pOMS Page tlo.

15
Date/

Breathing Exercise
Breuthingexercise Cand Yentilekory
trining Cre undanmentul intex uentior
the Prevention Hcute-
or
Cind Chran Dulmonur diseusse
Muinly for CopD C hranicbronthitis,|
Cmphysemc Cnd asthma) putie t
lith high Spinal
Cord lesion
and Who under ent thorucic n d
cahdominal uge und bedridd en
potient s

SLudies indicate thut brethi

CXerciSe und Yentrilutory. training-
have uttect Cand olter
Dutienks rate_ nd deptba
Ventilution Ehese kechniqu
15 uses to LmproVe the
pulmonury Shutus and ncrese
patients OVerlo ad enduran Ce

rouls of reuthng exer C Se-

mproe Nentilution
LhcreuSe the effectiveness of
Cough nd Pro mo te Cairi
cy-
Cleurunle.
Toprevent
Pulmanr Complicutians 0pDerive
euntain Cand
thoracic mobility impyae Chest and
P
Promete reloxation_ relives
Stress

Assisting n
_Yemayal
Secretion-
Lorr ect ubner mal br eathing
Cand decr eaSe- Ehe
puttern-
alark
Cretoin

zuideline for teuchig

rectbing CxerciSe

ChoosSe uite Cureu to

get -proper 1ntepcLct on
with
mnmncl distraction
Explun Ene Outieg Abaut the
Cnd how it LorHS. tor
his mairmentE

Flave Ehe putien.tE Felcxed

Positicn Land loosen the lothes

 oMSage No. [Ss2
Dato

Mahe Semiflowlers Position

ith heud nd trunk elevuted
Cp.r.ox 5 Lo.tu Support oempizesu
to the
heud Cun d
runk Cind
lexing
the hip Cand Knees. with pillow
Suppoxt D the abdomina Muscle
DeCome elaxed.

Other PositionG Such uS Supine

GtLing
use
Or Gtandin4
the
m be
Potient Proess.es
uring treutment
ObServe Cno CACCe SS the Patients
Spontaaeous breuthing- puttern
Lwhile ut rest aHd during Cuctiui ty
neCesS uru teuch the Patien t
eluxution telhniqueS relux. he
MscleS Of
and
upper tho ra neck
Shou ldey. to minimize.
USe the
CUCeior Musle

Speciul OLention
upper uezius Glernocleidomtord
Supulue.
Cand levuto

DemonStrule the bre thin Puller n

to the potient.
Preution S www.

Never ullou the. uti.ent

Horce expiraki on. -it. inirecse-
the tur bulence Ln the.
which leud s
Cn CAr lal- resis tonce
bronchospusm

Aatoid prolonged expirctian it

Cuuse the potient gruSp
hlith the _next inspiratiod and_.
breathing puttern ecome irregulr
nd ineicient

Oo nat- allo the Patient- to

initiat.e inspirution- with aLessor
Muscles and_ upper Chest dvice
nim thut Chest 2houldd
be quite during breathing-
Allew the putient Pertor m
deep breu thivag-
Cvoid
only Sor -
p e x g u e n t i |ation.
4 times

NechuniS kameeibe
noyMal breuthing
The ung expund during Gprution
Cnd retrac
during the Cxpirca tion
 Date 154

[his_ Movemen is 4overened by-

uctors by
Aieruking the Ccpucityo
Cre brought- Cbolut b
thorax
MoveMent_
of thokax Coity Create
Dasitiualu intrutharuid Pressuye
hich Suc ks nto the ungS
movement OCLur ut Costo ven.triular
Cnd munubriosternal vointS

Elastic
Cand at
recoil
Pulmonuvy- alveali
the thoraicic wll which_
Qxpels i Out_ rom
uring xpikution. ungs

Muscles f Ne Spircotion
nspiration
Primuru Muscles Qiuphrugm
Sculene
Paruskenul
Hcessor4 Musces -SEernocleidomestoid
upportropezilus
Pectozulis muior
Pecko pds mina
Suhcloiks
Pxtenuinter Costul.
 er

txpiration
trimar Muscle Nom Cac.t.ivin9
urina
esting expia ti on

cceShor muscles Abdomi nals

- Rectus including
Abdamins
257
runsverse ubde mins
Lnternal Cnd exter ne
oblique
-
Peckoralis
Inter nal
MaA
inte Cos ls.

CnungesS horatci dur in

th PrOCes of reathg

Euch i6s us it putLern

of movement.. he ribs lluch
Cunternr Sternu exLept th
and 12h ribs Cand Pasteriory
Verke byul bodies disC Cand
roCesS
 Thorax enlurges in cll t h e three
plune during inspikation

LntreuSe in unteropaster
ior diumeter
n_Lontrution of extern interCosta
Muscle Cand elevetion ribs CLnd_
Lupard and toracrdd Mov ement of_
Sternum

-This Move ment Called uS Pump

hundle Move men t

inreuSe_Anterior DoSterior diameter

thoruX
ncea5e n transyerSe
Diameter
he middle shus!
lies Ot - the ribs
loJer level
plone hun the
S6 during Pussingeleyotion
thraugh to ends
of ribS the
Shuft also Moves OutiuY d
This intrese trung verSe
thorux diameter
This. Move ment 19 Culled
bucket hundle movem ent
The lower rib S-10 hich re
no diretly uttached ko Gkernumn
nCreuse ubcosts angle.-
ncreuSe. Verticu *****"***

diumeter

The diu phrug.m decends he

Muscle Contructs during inspiratian-
itiS descibed s piskon CCtion.

