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Therapeutic Exercise Foundations and Techniques

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Therapeutic Exercise Foundations and Techniques 00Kisner (F)-FM 3/9/07 1:28 PM Page i Therapeutic Exercise Foundations and Techniques FIFTH EDITION 00Kisner (F)-FM 3/9/07 1:28 PM Page ii 00Kisner (F)-FM 3/9/07 1:28 PM Page iii Therapeutic Exercise Foundations and Techniques FIFTH EDITION CAROLYN KISNER, PT, MS Assistant Professor Emeritus The Ohio State University School of Allied Medical Professions Physical Therapy Division Columbus, Ohio LYNN ALLEN COLBY, PT, MS Assistant Professor Emeritus The Ohio State University School of Allied Medical Professions Physical Therapy Division Columbus, Ohio 00Kisner (F)-FM 3/9/07 1:28 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2007 by F. A. Davis Company Copyright © 2002, 1996, 1990, 1985 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmit- ted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher: Margaret Biblis Manager, Content Development: Deborah J. Thorp Developmental Editor: Jennifer A. Pine Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Kisner, Carolyn. Therapeutic exercise : foundations and techniques / Carolyn Kisner, Lynn Allen Colby. — 5th ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-1584-7 ISBN-10: 0-8036-1584-1 1. Exercise therapy—Handbooks, manuals, etc. I. Colby, Lynn Allen. II. Title. [DNLM: 1. Exercise Therapy—methods. WB 541 K61t 2007] RM725.K53 2007 615.8′2—dc22 2007007512 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1042-03 0 ϩ $.10. 25Kisner (F)-25 3/9/07 12:54 PM Page 851 Management of Pulmonary Conditions 25 CHAPTER REVIEW OF RESPIRATORY STRUCTURE Teaching an Effective Cough 868 AND FUNCTION 852 Additional Techniques to Facilitate a Cough and Thorax and Chest Wall: Structure Improve Airway Clearance 869 and Function 852 Suctioning: Alternative to Coughing 870 Muscles of Ventilation 852 POSTURAL DRAINAGE 870 Mechanics of Ventilation 853 Manual Techniques Used with Postural Anatomy and Function of the Drainage Therapy 870 Respiratory Tracts 854 Postural Drainage Positions 872 The Lungs and Pleurae 855 Guidelines for Implementing Postural Lung Volumes and Capacities 856 Drainage 874 EXAMINATION 856 Modified Postural Drainage 874 Components of the Examination 857 Home Program of Postural Drainage 875 BREATHING EXERCISES AND VENTILATORY MANAGEMENT OF PATIENTS WITH CHRONIC TRAINING 861 OBSTRUCTIVE PULMONARY DISEASE 875 Guidelines for Teaching Breathing Exercises 861 Types of Obstructive Pulmonary Disorders 875 Diaphragmatic Breathing 862 Pathological Changes in the Pulmonary Segmental Breathing 863 System 875 Pursed-Lip Breathing 864 Impairments and Impact on Function 875 Preventing and Relieving Episodes Management Guidelines: COPD 876 of Dyspnea 865 MANAGEMENT OF PATIENTS WITH Positive Expiratory Pressure Breathing 865 RESTRICTIVE PULMONARY DISORDERS 876 Respiratory Resistance Training 866 Acute and Chronic Causes of Restrictive Glossopharyngeal Breathing 866 Pulmonary Disorders 876 EXERCISES TO MOBILIZE THE CHEST 867 Pathological Changes in the Pulmonary Specific Techniques 867 System 876 Management Guidelines: Post-Thoracic COUGHING 868 Surgery 876 The Normal Cough Pump 868 Factors that Decrease the Effectiveness of the INDEPENDENT LEARNING ACTIVITIES 880 Cough Mechanism and Cough Pump 868 Cardiovascular and pulmonary physical therapy is a mul- Prevent airway obstruction and accumulation of secre- tifaceted area of professional practice that deals with the tions that interfere with normal respiration/oxygen management of patients of all ages with acute or chronic, transport. primary or secondary cardiovascular and pulmonary disor- Improve airway clearance, cough effectiveness, and ders. Although the cardiovascular and pulmonary systems ventilation through mobilization and drainage of are inherently linked as they interface with all other body secretions. systems, the focus of this chapter is on examination proce- Improve endurance, general exercise tolerance, and dures and therapeutic interventions used for the manage- overall well-being. ment of patients with pulmonary dysfunction. In particular, Reduce energy costs during respiration through exercise interventions and manual techniques that enhance breathing retraining. ventilation and airway clearance are presented. Prevent or correct postural deformities associated with The goals of cardiovascular and pulmonary physical pulmonary or extrapulmonary disorders. therapy for patients with respiratory dysfunction are to: Maintain or improve chest mobility. 851 25Kisner (F)-25 3/9/07 12:54 PM Page 852 852 REVIEW OF RESPIRATORY STRUCTURE AND FUNCTION All of these goals are aimed at improving a patient’s overall ability to meet necessary and desired functional demands. Treatment settings vary widely, from intensive care or postsurgical care units and extended care/subacute reha- bilitation facilities to outpatient pulmonary centers and the home setting. REVIEW OF RESPIRATORY STRUCTURE AND FUNCTION 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 FIGURE 25.1 Anterior view of the rib cage. (From Starr, J, Dalton, D: The thorax scope or purpose of this chapter. The reader is referred to and chest wall. In Levangie, PK, Norkin, CC [eds] Joint Structure and Function: A Compre- several references for further study.11,22,34,59,61 hensive Analysis, ed 4. FA Davis, Philadelphia, 2005, p 197, with permission.) External respiration describes the exchange of gas at the alveolar-capillary membrane and the pulmonary capil- laries. When a person inhales and oxygen is delivered to articulate directly with the sternum via the costal cartilage. the alveoli via the tracheobronchial tree, oxygen diffuses The eighth to tenth ribs have cartilaginous attachments to through the alveolar wall and interstitial space and into the the rib above, whereas the eleventh and twelfth are floating bloodstream through the pulmonary capillary walls. The ribs (Fig. 25.1).68 opposite occurs with carbon dioxide transport. Internal respiration describes the exchange of gas between the Muscles of Ventilation pulmonary capillaries and the cells of the surrounding tissues. Internal respiration occurs when oxygen in arterial Multiple muscles attaching to the thoracic cage have an blood diffuses from red blood cells into tissues requiring impact on the movement of air in and out of the lungs during either the inspiratory or expiratory phases of oxygen for function. The reverse occurs with carbon 8,11,68 9 dioxide transport. breathing. Box 25.1 lists the muscles of ventilation. Ventilatory muscles, also referred to as respiratory Ventilation, as it refers to the respiratory system, is the 56,68 mass exchange of air to and from the body during inspira- muscles, are classified as primary or accessory. The tion and expiration. This cyclic process requires coordinat- primary muscles of ventilation are recruited during quiet ed ventilatory muscle activity, rib cage movements, and (tidal) breathing, whereas the accessory muscles of ventila- appropriate structure and function of the upper and lower tion are only recruited during deep, forced, or labored respiratory tracts.8,22,34,59,61 breathing. During quiet inspiration the diaphragm, scalenes, and parasternals are activated.56,68 In contrast, no primary ventilatory muscles contract during resting expiration. Dur- Thorax and Chest Wall: ing deep or forced breathing different accessory muscles of Structure and Function ventilation are recruited, depending on whether inspiration or expiration is occurring, as noted in Box 25.1. The main functions of the thoracic
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