Many factors contribute to a patient’s postoperative impairments, any one of which influences postoperative management. A patient who has undergone thoracotomy for a pulmonary or cardiac condition typically is hospitalized for a week or less.  Therapeutic interventions begin on the first postoperative day and include breathing and coughing exercises, shoulder ROM, posture awareness training, and […]

Restrictive pulmonary disorders are characterized by the inability of the lungs to expand fully as a result of extrapulmonary and/or pulmonary disease or restriction. In other words, the patient has difficulty taking in a deep breath.
Acute and Chronic Causes of Restrictive Pulmonary Disorders
There are a variety of acute or chronic disorders directly involving structures of […]

Chronic obstructive pulmonary disease is a broad term encompassing a number of chronic pulmonary conditions, all of which obstruct the flow of air in the conducting airways of the lower respiratory tract and alter ventilation and gas exchange. Although a variety of pulmonary diseases are classified as obstructive in nature, each disease has its unique […]

Some patients who require postural drainage cannot assume or cannot tolerate the positions optimal for postural drainage. For example, a patient with congestive heart failure may exhibit indications of orthopnea (shortness of breath while lying flat). After neurosurgery a patient may not be allowed to assume a head-down (Trendelenburg) position because this position causes increased […]

Positions for postural drainage are based on the anatomy of the lungs and the tracheobronchial tree.
RIGHT AND LEFT LOWER LOBES
The patient may be positioned on a postural drainage table that can be elevated at one end, a tilt table, a reinforced padded table with a lift, or a hospital bed. A small child can be […]

Postural drainage (bronchial drainage), another intervention for airway clearance, is a means of mobilizing secretions in one or more lung segments to the central airways by placing the patient in various positions so gravity assists in the drainage process. When secretions are moved from the smaller to the larger airways, they are then cleared by […]

An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear. Airway clearance is an important part of management of patients with acute or chronic respiratory conditions.
The Normal Cough Pump
A cough may be reflexive or voluntary. When a person coughs, a series of actions occurs Under normal conditions, the cough pump is […]

Chest mobilization exercises are any exercises that combine active movements of the trunk or extremities with deep breathing.21,60 They are designed to maintain or improve mobility of the chest wall, trunk, and shoulder girdles when it affects ventilation or postural alignment. For example, a patient with hypomobility of the trunk muscles on one side of […]

Inspiratory resistance training, using pressure- or flow-based devices to provide resistance to airflow, is designed to improve the strength and endurance of the muscles of inspiration and decrease the occurrence of inspiratory muscle fatigue. This technique has been studied in patients with acute and chronic, primary and secondary pulmonary disorders, including COPD, cystic fibrosis, respiratory […]

Positive expiratory pressure breathing is a technique in which resistance to airflow is applied during exhalation, similar to what occurs during pursed-lip breathing, except that the patient breathes through a specially designed mouthpiece or mask that controls resistance to airflow. This breathing technique is used to hold airways open during exhalation to mobilize accumulated secretions […]

Many patients with COPD (e.g., emphysema and asthma) may suffer from periodic episodes of dyspnea (shortness of breath), particularly with physical exertion or when in contact with allergens. Whenever a patient’s normal breathing pattern is interrupted, shortness of breath can occur. It is helpful to teach a patient how to monitor his or her level […]

Breathing exercises and ventilatory training are fundamental interventions for the prevention or comprehensive management of impairments related to acute or chronic pulmonary disorders. For example, these interventions are frequently advocated in the literature for patients with COPD (chronic bronchitis, emphysema, asthma) or cystic fibrosis, for patients with a high spinal cord lesion, for patients who […]

Breath sounds are classified by location, pitch, and intensity as well as the ratio of sounds heard on inspiration versus those heard on expiration. Breath sounds also are identified as normal or adventitious (extra).
Normal breath sounds occur in the absence of pathology and are heard predominantly during inspiration. Normal breath sounds are categorized as vesicular, […]

Symmetry of chest movement. Analysis of the symmetry of the moving chest during breathing gives the therapist information about the mobility of the thorax and indicates indirectly what areas of the lungs may or may not be responding.
Procedure: Place your hands on the patient’s chest and assess the excursion of each side of the thorax […]

Symmetry of the chest and trunk. Observe anteriorly, posteriorly, and laterally; the thoracic cage should be symmetrical.
Mobility of the trunk. Check active movements in all directions and identify any restricted spinal motions, particularly in the thoracic spine.
Shape and dimensions of the chest. The anteroposterior (AP) and lateral dimensions are usually 1:2. Common chest deformities include:
• […]

Examination is the evaluation of the patient with pulmonary dysfunction and determination of a diagnosis, prognosis, and intervention plan are based on the findings derived from a comprehensive examination, including a history, systems review, and specific tests and measures.
Components of the Examination
A comprehensive examination of a patient with known or suspected dysfunction related to primary […]

Pulmonary function tests that measure lung volumes and capacities are performed to evaluate the mechanical function of the lungs. Lung volumes and capacities are related to a person’s age, weight, sex, and body position and are altered by disease. Two or more lung volumes, when combined, are described as a capacity. A basic understanding of […]

The upper and lower respiratory tracts, as a unit, serve the following functions. They:
• Conduct air to and from the alveolar system for gas exchange
• Assist with humidification and trap small particles to clean the air with the mucosal lining
• Warm the air by the vascular supply
• Move mucus upward with the cilia
• Elicit the […]

Upper Respiratory Tract
The structures of the upper respiratory tract are the nasal cavity, pharynx, and larynx. As air is brought into the body, the nasal cavity and pharynx filter and remove particles in the air and begin to humidify and warm it to body temperature. The mucosal lining of these structures has cells that secrete […]

Movements of the Thorax During Ventilation
Each rib has its own pattern of movement, but generalizations can be made. The ribs attach anteriorly to the sternum (except ribs 11 and 12) and posteriorly to the vertebral bodies, disks, and transverse processes, making a closed kinematic chain. The thorax enlarges in all three planes of movement during […]

Inspiration
• Primary muscles: diaphragm, scalenes, parasternals
• Accessory muscles: sternocleidomastoids, upper trapezius, pectoralis major and minor, subclavius, and possibly the external intercostals
Expiration
• Primary muscles: none active during tidal (resting) expiration
• Accessory muscles: abdominals including the rectus abdominis, transversus abdominis, and internal and external obliques; pectoralis major; and possibly the internal intercostals
Parasternal intercostals.  The parasternals, a portion […]

Respiration is a general term used to describe gas exchange within the body and can be categorized as either external respiration or internal respiration. Basic terms are described here but an in-depth discussion of respiratory physiology, including diffusion and perfusion, goes well beyond the scope or purpose of this chapter. The reader is referred to […]

Multiple muscles attaching to the thoracic cage have an impact on the movement of air in and out of the lungs during either the inspiratory or expiratory phases of breathing.
Ventilatory muscles, also referred to as respiratory muscles, are classified as primary or accessory. The primary muscles of ventilation are recruited during quiet (tidal) breathing, whereas […]

Cardiovascular and pulmonary physical therapy is a multifaceted area of professional practice that deals with the management of patients of all ages with acute or chronic, primary or secondary cardiovascular and pulmonary disorders. Although the cardiovascular and pulmonary systems are inherently linked as they interface with all other body systems, the focus of this chapter […]