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Neurologic/Geriatric>>Pulmonary Rehabilitation - 1/5/2007

I.                     Outcomes/Goals:  With Chronic respiratory impairment, lung function cannot be significantly changed; however, through physical therapy there can be improved strength, mobility and endurance gained.  Also, teaching of breathing techniques and re-education of respiratory muscles can allow for improve, more efficient breathing.

A.       Reduce shortness of breath

B.       Reduce Anxiety

C.      Increase ability to perform normal daily activities

D.      Master proper breathing techniques

E.       Reduce hospitalizations

F.       Promote self-reliance and independence


II.                    How the program works

A.       Diagnostic work-up/Pulmonary function study (Pulmonologist)

B.       Review of Medications and clearance for entry level physical therapy pulmonary rehab program

C.      Physician referral to physical therapy pulmonary rehab program

D.      Program is runs three times a week for 8 weeks.

1.       Therapists tailor safe exercise program to each participant’s needs based.

2.       Initial focus on increasing muscular strength and flexibility.

3.       Progress to exercise intermittently for 60 minutes

4.       Aerobic protocols follow the American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines and the standards from American College of Sports Medicine.

5.       Education

a.  Posture

b. Energy conversation

c.  Pursed lip and diaphrammatic breathing

d.  Modification of ADLs

e.  Anxiety reduction


III.                  Appropriate Population/Referral:  The program is designed for people with chronic respiratory impairments that have resulted in functional disabilities limiting exercise and participation in everyday life activities.  Includes conditions such as emphysema, asthma, or chronic bronchitis.  Reason for referral includes the following medical necessities:

A.       Recent Exacerbation and hospitalization

B.       Oxygen desaturation or diminished PFTs

C.      Use of supplemental oxygen

D.      Diminish in functional mobility and physical activity

E.       Complaints of dyspnea


IV.                  Contraindications:  Participants should be able to understand the educational materials, as well as exercise in a safe manner.  Therefore, it is not recommended for persons who have the following acute or chronic diseases: 


A.       Left heart failure

B.       Uncontrolled angina

C.      Hypertension or hypotension

D.      Acute systematic illness or fever

E.       Organic brain syndrome

F.       Cancer (advanced)

                   *Persons with cardiac co-morbidity should be referred for a graded exercise test, supervised in a cardiac rehab program.

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