Elevution riSk ntreuse Vertebral

dimension thoraX and improve

ettectieness of diuphrugm-

AL the end inSDiru tion muscle

to
relay and the ribs peturns
their resting Position

4pes Breuthing eXerc1Se

ure tour tpes

-lhere
@Xer LiSe
breuthin
D Diuphrug.mutic Brething-
Segmentul reuthing
L Apic Oreathn4-
LuterclLost -expunSion-
busu expunsion
steriox
Cslo SSo phurange4 Gresthimg
Pur sed p Brecthing
 Diadhrug.matic- Breakhi
iaphragm 14 the primax Muscle
Of brecthing

Diaphragm Lontrols breuthin un

involuntur leve u kient i t h
Drimar Dulmonur 4 diseuse k e CoPD
Lan taught breuthiag Londral by
OPtima
reluxution diaphragm und
alcesory muscles.
Dicphrpmutic
exereise Care
breathinge _
uSe
in Dulmonar mabili2e ung
to
SeLretion
J diseuse
Proredure
-Pre pure the Qutient
reluxed und
Comtortuble position_ in lhich he
grety ussist the
emilo wer Doitiona diaploragmn Such
O notice
actiuation uny ALLeL20ru Musce
Stop him and do
relaxution echniques
Ploceye
Chdomin
hund
Just
Oer
belau the rectus
the Lunterio
Costal Murgin osk he Potient
breath Slowlyunddeeply noSe
 T*

by Keepi.ng Ehe Shoulder relx

unper Chest quiet
No SK him. to Sloy let ull
the air Out uSing Contro ed expixution
throuah mouth

Have Ehe putient practice this

3 to times_Cund then
then estE ww.mvnm

After he Putient understunds uind

uble to Contro breuthin Using
using
diuphrngm.cetic
uttern AeefPing-
the Shoulders relaxed pructice-
diuphrug mutic breathing n C

o 0ositions ke Sitting
- -
Gtandin

To increase C iCien.cu ventilu tion,

To decreuse - -
lerk of orething..
****

-lo incyease he -

eXChuvage- Cund

OKygenatioh.

To mobilise the Secretions durin

poskure drain cae-
2 Segmental Yreut.hing
I is Reriormed On Segment
Jung Ox Secretioan of.
Chest Nul necds norcus.ed
Nentilution Or nOve Ment.

Taio LXumples breathiag- thcdturget

the latex and Oosterlor Segment o f
bhe Idiwer lobes and upkul Cnd
ingula SEgnei he upperlobe
Care describ.eg

LulerlLasta XDn5ion
i s also Called the luker
basal Cxpunsion

Can be done by uni lutehally-

Cand bilutercelly

ProCedue
-The Ahiend May be Sitking
hoakkying Dositian

Pluce our unds Cilon- the ateral

Cspect he lodex rihs
Askthe
Cund teel
patient breath out
he ib MOve
Onlcer ds CAnd
Ccge
nwag.

he atient breaths ut-

lace donward p r e ssure. into

the ribs with- the palms

Apply Light ManucL resis t ante-

increcSe- ensor
Ehe loywe pib
khe- pctient oreuthS
und the Chest expun.d
in decplu-
Cund ibS
 T
T

Posterior busl expunsion

Hcaue the Putient Sit und eun
*o lalurrd
bending-
on
the
C

hips
pillowSlightly-
Pluce yor unds ONer the posterio
aSpect he owe ribs

This torm Segmentul Drecthing-

5 imp.orkent tor the Dos Sungica
Dutient lho Contines to be
C
in emiuprigh poStlon an-
extended Deriod of time

ecretion 5 CacCumulates in the

DoStepior Segmenbs the lowey
rib5

Linqua expunsion LRagh middle Jobe

Potient Sitting Position.

Pluce 4our hnds

the lest
at
Sidc
either
of
the
the
right Or

puti ent S chest Just belo the

CLxilla

Pro cedure
Folow the Gome
exponslon
tor luterul . busul
Apial expunSion
Apply pre5sure uSually uniluterully
belo the Cluvi cle with the inger
kips
This
upica
pattern isuppropriute
utter lobectom,
pneumthorux

3 Tlos5 opharunge Breuthin4

Lt i5 C Mean ot ncreaSing -
Patients inspirator Cupacity when
there Severe Weukne55 O the
Muscle nspirution-
It is aught to Putient Jho
hove difficulty dee
intuking deep
breuth or in pre parcatian
Cougking
Pro cedure

The patient tuhe in Severcl

gulps of

Then the mouth Closed and

the tongue Pushes the Ci bach
Cand traS it the phurynX
The r- then oxced into
he lungs when the 4latkis
Dened

his increase the depth the

ingpiration und patienAs. Nital
Cupcacity-
This echnique is
Ner diffiult
to teach and learrns

Pursedlip Breuthing-
IL is to help
tuugh
Datien t with Chronit obStrultion-
Qulmonuru diseuse deud i t h attecks
Shortnes5 oreuth

Procedure
Huve the putient CSSumne
Lomor tuble Posikion und relax
muth possible

-Expluin the puti ent thce expiration

relaxed
Must be and that
Contruckion oB the Cinimels must
be avoided
Pluce your hund 0Ver the
abd.ominul MuSle s patients
to delect
Cn y Contvactio n the usdominul
Lnstruct the putien -
breuth
in Sloly und deep y
hen huve he Putient loosel
purse the lips and exhale

ndicutions
Cystictic tibrosi
2Bronchiectasis
3 Lung akses5
h Preumanius
Hcut e ung diseuse
CoPD Cmphysem a Chronic ronchitis
A cluxuton proLe dure
SFor putient With high Spinul
Cord lesion Spinul Cord in ur yMyoputh e
For put ents Who Must remai n in
bed or Cxtende perlod time

Contru indicutions
Severe Pain nd discomdo rt
2 Acute mediu Or
rutient wth
Surgicul emerAEnLy
redued Consci ouS lev.el