BREATHING EXERCISE

Seminar Delivered by : Dr. A . K . Tanaya (PT) MPT Student Hi Tech Physiotherapy College Bhubaneswar

INTRODUCTION AIM PRINCIPLES PRECAUTION CLASSIFICATION TECHNIQUE

INTRODUCTION
Exercises which are given to strengthen the respiratory muscles(diaphragm ,accessory costal & apical muscles)to maintain or increase the range of inspiration & expiration is called breathing exercise.

AIM

Strengthen the muscles of respiration. Improve ventilation, oxygenation & gas exchange. Lessen the work of the breathing. Teach active ROM exercises of the shoulder & trunk that help to expand the chest. Facilitate the deep breathing Improve pulmonary status & patients overall endurance Improve the ADL Promote relaxation Prevent pulmonary impairment Improve patients overall functional capacity

The breathing exercises are often associated with the postural drainage , respiratory therapy devices & medications.

INDICATIONS

Pre & post operative cardiac surgery conditions Acute respiratory distress Chronic obstructive pulmonary diseases ,asthma & bronchiectasis Pneumonia Ankylosing spondylitis Scoliosis,kyphosis which affect the respiratory function Nervous system deficits or trauma which cause weakness of respiratory muscles:

High spinal cord injury Acute , chronic or progressive myopathic or neuropathic diseases

Stress management Relaxation

PRINCIPLES

The instruction to the patient regarding the therapy should be given clearly & in simpler manner The treatment area should be quiet Explain the patient the importance of breathing exercise Patient should be comfortable & relax and wear loose clothing & avoid restrictive clothing Position of patient is crook lying in bed with head and trunk elevated to 45 degrees

PRINCIPLES ..contd

Abdominal muscles are relaxed when head & neck are well supported. Hip & knee are flex and legs are supported with a pillow As the patient is perfect in this position, progression is taught in other position like supine lying, sitting and standing position The patient is taught relaxation techniques The patient should practice on his/her own and should be perfect with the correct techniques

PRECAUTIONS

The expiration should be relax & passive We should never encourage the patient to expire forcibly, as this leads to increase airway resistance and bronchospasm The patient should not continue prolong expiration (as this mixes with the next inspiration resulting in irregular and insufficient breathing patterns) The patient should not use accessory muscles and upper chest to initiate inspiration To avoid hyper- ventilation ,the patient should practice deep breathing for 3-4times(inspiration & expiration)

CLASSIFICATIONS

Diaphragmatic breathing Segmental breathing

Apical breathing Lateral costal breathing Posterior basal breathing Lingular breathing

Ventilatory muscles training

Diaphragmatic training using weights Inspiratory resistance training Incentive respiratory spirometry

Glosso - pharyngeal breathing Pursed lip breathing

AIMS:

Improve gas exchange

Improve oxygenation Improve ventilation Improve ascent or descent of the diaphragm

Mobilize lung secretion during postural drainage

Decrease work of the breathing

PROCEDURE

Patient position:

Half lying supported by the pillow

Therapist position: Therapist stand besides the patient Technique:

Hand should place on rectus abdominis below the ant.costal margin Initially therapist place hand on pts abdomen & ask the pt. to inspire .so, abdomen bulges out & contract When pt. expire abdomen falls back to normal position Ask pt. to breath in through nose & breath out through mouth. practice for3-4 times

Initially therapist demonstrate the technique then train the pt to practice by keeping hands on abdomen& feel

Segmental breathing

APICAL BREATHING:

INDICATION:- Lobectomy patient position:-sitting,crook/half crook lying Therapist position:-stands in front of the pt.& applies pressure below the clavicle with the finger tips DURING INSPIRATION:-therapist applies the stretch downward & inwards to chest & muscles move in direction of outward & upward. This streches the external intercostals on the side of the pressure ,i.e right side or left side

UNILATERAL APICAL BREATHING:

DURING EXPIRATION: The therapist with palms gives firm downward pressure and the ribcage is moved downward and inward on the side of the pressure

