PULMONARY REHABILITATION

SUNARYO B SATRADIMAJA, dr.Sp KFR

PHYSICAL MEDICINE AND REHABILITATION

FKUP/RSHS
 DEFINITION

COMPREHENSIVE TEAM APPROACH THAT

PROVIDE PATIENTS WITH THE ABILITY TO
ADAPT TO THEIR CHRONIC LUNG DISEASE, IT
INCLUDES MEDICAL MANAGEMENT, TRAINING
AND COPING SKILLS AND EXERCISE
RECONDITIONING

AGUSTA ALBA ;CONCEPT IN PULMONARY REHABILITATION, BRADDOM

 DEFINITION OF RESPIRATION

1. PROCESS OF MOVING OXYGEN FROM THE AIR

TO ALVEOLI OF THE LUNGS BY A MASS
MOVEMENT OF AIR AND REMOVING CARBON
DIOXYDE FROM ALVEOLI BY THE SAME
MOVEMENT

2. THE CIRCULATORY SYSTEM PROVIDE THE

TRANSPORT OF OXYGEN BETWEEN LUNG AND
THE TISSUE

H.FREDERIC HELMHOZ,JR, HENRY H.STONNINGTON

PULMONARY REHABILITATION, KRUSEN

 PHYSIOLOGICAL BASIC OF DISORDERS
OF RESPIRATION

1. INADEQUATE TRANSPORT OF OXYGEN IN AND

CARBON DIOXYDE OUT OF THE LUNG

2. RETENTION OF CARBON DIOXYDE

3. LACK OF OXYGEN
 THE CAUSE OF THE RESPIRATORY
DISORDERS

1. MUSCLE WEAKNESS OR INEFFICIENCY OR

INCREASING OF ELASTIC COMPONEN

2. INCREASE RESISTANCE TO AIRFLOW THROUGH THE

TRACHEOBRONCHIAL TREE
ELASTIC COMPONENTS ARE

 LUNGS
 THORACIC CAGE
 DIAPHRAGM
 ABDOMINAL COMPLEX
 ACCESSORY MUSCLES
 THE RESPIRATORY DISORDERS ARE
CLASSIFIED AS

1. RESTRICTIVE DISORDER

2. OBSTRUCTIVE DISORDER
 RESTRICTIVE DISORDERS ARE
CHARACTERIZED BY

1. AN INCREASE IN ENERGY REQUIREMENT TO

OVERCOME ELASTIC RECOIL OF LUNG OR CHEST
STRUCTURES AT ANY GIVEN VENTILATION

2. REDUCED VITAL CAPACITY

 OBSTRUCTIVE DISORDER
CHARACTERIZED BY

1. RESISTANCE TO AIRFLOW  AIRFLOW STOP BEFORE

EMPTYING IS COMPLETE  AIR TRAPPING

2. FIXATION THE CHEST IN A POSITION LARGER THAN THE

NORMAL END-EXPIRATION LEVEL

3. INCREASE IN THE FUNCTIONAL RESIDUAL CAPACITY

AND RESIDUAL VOLUME
 OBSTRUCTIVE DISORDER
CHARACTERIZED BY

4. FLATTENING OF THE DIAPHRAGM

5. LESSEN THE USE FULLNESS OF THIS MUSCLE IN

INSPIRATION
 PULMONARY REHABILITATION GOALS

1. AN IMPROVEMENT IN CARDIOPULMONARY FUNCTION

2. THE PREVENTION AND TREATMENT OF COMPLICATION

3. THE RECOGNITION AND TREATMENT OF STRESS AND

DEPRESSION, WHICH OFTEN CAN INTERFERE WITH
COPING MECHANISM AND INDEPENDENCE
 PULMONARY REHABILITATION GOALS

4. THE FACILITATION OF COPING MECHANISM TO

OVERCOME :

