DEEP BREATHING EXERCISES FOR NON- COVID

Physiotherapy plays crucial role in augmenting immunity and mental health during pandemic. It aids treatment and recovery of COVID-19  patients.

Physiotherapy  interventions not only assists medical specialists in the course of the treatment of COVID-19 patients, but also has a definite preventive role for general public. PHYSIOTHERAPY interventions are commonly used in the Intensive Care Unit (ICU)settings to help in the recovery of patients who have been infected with COVID 19. The physiotherapist can help the patients by using specialist interventions including the energy conserving techniques of breathing and mobilization.These interventions would not only promote an enhancement in the oxygenation required  for patients who have low oxygenation, but also helps in boosting their immune system that would  help them fight against the disease.

Physiotherapy’s role in non-COVID cases

•Precautions alone cannot protects us against the virus. I view that we must focus on boosting our immunity by having a good combination of a balanced foods rich in micro nutrients and physical fitness and practice appropriate Breathing exercises.

•As the corona virus particularly affects the respiratory system, physiotherapy interventions can help in strengthening the lungs and the cardiovascular system in the body with the help of exercises.

Breathing exercises 

Exercises help in reaching the full capacity of lungs and incorporating them into our lifestyle can prove beneficial during the pandemic.

     1.DIAPHRAGMATIC BREATHING

             2.PURSED LIP BREATHING
   3.THORACIC EXPANSION EXERCISES
               A) APICAL.

                               B)LATERAL COSTAL EXPANSION.

                               C)POSTERIOR BASAL EXPANSION.

  4.BUTEYKO INSPIRED BREATHING.

   5.SUSTAINED MAXIMAL INSPIRATION.

1.DIAPHRAGMATIC BREATHING

•         Diaphragm is the main muscle which facilitates our breathing. Performing diaphragmatic breathing  regularly is key to encouraging it

•         Diaphragmatic breathing pattern concentrates on forward movement of the whole abdominal wall .

•         Another technique combines forward movement of upper abdominal wall with some lateral movement of the lower ribs

     

POSITION:

•           Done in a relaxed half lying /sitting position.
•        Should be sitting straight and upright with the head and back fully supported and the abdominal wall relaxed.

     

1. THE FIRST CONCENTRATES ON EPIGASTRIC AND LOWER RIB MOVEMENT:

•        Place one hand over the anterior costal margins(CHEST)

•        Other hand on upper abdomen to feel the movement occurring (breathe in gently and feel the air coming will around the waist)

•        The upper abdomen will bulge forward slightly and the anterior  margins will move up and out

       

2 PLACE BOTH HANDS OVER THE ABDOMEN TO FEEL MOVEMENT.

        Gently breathing in and concentrating on allowing the abdominal wall to swell, gently not forcibly,the emphasis should be on gentle breathing with the minimum of effort.

•         It is vital to remember that the expiratory  phase is completely passive ;any forced or prolonged expiration may increase airways obstruction.

•       Performing it 3-4 times at a stretch and 2-3 times a day will stimulate the diaphragm.

2.PURSED LIP BREATHING

Position:

•      Pursed Lip breathing technique is to sit comfortably on a chair with relaxed shoulders,
•        Take in a deep breath from the nose and hold it and then exhale slowly via the mouth with pursed lips.
•          This will create a small positive pressure which prevents the collapse of the airway.

3.Localised basal expansion

ADVANTAGES OF SEGMENTAL BREATHING: 

 Prevent accumulation of pleural fluid 

• Prevent accumulation of secretions 

• Decreases paradoxical breathing 

• Decrease panic 

• Improve chest mobility Lateral costal expansion

 • This is sometimes called lateral basal expansion and may be done unilaterally or bilaterally 

 

   A.LATERAL COSTAL EXPANSION.

           1.The sitting / in a hook lying position. 

       2.Place your hands along the lateral aspect of the lower ribs to fix the person attention   to the areas which movement is to occur. 

         3. Ask the person to breathe out, and feel the rib cage move downward and inward. As  person breathes out.

    4. Apply light manual resistance to the lower ribs to increase sensory awareness as the   person breathes in deeply and the chest expands and ribs flare. Then, as the person breath   out, assist by gently squeezing the rib cage in a downward and inward direction.

5. The person may then be taught to perform the maneuver independently. by place the hand (s) over the ribs or apply resistance using a belt.

1. 
   
   
2.  Belt exercises reinforce lateral costal breathing (A) by applying resistance during inspiration and (B) by assisting with pressure along the rib cage during expiration.

1. B. Right middle lobe or lingula expansion

1.  • Sitting Position. 
2. • Place your hands at either the right or the left side of the chest, just below the axilla. 
3. • Follow the same procedure as described for lateral basal expansion. 
4. 
   

1. c.Apical expansion 

1. •  Sitting position. 

1. • Apply pressure (usually unilaterally) below the clavicle with the fingertips. 

1. 
   

1. 
   

4.Buteyko breathing technique

Buteyko breathing technique is a specialised technique of breathing which focuses on only breathing through the nose both during the day and while asleep. 

      The Buteyko breathing techniques help in opening the airways and improve blood circulation in a matter of minutes. These are more direct and tailored as per the requirements of individuals for different age groups from teenagers to senior citizens. Buteyko also focuses on ‘control pause’ which involves timing how comfortably the breath hold can be performed after the exhalation.

         The goal of this is to reach the control stop for a short period of 40 or more seconds which is considered as being normal for the lungs. It can also be a tool to test the functionality of the lungs.

5.SUSTAINED MAXIMAL INSPIRATION.

     sustained maximal inspiration. A deep-breathing maneuver that mimics the normal physiological sigh mechanism. The patient inspires from a resting expiratory level up to maximum inspiratory capacity, with a pause at end inspiration.

An incentive spiro-meter is a medical device that facilitate SMI with incorporated visual indicators of performance (inspiratory effort) in order to aid the therapist in coaching the individual to optimal performance and likewise individual uses this visual feedback to monitor their own efforts. The device gives the individual visual feedback regarding flow and volume. 

The visual dimension of the therapy serves as a motivation or goal for the patient to try to meet by repeating the maximal effort frequently.

Technique ;

1. Person should be in a relaxed position suitable for deep breathing (e.g. sitting upright in a chair or side lying if extra volume is required in one lung due to ventilation perfusion matching).
2. Person creates a tight seal around the mouthpiece and inhales deeply and slowly. Than watches the flow meter for visual feedback. If possible the we can sustains the inhalation to create an end-inspiratory hold. Ideally, the inhalation is sustained for 4-5 seconds.
3. Than relaxes seal around the mouthpiece and exhales; normal breathing is resumed with relaxed shoulder girdle.

•  However, using an incentive device as feedback may create greater inhaled volumes, greater control of flow and more motivation to participate in therapy.