المساعد الشخصي الرقمي

مشاهدة النسخة كاملة : العلاج الطبيعي للصدر


salo_spin
12-01-2007, 03:35 PM
Chest physical therapy

Multifaceted area of professional practice that deal with the evaluation and treatment of patients of all ages with acute chronic lung disorders .
Goals: prevent airway obstruction &accumulation of secretion that interfere with normal respiration
2-improv endurance and general exercise tolerance
3-reduce energy costs during respiration through breathing retraining
4-privint or correct postural deformities associated with respiratory diseases
5-promterelaxation
6-improve cough affectivity
Maintain or improve chest mobility

Birthing RETRAINING :
Ventilator muscle training improves the efficiency of breathing by decreasing the work of breathing
Aspiratory muscle trainers –decrease o2 consumption of ventilator muscles during respiration
abdominal weights -increase efficiency of diaphragm birthing
Decrease use of accessory muscles biofeedback
Pursed lip breathing -decrease respiratory heart ;increase tidal volume
Birthing retiring in differed **** position
Birthing exercise
-diaphragmatic birthing –patient can be taught voluntary control by correct use of diaphragmatic and relaxation of accessory muscles
Patient is positioned in relaxed position with hand placed on the rectos abdomens just below the anterior costal margin .maybe done in sitting ,standing or during activity.
Lateral costal expansion (lateral ****l expansion )
Hands are placed along the lateral aspect of the lower ribs and patient is asked to breathe out feeling the the rib cage moving downward and inward .
b.poseterior basal expansion
hand are placed over the posterior aspect of the lower ribs
c. right middle lob of lingual
hands over the (R) 0R (L) SIDE OF THE patient’s chest just below the axils
d . apical expansion
pressure placed at clavicle with fingertips.useful in apical pneumothorax after lobotomy
.glosspharyngeal breathing -means of increasing a patient aspiratory capacity when there is severe weakness of the muscles of aspiratory capacity when there is severe weakness of the muscles of aspiratory
-patient takes in several gulps of air .mouth is closed and tongue pushed far back and traps it in the pharynx
Air is forced into the lungs when the glottis is opened
pursed lip breathing –patient is instructed breath in slowly and deeply have patient loosely purse his lips and exhale : avoid using abdominals to force expiration
COUGHHING EXERCISES :
1- manually assisted cough –manual pressure applied over abdominal area
2- splinting -hand pillow firmly placed over incision to support painful area as he coughs
3- humidification –maybe through ultrasonic nebula zed therapy
4- TRACHEL TICKEL-fingers placed at the sternly notch and apply a circular motion with pressure downward into the trachea to facilitate a reflexive
AIRWAY CLE ARANECE
1-COUGH –simplest way of airway clearance
Deep inhalation ---close glottis –clearance
Release glottis –expel air –abdominal muscle contraction

2-huff same with coughing but with the glottis open
Aids in stabilizing collapsible airway walls .in COPD
3-tracheal STIMULITION
Apply a quick pressure over the trachea above the supernatural notch mannerism in young patients with neuralgic deficits
4-ASISSTED COUGH –fisted hand is positioned below the xiphoid process: pushed upward and inward as the patient exhales :in SCI patients with weak abdominal muscles
5-SUCTIONING –invasive :least desirable
ECRTION REMOVAL TECHNIQUES
Excessive pulmonary secretions
1- aspiration
2- telecasts caused by mucus plugs
postural drainage
the patient is varying position for optimal gravity assisted drainage of the secretions and increased expansion of the involved segment
duration :usually patient is maintained for 20 minutes per postural daring position daring position
anterior apical segment of the upper lobs .
patient is seated : leaning backward by billow approx .45 percussion is applied directly under the clavicle .
posterior APICAL SEGMENT –UPPER LOBES
patient is seated : leaning forward onto a pillow .percussion is done over both sides is the back above the scapula with the fingers curving a little over the shoulder >
INTRODUCTION:
salo turkmany

rainy
12-01-2007, 08:25 PM
اشكرك اختي العزيزه

Dr.Sultan
12-02-2007, 07:55 PM
موضوع جدا مفيد شكرا لك
وهذه اضافة اخرى لنفس الموضوع ولاهمية للاخصائيين والفنيين

Chest physiotherapy (CPT) is a means of clearing the lungs of accumulated mucus. It uses gravity and physical therapy to help move the secretions out of the lungs and stimulate coughing. It is used for persons with increased amounts of mucus or thick secretions, those with weak breathing muscles, or individuals with ineffective coughs. CPT consists of clapping, vibration, deep breathing, and coughing.

