Overview of Pulmonary

Rehabilitation
Definition
Council of Rehabilitation
“restoration of the individual to the fullest medical, mental,
emotional, social, and vocational potential of which he or
she is capable”
Petty TL
“art of medical practice wherein an individually tailored,
multidisciplinary program is formulated, which through
accurate diagnosis, therapy, emotional support and education
stabilizes or reverses both the physio- and psychopathology of
pulmonary diseases and attempts to return the patient to the
highest possible functional capacity allowed by his or her
pulmonary handicap and overall life situation”
Definition
ERS/ATS
“an evidence-based, multidisciplinary, and comprehensive intervention
for patients with chronic respiratory diseases who are symptomatic
and often have decreased daily life activities. Pulmonary rehabilitation
is designed to reduce symptoms, optimize functional status, increase
participation, and reduce healthcare costs through stabilizing or
reversing systemic manifestations of the disease “
History
Barach, et al (1952)
 Recommended reconditioning programs for patients with chronic lung
disease to help improve their ability to walk without dyspnea
*Physicians simply prescribed O2 therapy and bed rest. Patients
still became ill with increasing levels of dyspnea.
Pierce, et al (1962)
 Published the value of reconditioning
 Patients now have lower PR, RR, Ve, and CO2
Paez, et al (1962)
 Reconditioning can improve efficiency of motion and O2 use in
patients with COPD
History
At present time…
 PR benefits patients with obstructive and restrictive pulmonary
diseases
 Smoking cessation, optimization of blood gases, proper medication
use
 Evidence based guidelines by American College of Chest Physicians
(ACCP) and American Association of Cardiovascular and Pulmonary
Rehabilitation (AACVPR)
Goals
• Maximize functional ability and minimize impact of
disability
• Control and alleviate symptoms
• restore functional capabilities
• Improve quality of life
• prevent disease progression
• improve exercise tolerance
• improve health status
• prevent complications
• prevent exacerbations
• reduce mortality
 DISABILITY, IMPAIRMENT,
HANDICAP
IMPAIRMENT
 any loss or abnormality of
psychological, physiological or
anatomical structure or
function
 refers to a problem with a
structure or organ of the body
DISABILITY HANDICAP
 any restriction or lack  a disadvantage for a given
(resulting from an impairment) individual that limits or
of ability to perform an activity prevents the fulfillment of
in the manner or within the a role that is normal
range considered normal for a  refers to a disadvantage in
human being filling a role in life relative
 functional limitation with to a peer group
regard to a particular activity

COPD Unable to walk far or Limitations in participating

climb on stairs due to fully in family and
dyspnea community activities
(doing household chores,
family gatherings, job etc)

https://med.emory.edu/departments/pediatrics/divisions/neonatology/dpc/impairment-mx.html
Setting
• Inpatient Setting
Medical center
Skilled nursing facility
Rehabilitation hospital
• Outpatient setting
Out-patient hospital-based clinic
Physician’s office
Extended care facility
Patient’s home
Multi-disciplinary
• rehab team often includes doctors, nurses, physical
therapists, respiratory therapists, exercise specialists
and dietitians
• health professionals create a personal program to
meet your specific needs
Role of RT
• Educator
• Assists patients during performing reconditioning
exercises and breathing exercises
• Monitor patient’s vital signs including O2
requirement and symptoms
• Evaluates patient’s overall
performance during the course
of the program
Indication
• Dyspnea during rest or exertion
• Hypoxemia/ hypercapnia
• Reduced exercise tolerance
• Unexpected deterioration or worsening of
symptoms
• Ventilator dependence
• Increasing need for acute care intervention
(emergency dep visits, hospitalization,
unscheduled physician visits)
Contraindication
• Ischemic cardiac disease
• Acute cor pulmonale
• Severe pulmonary hypertension
• Significant hepatic dysfunction
• Metastatic cancer
• Renal failure
• Severe cognitive deficit
• Psychiatric disease affecting memory and compliance
• Substance abuse
• Physical limitations (eyesight, hearing, speech
impediment, orthopedic impediment)--MODIFICATION
Hazards & Complications
• Exercise Component
Muscle or ligament injuries
Cardiac Rehabilitation
• Patients with cardiac diseases to improve
cardiovascular fitness
• Comprehensive exercise and educational
program
• Multidisciplinary approach
Cardiac Rehabilitation
GOALS
Patient education promoting heart-healthy living
Physical reconditioning to improve work capacity
Weight loss
Return to work
Assist patients in developing regular pattern of
safe exercise to achieve greater cardiovascular
performance
Cardiac Rehabilitation
SETTING
Hospital facility
 Pulmonary vs Cardiac
Rehabilitation

PULMONARY REHAB CARDIAC REHAB

-patient evaluation before program enrollment
-patient education
-exercise to increase fitness and stamina
-monitoring patients during exercise
• disease focus: PULMONARY • disease focus: CARDIAC
• patient age: 50 yrs and above • patient age: 30s to 70s
• exercises: breathing • exercises
• patients experience shortness of • patients are able to walk up to an
breath even for a few minutes of hour
walking
• RTs play a major role • RTs involved with O2 use and
some of exercise sessions