PULMONARY REHABILITATION FOR PHYSIOTHERAPISTS

1. PULMONARY
REHABILITATION

2. DEFINITION
 It is an art of medical practice where an
individually tailored multidisciplinary
program is formulated through accurate
diagnosis , therapy , emotional support
and education ,stabilizes or reverses
both the physiology and
psychopathology of pulmonary diseases
and attempts to return the patient to the
highest possible functional capacity
allowed by his pulmonary handicap and
overall life situation

3. AIMS
 PRIMARY AIMS
 To decrease activity limitation and
participation of persons with chronic
lung diseases
 To restore patients to the highest level
of independent functioning
 To increase ex. Tolerance in order to
reduce impairment
 Improve adherence to recommended
treatments

4.  Reduce frequency and severity of
symptoms
 Improve mood and motivation
 Reduce dependency
 Increase participation in everyday
activities
 Improve QoL
 Reduce health care burden for patients
,families and communities
 Improve survival

5. PROGRAM GOALS
 Design and implement a patients
individualized program under medical
direction of physician
 Train , motivate and rehabilitate the
patient to maximum potential through
organised team effort
 Educate the general public and health
care professionals about pulmonary
health and rehabilitation

6.  Increase awareness in medical
community regarding the importance
of early detection of pulmonary
disease through screening

7. INDICATIONS
1)OBSTRUCTIVE PULMOMARY
DISEASES
 COPD
 Asthma
 Chronic bronchitis
 Bronchiectasis
 Emphysema
 Cystic fibrosis

8. 2)RESTRICTIVE PULMONARY
DISEASES
 Interstitial fibrosis
 Rheumatoid pulmonary diseases
 Collagen vascular lung disorders
 Pneumaconiosis
 sarcoidosis

9. 3)RESTRICTIVE CHEST WALL
DISEASES
 Kyphoscoliosis
 Poliomyelitis
 Severe obesity
4)OTHER CONDITIONS
 vascular diseases
 Lung resection
 Lung transplantation
 Environmental lung diseases

10. CONTRAINDICATIONS
 Severe cognitive impairment
 Severe psychiatric impairment
 Relevant infectious disease
 Musculoskeletal or neurological
disorders that prevent exs.
 Unstable cardiovascular diseases

11. REHABILITATION TEAM
 Patient
 Physician
 Pulmonologist
 Physiotherapist
 Nurse
 Occupational therapist
 Dietician
 Psychologist
 Ergonomic specialist
 Ex. Physiologist
 Social worker

12. Rehabilitation setup
 Inpatient
 Outpatient
 Community based/home program

13. PATIENT ASSESMENT
 MEDICAL HISTORY should be taken
to determine whether patient can
participate in ex. Program
 BMI(20-25 normal,›30-obese,‹20-
underweight)
 Check any history of weight loss or
gain for more than 10 percent in the
past 6 months

14.  ASSESING MENTAL HEALTH:
 Screening of patient for existence of
clinically significant symptoms of
anxiety and depression
 SMOKING HISTORY
 If patient still smokes refer to smoking
cessation clinic or equivalent
 SPIROMETRY
 To find the degree of airflow limitation

15. BODE INDEX
 The BODE index , for Body-mass
index , airflow Obstruction , Dyspnoea
and Exercise is a multidimensional
scoring system and capacity index
used to test the patients who have
been diagnosed with COPD and to
predict long term outcomes for them
 The index uses the four factors to
predict risk of death from the disease

16.  The BODE index will result in a score of
zero to ten dependent upon FEV
1,BMI,six minute walk test and the
modified MRC dyspnoea scale
 Higher the score severe the condition
 BODE index helps to determine the level
of functional impairment and activity
limitation , factors that limit the ex
capacity , to plan a proper rehabilitation
program and to find the effectiveness of
rehabilitation

17. COMPONENTS OF
PULMONARY REHABILITATION
1. EVALUATION( assessment of
dyspnoea and QoL )
2. EXERCISE PRESCRIPTION
3. PATIENT TRAINING AND
EDUCATION
4. COUNSELLING
5. FOLLOW UP

18. 1.EVALUATION
A. ASSESMENT OF DYSPNOEA
 Primary goal of pulmonary rehab is
to decrease the shortness of breath
 Dyspnoea assessment is essential
both before and after rehab program

19.  Measurement tools of dyspnoea are:
1. Modified Medical Research Council
scale
2. Modified Borg Dyspnoea scale
3. Chronic respiratory disease
questionnaire

20. B) Assessing QoL
 Health related QoL can be measured
with disease specific or generic
measures
 Common questionnaires in use are
1. St.Georges respiratory
questionnaire
2. Chronic respiratory disease
questionnaire
3. MOS SF-36 questionnaire

21.  Disease specific questionnaire are
more likely to be responsive to
changes after pulmonary rehab and
more sensitive to specific respiratory
issues
 Generic questionnaires provide a
more global view of respiratory
patients QoL

22. 2. EXERCISE
PRESCRIPTION
 It incorporates 4 variables
a)MODE
 Sustained aerobic activity is
recommended
 ADVANTAGES
 Increase ex tolerance
 Overall functional status

23. B)INTENSITY
 It depends upon
1)Oxygen consumption:60 percent of VO2 max
2)Heart Rate:60 percent of HR max
2)Rate of perceived exertion : the BORG RPE
SCALE
 Rating between 3-6 patients with pulmonary
dysfunction can be taken for general exs
 3 corresponds to 50 percent VO2 max
 6 corresponds to 85 percent VO2 max

24. 3)DURATION
 It is inversely proportional to intensity
 Maximum of 30 min depending upon the
pts tolerance exclusive of warm up and
cool down period
 Frequent rest periods should be given
4)FREQUENCY
 Depends upon both intensity and
duration
 5-6 times in a week is recomended

25. 3. PATIENT TRAINING AND
EDUCATION
 Includes participation and instruction in
correct inhale techniques , respiratory
muscle training , bronchial hygiene,
nutrition , medications , ex. Principles ,
ADLs , psychosocial interventions ,
smoking cessation , self assessment and
treatment , various breathing and
relaxation techniques etc
 It helps the patient to understand the
disease prognosis and to make life
modifications to improve the health
status

26. 4. COUNSELLING
 Essential component as most of the
patients with pulmonary diseases are
often depressed , anxious and angry

27. 5.FOLLOW UP
 It helps to maintain the benefits
accomplished during the program and
to improve patient compliance
 Activities like group outings , patient
volunteers , maintenance exs ,
monthly education and support groups
are incorporated in pulmonary rehab

28. SOME EXERCISE
PROGRAM
1)WARM UP
 Dynamic Stretching for cervical , shoulder ,
trunk , lower extremity and gastrosoleus
stretch
2)AEROBIC PHASE
 Walking
 Stationary cycle
 Treadmill
 Stair case climbing
 Bicycle
 Swimming
 Aquatic exs

29. 3)COOL DOWN PHASE
 Stretching
 Floor exs like pelvic tilting , partial sit
ups, hamstring stretches
 Breathing exs