Breathing exercises, classification

 The breathing exercises are useful to loosen secretions. breathing exercises are combined with postural drainage, exercises respiratory therapy devices and medications. 

Classification:- 

Diaphragmatic breathing:-

Aims:- 

• To remove gas exchange
• To improve oxygenation
• To improve ventilation
• To improve ascent or descent of the diaphragm
• To mobilize lung secretions during postural drainage
• To decrease work of the breathing. 

Procedure:- 

• Position of the patient half lying supported by pillows
• Physiotherapist stands besides the patient. 
• Technique - hands should be placed on the rectus abdominis below the anterior costal margin 
• Initially therapist places hands on patient abdomen and ask him to inspire so that abdomen bulges out and contracts
• Ask the patient to breathe in through the nose and breathe out through the mouth. Practice the same 3 or 4 times then rest for brief period of time. 
• Train the patient to practice the on his own by keeping hands on the abdomen. 

Segmental breathing:-

Apical breathing:- In lobectomy patients, position of patient is Sitting, therapist stands in front of the patient and applies the pressure below the clavicle with the finger tips. 

Unilateral apical:-

• During inspiration therapist applies stretch down & inwards to chest and muscle moves in the direction of outward and upward, This stretches the external intercostal muscle on the side of the pressure, right side or left side. 
• During expiration therapist with palm gives firm downward pressure and the ribcage is moved downwards and inwards on the side of the pressure, right side or left side. 

Bilateral Apical breathing:- 

• During inspiration therapist applies stretch down & inwards to chest  & muscle moves in the direction of outward and upward. This stretches the external intercostal muscle on the side of the pressure bilaterally. 
• During expiration:- The therapist with palm gives firm downward pressure and the ribcage is moved downwards and inwards on the side of the pressure bilaterally. 

Lateral costal breathing:- this is also called lateral basal expansion. 

Position of patient crook lying 

therapist stands behind patient & hand placed on right side if right lateral costal breathing or on left side if left lateral costal breathing. 

Technique chest moves upwards and outwards during inspiration and downwards and inwards during expiration. 

Unilateral costal breathing:- 

• During inspiration therapist applies stretch down & inwards to chest  & muscle moves in the direction of outward and upward. This stretches the external intercostal muscle on the side of the pressure right side or left side. 
• During expiration:- The therapist with palm gives firm downward pressure and the ribcage is moved downwards and inwards on the side of the pressure right side or left side. 

Bilateral costal breathing:- 

• During inspiration therapist applies stretch down & inwards to chest  & muscle moves in the direction of outward and upward. This stretches the external intercostal muscle on the side of the pressure bilaterally. 
• During expiration:- The therapist with palm gives firm downward pressure and the ribcage is moved downwards and inwards on the side of the pressure bilaterally. 

Posterior Basal Breathing:-

Position of patient Sitting position and leaning forward on a pillow. 

Position of the physiotherapist:- therapist stands behind the patient and the therapist hands are on the posterior aspect of the lower ribs. 

Lingular breathing:- 

This is also called as right middle lobe expansion as left lung has only two lobes. 

Position of patient Sitting position. 

Therapist stands behind the patient & hand is placed on the right side of the patient chest below the axilla. 

Ventilatory Muscle Training:- 

This technique is for improving the strength of the breathing muscle especially muscle of inspiration. 

Types:-

• Diaphragmatic training using weight:-patient in supine lying
• Inspiratory resistance training
• Incentive respiratory spirometry

Diaphragmatic training:- 

• Position of patient is supine lying 
• Put small weight of about 3 to 5 pounds over the epigastric region of patient abdomen. 
• Ask patient to breathe in against resistance of weight increase the number of time s of the resistance breathing. 
• Weight can be increased gradually and also the time duration can be increased for about 15 min. 
• This strengthens the diaphragm this is useful for the patient with weakness. 

Inspiratory resistance training:-

This method increases the strength and endurance of the inspiratory muscle and decreases inspiratory muscle fatigue

This is through breathing device called resistor this resistor is put inside patient mouth & patient inhales through device increase resistance to the inspiratory muscle

Gradual increase of the time to 20 to 30 min once strength and endurance is increased the diameter of the tube is decreased. 

Incentive respiratory spirometry:-

This is also called sustained maximal inspiratory maneuver. 

 

Glossopharangeal breathing:-

Technique - patient is asked to take gulps of air. The mouth is closed and the tongue moves the air to pharynx, the glottis gets opened and the air goes to the lungs. This way inspiration is increased and also the vital capacity of the lung. 

Pursed Lip breathing:-

Patient is in comfortable and relaxed position

Therapist places hand on abdominal muscle & patient is asked to take a deep inspiration and 

With the lips pursed patient is asked to expire the air. 

Procedure is repeated many times with frequent relaxation  in between.