BILATERAL APICAL BREATHING

DURING INSPIRATION: Therapist applies the stretch down ward and inward to chest and the muscles moves in the direction of outward and upward This help in stretching of inter-costal muscles on the side of pressure bilaterally DURING EXPIRATION: Therapist with palms give firm downward pressure and rib cage is moved downward and inward on the side of pressure bilaterally

APICAL BREATHING

LATERAL COSTAL BREATHING

This is also called as lateral basal expansion TYPES:UNILATERAL BREATHING:- Rt/lt side Position of patient:- Crook lying Position of therapist:- Stand behind the patient and hand is placed on the rt.side in case of rt.lateral costal breathing or lt.side in case of lt.lateral costal breathing. TECHNIQUE:- Chest move upward & outward during inspiration &move downward & inward during expiration.

UNILATERAL COSTAL BREATHING

DURING INSPIRATION:

Therapist applies the stretch downward & inward to chest Muscles moves in the direction of outward & upward.This stretches the external intercostals on the side of pressure. Therapist with palm give firm downward pressure & the ribcage is moved downward & inward on the side of pressure

DURING EXPIRATION:

BILATERAL COSTAL BREATHING

Therapist place both hand on the bilateral aspect of chest wall and firm pressure is given for Inspiration& expiration DURING INSPIRATION: Therapist applies the stretch downward & inward to chest & muscles move outward & upward.This help in stretching of external intercostals bilaterally DURING EXPIRATION:

Therapist give firm downward pressure and ribcage is moved downward & inward bilaterally

LINGULAR BREATHING
It is also called as right middle lobe expansion

Position of patient:- Sitting position Therapist position:- Stand behind patient & hand is
place on right side of the chest below the axilla

Procedure:-(during inspiration):- Therapist

applies the stretch downward &inward to chest &muscles move in direction of outward & upward.This stretches the intercostals on side of pressure.

During expiration:-Therapist give firm downward pressure

& ribcage move downward & inward on side of pressure

Ventilatory muscles training

Indications: Acute pulmonary diseases Chronic pulmonary diseases Weakness Atrophy Insufficiency of muscles of inspiration

Types:

Diaphragmatic training using weights:Position of patient:-supine lying Procedure:-put small wt of 3 to5 pounds over epigastric region. ask pt breath-in against resistance. Increase the no of time of resistance breathing. wt should increase gradually with time increase up to 15 min. this helps in strengthen the diaphragm.

Inspiratory resistance training

This technique done through breathing device called resistor. This resistor put in patient mouth & patient inhale through the device ,that give resistance to inspiratory muscles. If diameter is more narrower,the resistance should more require.there should be gradual increase in time i.e 20 to 30 min. Once strength & endurance is increase, then tube diameter is decrease.

Incentive respiratory spirometry:-also

called as sustained maximal inspiratory maneuever.

Glossopharyngeal breathing

Indication:Severe weakness of inspiratory muscles Spinal cord injury Post polio patient with inspiratory muscles weakness

Aim:To increase patient inspiratory capacity To prepare the patient for coughing To advise the patient with difficult deep breathing

Procedure:-Ask the pt.to take gulps of air.Mouth is

close & tounge move the air to pharynx,glottis gets open & air goes to lung.

GPB involves a series of gulps using the lips, tongue, pharynx, and larynx to pull air into the lungs when the normal respiratory muscles are not functioning. GPB consists of cycles of 6 to10 gulps of air followed by exhalation. Exhalation occurs when the glottis opens and the inflated lungs deflate passively due to the elastic recoil of the lungs. GPB allow an individual to perform a functional cough to clear tracheal secretions, increase the volume of the speaking voice, and maintain chest wall mobility.

Pursed lip breathing

Indications:Chronic bronchitis Asthma Bronchiectasis Cystic fibrosis bronchitis

Position of patient:-Sit
with relax position

Technique:-Therapist places
the hands on abdominal muscles & pt is ask to take deep inspiration & with the lips pursed patient is ask

BREATHING EXERCISE IN
ANTENATAL

PERIOD

BREATHING EXERCISE IN ANTENATAL

PERIOD

REFERENCES:Text book of physiotherapy for cardiac and thoracic surgical conditions By G.B.MADHURI

Chest,heart & vascular disorders for physiotherapist- Edtd. By Patricia A.Downie