA, AND DECREASED TIDAL
VOLUMES.
3. • PATIENTS WITH RESPIRATORY MUSCLE
WEAKNESS OR FATIGUE MAY HAVE SUCH
DIAGNOSES AS COPD, ACUTE SPINAL CORD
INJURY, GUILLAIN–BARRÉ SYNDROME,
AMYOTROPHIC LATERAL SCLEROSIS,
POLIOMYELITIS, MULTIPLE SCLEROSIS,
MUSCULAR DYSTROPHY, MYASTHENIA GRAVIS,
OR ANKYLOSING SPONDYLITIS.
• IN ADDITION, IMT MAY BE INDICATED FOR
PATIENTS ON MECHANICAL VENTILATION TO
IMPROVE WEANING FROM VENTILATION.
4. • THE GOAL OF IMT IS TO INCREASE THE
VENTILATORY CAPACITY AND DECREASE DYSPNEA.
• AN IMT PROGRAM HAS TWO PARTS:
STRENGTHENING AND ENDURANCE TRAINING.
• EACH PART WILL HAVE INCREASED OR DECREASED
PRIORITY ACCORDING TO THE NEEDS AND MEDICAL
CONDITION OF THE PATIENT.
• CONCEPTS OF VENTILATORY MUSCLE TRAINING
ARE THE SAME AS THOSE FOR OTHER SKELETAL
MUSCLE TRAINING, INCORPORATING THE
CONCEPTS OF OVERLOAD, SPECIFICITY, AND
REVERSIBILITY.
5. • THE OVERLOAD PRINCIPLE APPLIED TO
ENDURANCE MUSCLE TRAINING REQUIRES LOW
LOAD IMPOSED OVER LONGER PERIODS.
• SPECIFICITY REFERS TO TRAINING THE
MUSCLES FOR THE FUNCTION THEY ARE TO
PERFORM, FOR EXAMPLE, RESISTANCE APPLIED
TO INSPIRATORY VERSUS EXPIRATORY
MUSCLES.
• TRAINING EFFECTS MAY BE LOST OVER TIME IF
TRAINING IS DISCONTINUED.
6. • THE FIRST STEP IN ANY PROGRAM IS TO TEACH
THE PATIENT (IF ALERT AND ORIENTED) THE
CORRECT WAY TO USE THE INSPIRATORY
MUSCLES TO ENSURE EFFICIENT INHALATION.
• INCLUDING FAMILY MEMBERS AND SUPPORT
SYSTEM MEMBERS IN THE TEACHING CAN
REINFORCE THE PROGRAM.
7. • WEAKNESS OF A MUSCLE IS THE INABILITY TO
GENERATE FORCE AGAINST RESISTANCE.
• THE LENGTH OF THE MUSCLE AFFECTS THE
FORCE OUTPUT, AS DEMONSTRATED IN THE
LENGTH–TENSION CURVE.
• IN THE RESPIRATORY SYSTEM, THE STRENGTH OF
THE DIAPHRAGM AND OTHER INSPIRATORY
MUSCLES IS MEASURED AS A FUNCTION OF
STANDARD PRESSURE–VOLUME CURVES.
• WEAKNESS OF THE DIAPHRAGM WILL DECREASE
THE NEGATIVE INSPIRATORY PRESSURE
GENERATED BY THE PATIENT, AND THEREBY
DECREASE THE VOLUME OF AIR INHALED.
8. • PATIENTS WITH COPD HAVE HYPERINFLATED
LUNGS AND A FLATTENING OF THE DIAPHRAGM,
WHICH ALTERS THE LENGTH–TENSION
RELATIONSHIP OF THIS MUSCLE.
• FATIGUE OF THE INSPIRATORY MUSCLES,
PARTICULARLY OF THE DIAPHRAGM, WILL RESULT
IN FAILURE TO MEET THE DEMAND FOR
ADEQUATE ALVEOLAR VENTILATION.
• HYPOVENTILATION WILL DECREASE THE
ARTERIAL PARTIAL PRESSURE OF OXYGEN (PAO2)
AND INCREASE THE ARTERIAL PARTIAL
PRESSURE OF CARBON DIOXIDE (PACO2), AND
CAN LEAD TO ACUTE RESPIRATORY FAILURE.