• ANY SENSE OF LOSS

• LOSS OF CONTROL OF PERSONAL AND SOCIAL
RELATIONSHIP
• SELF ESTEEM
• OR SENSE OF SELF WORTH
5. THE PROMOTION OF INCREASING PATIENT
RESPONSIBILITY FOR HIS OR HER OWN CARE AND
WELL-BEING INCLUDING ACCEPTANCE OF AND
COMPLIANCE WITH OPTIMUM MEDICAL CARE WITH
THE GOAL OF REDUCING NUMBERS OF
EXACERBATIONS, EMERGENCY ROOM VISIT AND
HOSPITALIZATIONS
 PULMONARY REHABILITATION GOALS

6. AN INCREASE UNDERSTANDING OF THE DISEASE AND

THE DISEASE PROCESS SO THAT THE PATIENT AND
FAMILY CAN CONFRONT IT REALISTICALLY

7. A RETURN TO WORK AND/OR A MORE ACTIVE ,

PRODUCTIVE, AND EMOTIONALLY SATISFYING LIFE
FOR THE PATIENT AND HIS FAMILY
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

1. MEDICATION (MOST OF THEM ARE DONE BY

PULMONOLOGIST)
2. EDUCATION
3. CHEST PHYSICAL THERAPY
4. UPPER EXTREMITY EXERCISES
5. RECONDITIONING
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

2. EDUCATION
- THE MOST IMPORTANT IS SMOKING CESSATION
- CHANGING IN LIFESTYLE TO ADAPT THE DISEASE
- UNDERSTAND THE DISEASE
- UNDERSTAND THE GOALS AND THE BENEFIT OF
THE REHABILITATION PROGRAM
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

3. CHEST PHYSICAL THERAPY

A. APPLICATION OF PHYSICAL METHOD TO THE
RESPIRATORY CARE OF PATIENS WITH
PULMONARY
DISEASE
B. THE COMPONENTS ARE
1. CONTROL BREATHING
2. CLEARENCE OF SECRETION
3. TRUNK FLEXIBILITY
4. UPPER EXTREMITY EXERCISES
5. RECONDITIONING
1. CONTROL BREATHING
- RELAX POSITION
- BREATHING EXERCISE
PURSEDLIPS BREATHING
SLOW DEEP BREATHING
DIAPHRAGMATIC BREATHING
SEGMENTAL BREATHING
DON’T PANIC :RELAX YOURSELF
DON’T PANIC : CONTROL YOUR
BREATHING
CONTROLLED BREATHING ACTIVITY
 DIAPHRAGMATIC BREATHING

http://thepeaceportal.blogspot.com/
SEGMENTAL BREATHING
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

2. CLEARENCE OF SECRETION
- POSTURAL DRAINAGE
- CHEST PERCUTION AND VIBRATION
- CONTROL COUGHING

3. TRUNK FLEXIBILITY
- NECK
- COMPONENT SHOULDER GIRDLE
- TRUNK
Postural Drainage
CHEST PERCUTION
CHEST VIBRATION
CONTROL COUGHING
TRUNK FLEXIBILITY EXERCISE
ACCESSORIES MUSCLES RELAXATION

1. Neck muscles
2. Shoulder muscles
3. Chest flexibility
Abdominal Muscles Exercises
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

4. UPPER EXTREMITY EXERCISES

A. STRENGTHENING OF THE UPPER BACK MUSCLES

B. STRENGTHENING OF THE UPPER EXTRIMITY MUSCLES

C. RANGE OF MOTION EXERCISE OF THE SHOULDER-

GIRDLE COMPLEX
Upper Extremity Exercises
 COMPONENT OF PULMONARY
REHABILITATION FOR OBSTRUCTIVE
DISORDERS

5. RECONDITIONING
AEROBIC EXERCISES
1. INTENSITY DEPENDS ON THE EXERCISE TESTING
2. DURATION 20 – 30 MINUTES
3. FREQUENCY 3 – 4 TIMES AWEEK

WALKING, JOGGING, CYCLING,

ERGOCYCLE,TREADMILL,SWIMMING, ETC
 WHEN ARE THE PATIENTS REFERED TO
THE PULMONARY REHABILITATION?

MOSTLY:
1. PATIENTS WITH DIFFICULTY IN CLEARING
SECRETION
2. PATIENTS WITH DYSPNEA AND HYPOXIC PANNIC
3. PATIENT WITH PULMONARY CHRONIC DISEASE
4. PRE AND POST THORACIC SURGERY