Clap ping With the Cupped Hand

Clapping with the cupped hand on the chest wall over the section of the lungs to be drained starts vibrations which are transmitted to the air passages (bronchi), stimulating the movement of secretions. These vibrations may help to remove secretions sticking to the walls of the air passages.
The hand is cupped by holding the fingers together so that the shape of the cupped hand conforms with the chest wall. The cupped hand tends to trap a cushion of air which softens the blow of the clapping. Clapping should be vigorous but not painful. Clapping should not be done on bare skin, but over soft comfortable clothing or towels. Rings should be removed before clapping. Ribs are strong and flexible but can be broken by a blow with the hand. The cupping technique cushions the blow of the hand during clapping by trapping air between the hand and chest wall.
Vibration

Vibration is more difficult than clapping, but is valuable because it helps stimulate the flow of secretions. The assistant presses flattened hand firmly over the proper section of the child's chest wall, then tenses his upper arm and shoulder muscles (isometric contractions). At the same time, the child should make an "fff" or "sss" sound as he exhales as slowly and completely as possible.

Deep Breathing

Deep breathing assists in the movement of secretions and may stimulate coughing. With inhalation (breathing in), the airways widen and lengthen; with exhalation (breathing out), the airways narrow and shorten. A forced but not strained exhalation following a deep inhalation may move secretions and may stimulate a productive cough. An effective cough is an essential part of clearing the airways.
Cough

An adequate cough is an essential part of the chest physiotherapy program. The ability to cough effectively is the major defense against retaining mucus in the lungs. An effective cough is accomplished by taking two or three deep breaths, exhaling slowly, followed by a deep intake of breath and a deep cough. This should be done at least two times, or more as necessary, following chest physiotherapy. To minimize the chance of vomiting, chest physiotherapy is best done before meals or no sooner than one hour after eating. Early morning and bedtime are usually recommended. CPT exercises before bedtime help clear airways of accumulated secretions and may reduce nighttime coughing.
Mechanical Percussors/Vibrators
Various mechanical percussors and vibrators are available commercially, but your physician should be consulted before any purchase is made.

CPT Do's and Dont's
The chest should be protected by one layer of clothing or by a towel. This prevents irritation caused by clapping the bare chest with the hand. Clap over each area shown in the illustrations for one minute with a cupped hand.
Vibrate over each area following CPT five times while child is exhaling.

CPT is to be done prior to meals or no sooner than one hour following meals, to prevent vomiting. Do not clap over any bony portions of the chest, for example, the breastbone or the spine. Never clap below the bottom of the rib cage. Encourage the child to cough following CPT.

Upper Lobes
Child is in sitting position. Clap over upper shoulder and blade on each side of the back.
Child lies flat on back. Clap just below collar bone on each side of chest.

Middle Lobes
Child lies head down, on his side and rotates 1/4 turn backward. A pillow may be placed behind child for support. Clap over the nipple on each side.

Lower Lobes
Child lies head-down, on his side. Clap on lower part of chest toward the front, and upper part of chest on the back. Since these two positions are done at the same time, allow longer time for clapping (2-3 minutes).
Child lies on abdomen in a head-down position. Clap on lower back on each side of spine.

salo_spin
12-03-2007, 06:19 AM
شكرا لك
الله يعطيك العافية ومنك نستفيد

* * big star * *
12-17-2007, 01:51 PM
.................... موضوع أكثر من رائع ..........بوركت جهودكم ....................

salo_spin
12-17-2007, 01:54 PM
شكرا لك اختي الكريمه بارك الله فيك ويكتر من امثالك

منى
01-04-2008, 12:38 PM
يعطيك العافية اخي الكريم

salo_spin
01-04-2008, 02:06 PM
شكرا لك دمتي بود

ميسون محمد
09-13-2010, 10:04 PM
بسم الله الرحمن الرحيم شـكــ وبارك الله فيك ـــرا لك ... لك مني أجمل تحية .

lanbash
09-18-2010, 05:46 PM
شكرا على كل هذه المعلومات

jarelnabi
11-15-2010, 10:38 PM
موضوع رائع .. رائع