9. • THE DIAPHRAGM IS MADE UP OF ALL THREE
TYPES OF MUSCLE FIBERS, INCLUDING SLOW-
TWITCH OXIDATIVE (SO), FAST-TWITCH
OXIDATIVE GLYCOLYTIC (FOG), AND FAST-
TWITCH GLYCOLYTIC (FG).
• THE ADULT DIAPHRAGM IS APPROXIMATELY 55%
SLOW-TWITCH FIBERS, COMPARED WITH ABOUT
10% IN THE INFANT.
• FATIGUE IS RELATED TO THE ‘SO’ FIBERS,
WHEREAS WEAKNESS IS ATTRIBUTED TO THE
FG FIBERS.
10. • WHEN INITIATING PHYSICAL THERAPY
TREATMENT, THE THERAPIST SHOULD REALIZE
THAT ALL FIBERS NEED TO BE ADDRESSED IN THE
CARDIOPULMONARY TREATMENT PROGRAM.
• WHILE MECHANICALLY SUPPORTED ON A
VENTILATOR, THE DIAPHRAGM CAN LOSE 5% OF
ITS STRENGTH PER DAY.
• WHEN THE PATIENT BEGINS THE WEANING
PROCESS, THE INSPIRATORY MUSCLES WILL GAIN
ENDURANCE WHILE PERFORMING INHALATIONS
WITHOUT THE ASSISTANCE OF THE VENTILATOR.
11. • ENDURANCE TRAINING OF THE DIAPHRAGM
WILL INCREASE CAPILLARY DENSITY,
MYOGLOBIN CONTENT, MITOCHONDRIAL
ENZYMES, AND THE CONCENTRATION OF
GLYCOGEN.
• OVERALL, IT WILL INCREASE THE PROPORTION
OF FATIGUE-RESISTANT SLOW-TWITCH FIBERS.
• THE RECOMMENDATIONS INCLUDE TWO TO
THREE DAILY SESSIONS OF 30 TO 60 MINUTES
OF DEEP BREATHING, CONCENTRATING ON
USING A DIAPHRAGMATIC BREATHING PATTERN.
12. • AN EARLY-STAGE IMT TECHNIQUE IS SNIFFING.
SNIFFING NATURALLY ENLISTS THE DIAPHRAGM.
• WITH THE PATIENT IN A COMFORTABLE POSITION
SUCH AS SIDE-LYING OR RECLINED, THE
THERAPIST MAY ASSIST THE PATIENT IN PLACING
BOTH HANDS ON THE ABDOMINAL AREA TO
PROVIDE PROPRIOCEPTIVE FEEDBACK.
• THEN, IN A RELAXED TONE OF VOICE, THE
THERAPIST INSTRUCTS THE PATIENT TO SNIFF
QUICKLY THROUGH THE NOSE THREE TIMES WITH
SLOW, RELAXED EXHALATIONS.
13. • THE THERAPIST GIVES FEEDBACK THROUGHOUT
THIS TECHNIQUE ON THE QUALITY OF SNIFFING,
ASSESSING WHETHER THE PATIENT IS SHOWING
A DIAPHRAGMATIC BREATHING PATTERN.
• IF THE PATIENT IS ABLE TO PERFORM THIS
EFFECTIVELY, THE PROGRESSION OF THIS
TECHNIQUE IS TO REDUCE THE NUMBER OF
SNIFFS FROM THREE DOWN TO ONE AT AN
INCREASINGLY SLOWER PACE.
• THE GOAL OF THIS TECHNIQUE IS TO INCREASE
THE AWARENESS OF CORRECT USE OF THE
DIAPHRAGM.
14. • THE TECHNIQUE PROGRESSION CONTINUES
UNTIL THE PATIENT SHOWS THE
DIAPHRAGMATIC BREATHING PATTERN AT A
NORMAL RATE AND DEPTH FOR ALL LEVELS OF
FUNCTIONING.
• ACCORDING TO MASSERY AND FROWNFELTER,
THERE IS AN 80% SUCCESS RATE, WITH
PATIENTS AFFECTED BY PRIMARY PULMONARY
PATHOLOGIES OR NEUROLOGIC IMPAIRMENTS
15. • STRENGTH TRAINING CAN BE PERFORMED IN A
NUMBER OF DIFFERENT WAYS, DEPENDING ON
THE INITIAL STRENGTH OF THE DIAPHRAGM.
• ONE METHOD THAT CAN BE UTILIZED EASILY
FOR THE PATIENT ACHIEVING TIDAL VOLUMES
OF 500 ML OR BETTER IS RESISTED INHALATION.
