งานนำเสนอเรื่อง: "Netraya Nimpitakpong MD., C.Ped. Physical Medicine & Rehabilitation Department, Faculty of Medicine, Thammasat University Netraya Nimpitakpong MD., C.Ped."— ใบสำเนางานนำเสนอ:
Netraya Nimpitakpong MD., C.Ped. Physical Medicine & Rehabilitation Department, Faculty of Medicine, Thammasat University Netraya Nimpitakpong MD., C.Ped. Physical Medicine & Rehabilitation Department, Faculty of Medicine, Thammasat University
What is Pulmonary Rehabilitation ? • Chest physical therapy • Home base exercise • Recreation activity • even Playing…
What is Pulmonary Rehabilitation ? • Chest physical therapy • Home base exercise • Recreation activity • even Playing… “GOAL” But need to be aim to “GOAL”
• Prevent airway obstruction • Improve airway clearance + ventilation • Reduce energy costs during respiration GOALS COPD & Asthma patient GOALS of Pulmonary Rehabilitation for COPD & Asthma patient
• Teach the patient how to deal with short-of-breath attacks • Improve endurance • Prevent accumulation of secretion & Increase the effectiveness of the cough mechanism Improve a patient’s overall functional capacity Improve a patient’s overall functional capacity
Normal Breathing Normal Breathing • Deep & slow rate • Quiet breathing & relax • Use normal respiratory muscles COPD & Asthma attack • Short shallow & rapid rate • Wheezing & restless! • Use respiratory muscles + Accessory muscles
How they feel when being breathlessness!! Increase respiratory rate lower alveoli ventilation & increase work load
How they feel when being breathlessness!! Breath in-breath out through mouse (instead of nose) Cold air cold airway increase bronchospasm Breath out …faster than normal collapse small airway & increase air trapping
Normal Breathing Normal Breathing • Normal airway diameter • Optimal secretion • Effective cough COPD & Asthma attack • Collapse airway diameter • Excessive and sticky secretion • Not enough breathing in Poor cough
ACUTE EXACERBATION!!! • When short of breath start….patient can feel scary. It helps the patient know what to do their can stay calm even they're short of breath. Pursed-lip breathing and diaphragmatic breathing will both help. These breathing methods prevent or reduce the trapped air in lungs, and allow patient to breathe in more fresh air. Thus teach them as the following;
ACUTE EXACERBATION!!! • Stop and rest in comfortable position, lower his/her head and shoulders Breathe in through the nose, and blow out through the mouth, breathe in and blow out just as fast as is necessarycomfortable position • Begin to blow out more slowly and for a longer time. Don't force it. Use pursed lip breathing, then slow rate of breathing downpursed lip breathing • Begin breathing through the nose • Begin doing diaphragmatic breathing and stay in this position for 5 minutes longerdiaphragmatic breathing
Comfortable positions when patient has short of breath • Sitting: 1.Sit with back against the back of the chair. Head and shoulders should be rolled forward and relaxed downwards. Rest the hands and forearms on thighs, palms turned upwards. Don’t teach them to lean on their hands ( นั่งเท้าคาง ) in this position. Their feet should be on the floor, knees rolled slightly outwards.
• Sitting: 2.Lean back into the chair in a slouched position, Head rolled forward, shoulders relaxed downward. Rest the hands gently on stomach. Keep the feet on floor, knees rolled outward 3.Place a pillow on a table and sit down, arms folded and resting on the pillow. Keep the feet on the floor or a stool, and rest head on your arms.
Sitting: – Lean back into the chair in a slouched position, Head rolled forward, shoulders relaxed downward. Rest the hands gently on stomach. Keep the feet on floor, knees rolled outward – Place a pillow on a table and sit down, arms folded and resting on the pillow. Keep the feet on the floor or a stool, and rest head on your arms. • Standing: 1.The same manner as the sitting can be used while standing, arms resting on kitchen counter or back of chair, not leaning, knees bent slightly, one foot in front of the other. 2.Lean with back to the wall, a pole, etc. Place feet slightly apart and at a comfortable distance from the wall, head and shoulders relaxed.
• “Keep doing pursed lip breathing until no longer short of breath” Let the air escape naturally- don't force the air out of lungs
• Breathe in slowly through the nose for 1 count • Purse lips as if you were going to whistle ( แบบผิวปาก, เป่าเทียนเบาๆ ) • Breathe out gently through pursed lips for 2 slow counts, breathe out twice as slowly as the breathed in ( ให้ง่ายหายใจเข้านับ หนึ่ง... สอง... หายใจออก นับ หนึ่ง.. สอง... สาม... สี่ )
• Let the patient sit and relax shoulders in a comfortable chair slightly lean backward for easy to breathing training. • 1 st step: Put one of patient’s hand on his/her upper chest, and the other on belly just above waist for monitor the movement of chest and belly while breathing.
• 2 nd step: Let them breathe in slowly through nose – instruct the patient that they should be able to feel the hand on their belly moving out but the hand on chest shouldn't move.
• 3 rd step: Breathe out slowly through pursed lips – instruct the patient that they should be able to feel the hand on the belly moving in as they breathe out.
Want to be stronger! Learn to improve pulmonary fitness and also effective coughing
• Sit down, head slightly lean forward, place both feet firmly on the ground. • Demonstrate a sharp, deep, double cough to the patient • place the patient’s hands on his/her abdomen, let them try to making ”k” sound this manner make the vocal cord tightening, closure glottis, abdominal contraction then patient can detect the feeling when vocal cord closing. Maintenance: Cough Training
• Breathe in deeply using diaphragmatic breathing & try to hold the breath for three seconds. • While keeping mouth slightly open, cough out twice. • The first cough should bring up the phlegm, and the second cough should move it towards the throat. • Take a break and repeat these steps once or twice if necessary
Chest mobilization • Limb & body movement synchronized with breath in and breath out • Improve chest expansion better ventilation & gas exchange
How do I stop my breathlessness? Learn to use Diaphragmatic breathing & segmental breathing technique Learn to relax by use the proper position & pursed lip breathing when breathlessness Learn to do the effective coughing