Rehabilitation of

Pulmonary Diseases

Dept. Physical Medicine and

Rehabilitation Dr. Saiful Anwar
Hospital/ FK UB Malang

Medical Rehabilitation of
Pulmonary Diseases
To restore or prevent the remain of
disabled lung function due to
obstructive or restrictive disorder

Etiology
Restrictive pulmonary disorder,
especially due to thorax cage
abnormality.

Obstructive pulmonary disorder,

such as chronic obstructive lung
disease and asthma

Type of Lung Disorder

Restrictive Pulmonary Disorder
Pulmonary disorder with defect of function
because the lung does not inflate so
there is derangement of tidal volume,
vital capacity, tachypneu, difficullity in
deep breathing

Obstructive Pulmonary Disorder

Restrictive Pulmonary
Disorder
Extrapulmonal Type:
Pleural Effusion
Inflexible thoracic cage: pain in thoracic
cage, scoliosis, weakness of muscle
breathing, decreasing of diaphragm
movement

Pulmonal Type
Lung tumor, Atelektase, Pneumonia, Heart disease.

Atelectasis

Chronic Obstructive Lung

Disease
Chronic Lung Disease that cause

narrowing of airways, alter the

structure of alveoli and accumulation
of secret.

Type : Chronic Bronchitis; Empysema

Pulmonum; Bronchiectasis.

Medical Problem
1. Due to obstructive lung disease:
Decrease FEV1
Short of breath/dyspneu
Chronic accumulation of secreta
Prolonged expiration
Posture deformity
Decrease of endurance
Triad symptoms: short of breath, cough,
easy weak

Medical Problem
2. Due to Restrictive Lung Disorder :

Decreasing of vital capacity

Difficulty in deep breathing
Decreasing of thoracic cage mobility
Deviation of posture and shoulder
Decreasing of Endurance
Deconditioning Syndrome : decreasing of
fitness, cardiopulmonal and working capacity

Medical Problems
1. Sitting mobilization, walking and
2.
3.
4.
5.

standing are affected.

Problem in communication due to
cough and short of breath
Problem in ADL due to short of
breath and weakness
Problem in Vocational
Problem in Psychosocial

Protocol
Team Work
Chest Physical Therapy :
1. Relaxation Technique
2. Breathing Control
3. Breathing Exercise
4. Postural Drainage
5. Manual Technique
6. Cough Control

Patients with advanced COPD can develop an

increased anteroposterior
chest diametera barrel shaped chest

Indication for Chest

Physical Therapy:
1. COPD
2. Post Op. Thorax, Cardiovascular
system
3. Long standing lying down
4. Neuromuscular disease with
decrease of cough
5. Depend on ventilator machine

Relaxation Technique
Purpose:
1. To reduce tension of breathing muscle
2. To reduce anxiety.
3. To improve sense of well being
Position:

- Semifowler
- Side lying
- Manual strain on neck, shoulder and upper
extremity

Breathing Control
Breating Lower part of the chest
- Lower power

- Decrease short of breath

Advantages:
1.
2.
3.
4.

To reduce work of breathing

To reduce short of breath
To restore basal ventilation
To help normal breathing

Breathing Exercise
Patient is active during
inspiration and expiration as
Purpose : To achieve normal
lung function

The advantages of
Breathing Exercise:
1. To put off the sticky bronchial secrete
2. To help remove of secrete
3. To help inflation of lung
4. To mobilize thoracic cage
5. To restore ventilation-perfusion relationship
6. To exercise breathing muscle
7. To help patient to overcome short of breath

Postural Drainage
Definite position, so the gravitational effect can

help to expel secrete from lung region (according

to broncial anatomy)

Contraindication:

1.Hemoptoe
2.Severe Hypertension
3.Edema Cerebri
4.Aneurism aorta and cerebral aneurismal
5.Cor Aritmia
6.Lung Edema
7.Defect in esophagus diaphragm

Time and How Long?

In the excessive sputum condition , do

four times a day

Usually do twice a day, when wake up
in the morning, or before taking a bed
Do before eating
Nebulizer can be given before the
treatment is done
Do for 1 hour

Manual Technique
1.Percussion :
Clapping
Tapping

2. Shaking : rhythmical movement

down ward on chest with gentle push
3. Vibration : Soft vibration on chest
with ligth push

CONTRAINDICATION OF
CLAPPING
Tuberculosis
Lung Abscess
Broncogenic Carcinoma
Bronchiectasis with new bleeding
Newly post operation
Acute lung inflammation

Cough Control
Techinique

1.
2.
3.
4.
5.
6.

Slow deep breathing with diaphragm

Hold for 2 seconds
Do coughing twice, with slightly open
mouth
Pause
Inhale slowly
Take a breath

Endurance