THIS CAN BE PERFORMED MANUALLY BY THE
THERAPIST.
• THE THERAPIST HAS THE PATIENT ASSUME A
COMFORTABLE POSITION AS DESCRIBED
EARLIER TO PROMOTE DIAPHRAGMATIC
EXCURSION.
16. • THE THERAPIST GENTLY PLACES THE HANDS
JUST BELOW THE RIB CAGE ON BOTH SIDES OF
THE PATIENT’S THORAX.
• BEFORE THE PATIENT INITIATES AN INSPIRATION,
THE THERAPIST GIVES A SMALL AMOUNT OF
RESISTANCE TO THE DIAPHRAGM BY PUSHING
GENTLY UP AND IN, AND CONTINUES THIS
PRESSURE THROUGH THE INSPIRATORY PHASE.
• NO RESISTANCE IS GIVEN DURING EXHALATION.
17. • THE THERAPIST MAY ALSO USE WEIGHTS FOR
DIAPHRAGMATIC STRENGTHENING.
• TO EVALUATE IF THIS IS AN APPROPRIATE
METHOD, THE THERAPIST FIRST OBSERVES TO
DETERMINE WHETHER NORMAL
DIAPHRAGMATIC EXCURSION OCCURS AT REST
AND THEN WITH THE ADDITION OF WEIGHTS.
• THE PATIENT SHOULD BE ABLE TO BREATHE
COMFORTABLY AND WITHOUT ACCESSORY
MUSCLES FOR 15 MINUTES; IF THE AMOUNT OF
WEIGHT IS EXCESSIVE, THE PATTERN OF
INSPIRATION WILL BECOME UNCOORDINATED.
18. • SEVERAL AUTHORS SUGGEST THAT STRENGTH
TRAINING IN THIS MANNER SHOULD INCLUDE
TWO OR THREE SETS OF 10 REPETITIONS ONCE
OR TWICE A DAY.
• HOWEVER, WITH EITHER THE MANUAL OR THE
WEIGHTS METHOD, THE QUALITY OF THE
CONTRACTION NEEDS TO BE MONITORED.
• THE PATIENT SHOULD NOT BE “PUSHING” WITH
THE ABDOMINAL MUSCLES AGAINST THE
RESISTANCE, WHICH ENHANCES THE
EXHALATION PHASE OF BREATHING RATHER
THAN THE MUSCLES OF INSPIRATION.
19. • FOR A PATIENT WITH “FAIR OR REDUCED”
DIAPHRAGMATIC STRENGTH (TIDAL VOLUME
LESS THAN 500 ML), ACTIVE BREATHING
EXERCISES ARE INDICATED WITHOUT
RESISTANCE.
• A PATIENT WITH POOR STRENGTH WILL FIND IT
DIFFICULT TO EXERCISE WITH THE HEAD OF THE
BED ELEVATED; A SUPINE POSITION WILL
PREVENT THE ABDOMINAL CONTENTS FROM
PUSHING UP ON THE DIAPHRAGM AND LIMITING
ITS EXCURSION.
20. • ANOTHER FORM OF RESISTIVE TRAINING UTILIZES
SPECIFIC HANDHELD TRAINING DEVICES, SUCH AS
THE P-FLEX, DHD DEVICE, THRESHOLD, OR THE
PEACE PIPE.
• THE RESISTANCE IS INCREASED BY DECREASING
THE RADIUS OF THE DEVICE’S AIRWAY.
• THE PATIENT INHALES THROUGH THE DEVICE AT A
LEVEL THAT DOES NOT CAUSE ADVERSE EFFECTS,
SUCH AS DYSPNEA OR A DROP IN OXYGEN
SATURATION, FOR A 15- TO 30-MINUTE SESSION
TWICE PER DAY.
• WHEN THIS LEVEL IS COMFORTABLE FOR THE
PATIENT, THEN THE RESISTANCE IS GRADUALLY
INCREASED.
21. • MUCH CONTROVERSY HAS SURFACED
REGARDING THE EFFICACY OF IMT SINCE ITS
INTRODUCTION INTO CLINICAL PRACTICE.
• EVIDENCE HAS BEEN PRESENTED BOTH
SUPPORTING AND DISMISSING IMT AS A
RELIABLE TREATMENT METHOD.
