Intracranial pressure (ICP) > 20 mm Hg
Head and neck injury until stabilized
Active hemorrhage with hemodynamic instability
Recent spinal surgery (e.g .• laminectomy) or
acute spinal injury
Active hemoptysis Empyema
Large pleural effusions
Aged, confused, or anxious patients
Rib fracture. with or without flail chest
Surgical wound or healing tissue
Trendelenburg Position is Contraindicated for
the Following: .
Patients in whom increased ICP is to be avoided
Recent gross hemoptysis related to recent lung
Uncontrolled airway at risk for aspiration
Recent epidural spinal infusion or spinal anesthesia
Recent skin grafts, or flaps, on the thorax
open wounds. and skin infections of the thorax
Recently placed pacemaker
Suspected pulmonary tuberculosis
Osteomyelitis of the ribs
Coagulopathy Complaint of chest-wall pain
Effectiveness ( of considered technique
Ease (of learning and of teaching)
Skill of therapist/teachers
Fatigue or work required
Need for assistants or equipment
Limitations of technique based on disease type and severity
Costs (direct and indirect)
Desirability of combing methods
FACILITATING AIRWAY CLEARANCE WITH
EFFECTIVE COUGHING TECHNIQUE
What is cough….???
Stages of cough
Techniques of teaching effective coughing
self assisted coughing
TECHNIQUE TO FACILIATE VENTILATION
Mobilizing the thorax
Facilitating the accessory muscles of respiration
Standing upright position
Erect sitting (self supported or with assist) with feet
moving (e.g., active, active assisted or passive cycling
Erect silting (self-supported or with assist) with feet
Lean forward sitting with arms supported and feet
24S degree sitting with legs dependent
Erect long sitting (legs non dependent)
< 4S degrees sitting (legs non dependenl)
Prone and semi prone/side lying
FACILITATING THE ACCESSORY MUSCLES
To increase ventilation
Respiratory muscle weakness
MOBILIZATION AND EXERCISES
What is mobilization.?
Mobilization is defined as the therapeutic and
prescriptive application of low-intensity exercise
in the management of cardiopulmonary
dysfunction usually in acutely ill patients.
Primarily, the goal of mobilization is to exploit
the acute effects of exercise to optimize oxygen
Even a relatively low intensity mobilization
stimulus can impose considerable metabolic
demand on the patient with cardiopulmonary
In addition, mobilization is performed in the
upright position, that is the physiologic position,
to optimize the effects of being upright on central
and peripheral hemodynamics and fluid shifts.
Thus mobilization is prescribed to elicit both a
gravitational stimulus and an exercise stimulus
What are the exercises given
Exercise is the term used to describe the
therapeu tic and prescriptive application of
exercise in the management of subacute and
chronic cardiopul monary and cardiovascular
dysfunction. Primarily, the goal of exercise is to
exploit the cumulative ef fects of and adaptation
to long-term exercise and thereby optimize the
function of all steps in the oxy gen transport
TREATMENT PRESCRIPTION FOR
MOBILIZATION AND EXERCISES
It depends on the patient’s condition
Whether the patient is in patient or in out
Also it depends on the functionality of the patient
at the present stage
It is decided on the basis of the exercise testing
Also on the basis of METs
Identify all the factors underlying the pathology causing
deficits in oxygen supply.
Determine whether mobilization and exercise are indicated
and if so, which form of either will specifically address the
oxygen transport deficits identified in Step I.
Match the appropriate mobilization or exercise stimulus to
patient's oxygen transport capacity.
Set the intensity within therapeutic and safe limits of the
patient's oxygen transport capacity.
Combine the various body positions especially in the erect
position with the following maneuvers:
Set the duration of the mobilization sessions based on the
patient's responses (i.e., changes in measures and indices of
oxygen transport) rather than time.
Repeat the mobilization session as often as possible based on
its beneficial effects and on is being safely tolerated by the
Increase the intensity of the mobilization stimulus. duration of
the session, or both comml!l1surate with the patient's
capacity to maintain optimal oxygen transport when
confronted with an increased mobilization stressor, and in
the absence of distress; monitored variables to remain within
predetermined threshold range.
HEIARCHY OF TREATMENT FOR OXYGEN
PREMISE: Position of optimal physiological
function is being upright and moving.
Mobilization and Exercise
Breathing Control Maneuvers
To minimize the work of breathing. of the heart.
and oxygen demand overall
ROM Exercises (Cardiopulmonary indications)
Postural Drainage Positioning
PARAMETERS FOR TREATMENT PRESCRIPTION
IN THE MANAGEMENT OF CARDIOPULMONARY
Define parameters of treatment based on history,
laboratory investigations, tests, and assessment
Intensity (if applicable)
Instruct patient in "between treatment"
treatment, and if applicable the nurse. a family
member. or both
Reassessment every treatment
Modify as necessary within each treatment
Progress between treatments as indicated
Define treatment outcomes
Determine when treatment is to be discontinued
Request for additional supportive information. tests, and
investigations as indicated
Predict time course for optimal effects and course of
treatment to determine treatment efficacy; modify as
In conjunction with other interventions (e.g., medical,
surgical, nursing, respiratory therapy (weaning oxygen
sympathomimetic drugs, ADLs, balance with sleep and rest
periods. peak of nutrition and feeds. Peak energy times. peak
of drug potency and effects (e.g., pain, reduced sedation.
reduced neuromuscular blockade)
..Desktoppep on cystic fibrosis.pdf
..DesktopThe active cycle of breathing
Principles and practice of cardiopulmomary
physical therapy 3rd edition Donna Frownfelter
Physiotherapy for respiratory and cardiac
problems 3rd edition by Jenifer A Pryor
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