1. Breathing exercise

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II. ????????????????????????????
1. Breathing exercise 2. Glossopharyngeal
breathing 3. Positioning 4. Incentive
spirometry 5. Swedish pleurisy ex. 6. Chest
mobilization
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II. Increase lung volume techniques

• II.1 Breathing exercise
• Diaphragmatic breathing exercise
• Costal breathing exercise

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Advantage of breathing exercise

• lung / chest compliance
• improve ventilation, increase oxygenation
• TV
• Prevent pulmonary complication
• work of breathing
• ex. endurance
• strength , coordination and efticiency of
  respiratory m.
• improve relaxation
• efficiency of cough mechanism
• maintain or increase chest expansion

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Diaphragmatic breathing exercise

• ??????? Relax comfortable position
• (Sitting upright)
• Inspiration - by nose - elevate abdominal
• Expiration - by mouth - flat abdominal
• no use upper chest elevate shoulders

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Costal breathing exercise
Upper costal br.ex. Bilateral costal
br.ex. Middle costal br. ex.
Lower costal br. ex.
Anterior upper costal br. ex. Unilateral
costal br. ex. Lateral upper costal br. ex.
Lateral
lower costal br.ex.
Posterior lower costal br. ex.
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II.2 Glossopharyngeal breathing
????????????????????????????????????????????
??????????????????? high SCI. ????????????????????
???????? ????? ?????? ????????????????????????????
???????????????? glottis ??????? 6 - 10 ?????
/?????? ????????? 6 ??????/ ???
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II.3 Positioning

• ???????????????????????????????
  Ventilation
• Sitting upright
• Supine
• Rt. Side lying
• Lt. Side lying

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II.4 Incentive spirometry
Aim chest expansion Prevent post -
op Pulmonary complication ???????
????????????????????????? (Inspiration by mount)
- ??????????????????? 2-3 ??????
- ?????????????? ???????? 6
?????/?????? ???? ???????
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II.5 Swedish pleurisy exercise

• Aim chest expansion
• remove fluid in pleural cavity
• ??????? ?????????????????-?? ???????????????????
  ?
• ???????????
• ????????????-?? ???????????????-???
  ?????????????? l ???????????????????????????
  ???? ???? reabsorption ???

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??????? Side lying to no ICD side
1) Side lying , midposition Sh. Abduction - I
-nose Sh.Adduction - E - mouth 2) Side lying ,
lean backward Sh. Abduction - I - nose
Sh. Adduction - E - mouth 3) Side lying , lean
forward Sh. Flexion - I - nose Sh.
Extension - E - mouth ??????? ?? 15 ????? / ???
????????? 4 ??? / ???
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II.6 Chest mobilization

• Aim Maintain or increase chest expansion
• Active chest mobilization
• Passive chest mobilization

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Active chest mobilization

• Good conscious, Good communication
• Good active movement
• Stretch anterior and posterior chest wall
• Stretch lateral chest wall
• Stretch posterolateral chest wall
• Stretch anterior and posterior upper chest wall
• Stretch posteriorlateral upper chest wall

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Passive chest mobilization

• Unconscious , Poor communication
• Stretch anterior rib cage
• Lateral trunk flexion
• Trunk torsion
• Dorsal hyperextension
• Rib torsion
• effective infants pre - school patients

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III. Decrease work of breathing techniques

• III.1 Breathing control
• III.2 Relaxation technique
• III.3 Pursed lip breathing ex.

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III.1 Breathing control
Aim work of breathing
Bronchospasm ??????? ??????????????????????????
?????????????????????????????????????
????????????????????? ??????? Sitting , full
support c knee slightly flex. TV.
Breathing , I - nose - elevate abdominal c lower
costal expansion
E- mouth - downward abdominal c lower costal
expansion
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???????????????? breathing control
????????????????????????? - Dyspnea
- wheeze - Severe
bronchospasm ???????? ??????? 10 - 20
s. ???????? ??????? 5 - 10 s.
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III.2 Relaxation technique
???????????????????????????????????????? Aim
improve relaxation work of breathing
bronchospasm ?? 6 ??? - Upright
position - High side lying
- Sitting lean forward , forearm support on the
table
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- Sitting lean forward , forearm support on
the thigh - Relax standing or Back support
- Standing lean forward , forearm support
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III.3 Pursed lip br. ex.
??????????????????????????????????? (????????)
?????????????????????? Aim air
trapping tidal volume
RR. improve br. pattern
improve ex.. tolerance ????????????? COPD ,
asthma, bronchiectasis
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IV. Increase strength, endurance and efficiency
of respiratory muscle techniques
IV.1 Inspiratory muscle trainers (IMTS) IV.2
paced breathing exercise IV.3 Increase strength
of respiratory muscles
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IV.1 IMTS
?????????- ?????????????????? ???????????????? 6
?????? ???????? Upright ????????????? ET tube ,
TT ???? ??? ??? 6 ????? / ?????? ????????? 6
?????? / ???
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4.2 Paced breathing exercise
????????????????????????????????? ???????????? Pr
ogress ??? - ???????? - ?? ?????
- ????????????????
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IV.3 Increase strength of respiratory m.
??????? ??????????????????? ?????? ???,
??????? , ??????????????? ???????
Supine ??????????????? Progress
????????????? ???????????????????????????????????
??
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Reference
1. Barnes TA, Thomas AB. Core text book of
respiratory care practice. 2 nd ed. St. Louis
Mosby - Year Book , 1994 199 - 211 2. Eubanks
DH., Bone RC. Comprehensive respiratory care. 2
nd ed. St. Louis C.V. Mosby, 1990 511 - 36
3. Gaskell DV, Webber BA The Brompton hospital
guide to chest physiotherapy. 4 th ed. Oxford
Blackwell Scientific Publication, 1980 13-29
4. Hillegass EA., Sadowsky HS. Cardiopulmonary
physical therapy. 2 nd ed. Philadelphia W.B.
Saunders , 2001 647 -59
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5. Irwin S, Tecklin JS. Cardiopulmonary physical
therapy. 3 rd ed. St. Louis Mosby- year Book ,
1995 356 - 70 6. Kisner C, Colby LA.
Therapeutic exercise foundations and techniques.2
nd ed. Philadelphia F.A. Davis , 1990 577 -
614 7. Pryor JA , Webber BA. Physiotherapy for
respiratory and cardiac problems. 2nd ed.
Edinburgh Churchill livingstone , 1998 137 -
69 8. Scanlan CL, Wilkins RL, Stoller JK. Egans
fundamentals of respiratory care. 7th ed. St.
Louis Mosby , 1999 771 - 811
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Thank you