• THE MAJOR DISCREPANCY MAY EXIST IN THE
DIAGNOSIS FOR WHICH THIS TREATMENT IS
PRESCRIBED. A PATIENT WITH INSULT TO THE
LUNG TISSUE ITSELF—FOR EXAMPLE, COPD OR
ARDS—MAY NOT TOLERATE IMT.
22. • INSPIRATORY MUSCLE TRAINING, WHICH IS A
STRENGTHENING EXERCISE, WOULD INCREASE
THE DEMAND FOR OXYGEN DELIVERY IN THE
DISEASED LUNGS.
• HOWEVER, A PATIENT WITH A NEUROMUSCULAR
DISEASE AND INTACT LUNGS MAY BE MORE
LIKELY TO TOLERATE THE INCREASED OXYGEN
DEMAND AND DERIVE A BENEFIT, AS WOULD THE
PATIENT ON MECHANICAL VENTILATION WHO IS
TRYING TO BE WEANED FROM THE VENTILATOR.
23. • DEEP BREATHING EXERCISES ARE INDICATED
FOR THE PATIENT WITH ATELECTASIS, WHICH IS
CAUSED BY HYPOVENTILATION AND THE
COLLAPSE OF ALVEOLI IN THE LUNGS.
• THE USE OF AN INCENTIVE SPIROMETER IS AN
EFFECTIVE WAY TO PRACTICE DIAPHRAGMATIC
BREATHING, PREVENT OR REVERSE
ATELECTASIS, AND STIMULATE A COUGH.
• OFTEN, IT IS GIVEN TO THE PATIENT
PREOPERATIVELY SO HE OR SHE CAN PRACTICE
DEEP BREATHING.
24. • THEN, AFTER SURGERY, THE PATIENT MAY BE
ABLE TO PERFORM THIS TECHNIQUE FROM
MEMORY AS THE EFFECTS OF ANESTHESIA START
TO DIMINISH.
• THE PATIENT IS INSTRUCTED TO PERFORM DEEP
BREATHING EXERCISES WITH THE INCENTIVE
SPIROMETER 10 TIMES EVERY HOUR TO
REPLENISH SURFACTANT, WHICH IS LOST IN THE
PRESENCE OF ATELECTASIS.
• THE PATIENT NEEDS TO BE INSTRUCTED TO
PERFORM A SLOW, RELAXED BREATH THROUGH
THE MOUTHPIECE.
25. • IT IS OFTEN HELPFUL TO HAVE THE PATIENT
PLACE A HAND ON THE ABDOMINAL AREA TO
FEEL THE DIAPHRAGM WORKING IN THE
CORRECT WAY.
• IF THE PATIENT IS HAVING A DIFFICULT TIME
PERFORMING THIS TECHNIQUE, THE THERAPIST
MAY PLACE A HAND OVER THE PATIENT’S HAND
TO FACILITATE THE PROPER TECHNIQUE.
• THEN THE THERAPIST SHOULD INSTRUCT THE
PATIENT TO PERFORM THE BREATHING SLOWLY,
WITH THE ABDOMEN RISING OUT DURING
INSPIRATION.
26. • THE GOAL IS FOR THE PATIENT TO BE ABLE TO
USE THE INCENTIVE SPIROMETER
INDEPENDENTLY WITHOUT PROPRIOCEPTIVE
OR VERBAL FEEDBACK.
• ALTERNATIVELY, EARLY MOBILIZATION HAS BEEN
SHOWN TO BE AS EFFECTIVE AS DEEP
BREATHING EXERCISES AFTER GALLBLADDER
AND CARDIAC BYPASS SURGERY
27. • ENDURANCE TRAINING OF THE EXTREMITIES IS
ANOTHER TECHNIQUE THAT HAS BEEN
EXPLORED IN AN EFFORT TO INCREASE
VENTILATORY MUSCLE ENDURANCE.
• STUDIES ON PEDIATRIC PATIENTS WITH CYSTIC
FIBROSIS AND FOUND THAT UPPER EXTREMITY
ENDURANCE TRAINING DID INCREASE THE
ENDURANCE OF THE VENTILATORY MUSCLES.
• SOME STUDIES EXAMINED THE EFFECTS OF
UPPER AND LOWER EXTREMITY TRAINING ON
VENTILATORY MUSCLE ENDURANCE WITH ADULT
PATIENTS WITH COPD AND FOUND NO
CORRELATION.