Copd
Conditions
Keywords
diaphragmatic release, rib raising, thoracic lymphatic pump
Brief summary
This study will test the efficiency of rib rising technique and thoracic lymphatic pump technique combining with manual diaphragmatic release technique in patients with chronic obstructive pulmonary disease
Detailed description
Chronic obstructive pulmonary disease (COPD) is a complex and constantly evolving pathology which is characterized by a progressive and constant limitation of the available air volume. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) identifies COPD as: a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. COPD could become the third leading cause of death for the population by 2030. Exacerbation 0f COPD leads to hospital admission, high mortality and a decline in the ability to carry out daily activities' worse quality of life and increased disability. Cigarette smoking consider the most important risk factors air pollution, occupational chemicals and dusts, and frequent lower respiratory infections during childhood and not curable. Symptom of COPD is the chronic and progressive shortness of breath which is most characteristic of the condition, wheezing, chest tightness and cough. Thoracic hyperinflation caused by air trapping changes diaphragm muscle fibers orientation in a zone of apposition (ZOA), which makes the contraction less effective at lower rib cage expansion, The remodeling results in flattening of the muscle and subsequent decreased diaphragmatic excursion Osteopathic manipulative treatments (OMT) are hands-on manipulations of different body structures to increase systemic homeostasis and patient well-being include manipulation of the lymphatics, rib raising, diaphragmatic manipulations This treatment is used to stretch tight muscles, reduce pain, and improve circulation and lymphatic flow throughout the body The diaphragmatic release technique is a manual technique that has beneficial effect on elongating tight diaphragmatic muscle fiber, improve perception of breathing assist in return doming shape to diaphragm, this lead to enhance pulmonary function, and to improve diaphragmatic mobility in both healthy individuals and patients with COPD Rib raising is a manual technique increases thoracic mobility and lessens somatic dysfunctions of the area treated through normalized Parathoracic sympathetic ganglia. The Thoracic Lymphatic Pumping Technique promote relaxation, facilitate blood flow and lymphatic drainage, reduce pain, normalize muscular tone and increase rib cage mobility . this study aim to find out the effect of adding thoracic lymphatic pumping or rib raising manual techniques to diaphragmatic release in patients with COPD
Interventions
The participant lay in the supine position and the therapist stood at the participant's head, the therapist passed his hands (the hypothenar and the lateral 3 fingers) under the costal cartilage of the seventh to the tenth ribs bilaterally, with the therapist's forearm aligned up toward the subject's shoulder. Then, the therapist quietly drew the diaphragm in and upward during the inspiratory phase. The therapist then went deeply with both hands toward the inner costal margin during the expiratory phase to resist the rebounding movement of the thoracic cage. The depth of this manual contact was progressively increased in subsequent respiratory cycles. The maneuver was repeated in 4 sets, each of which consisted of 5 deep breaths with 2-min intervals in between if needed
OTHERrib raising technique in group A
• The patient is in supine position and therapist hand under the thorax The fingertips take up contact with the angular costae and move it up and in lateral traction and maintained and this will repeated until all ribs on the side are mobilized. This movement will be repeated several times until perceives an improvement in the rib flexibility
OTHERTHORACIC LYMPHATIC PUMP TECHNIGUE
* Patient in the supine position and therapist will stand the participant's head, facing The therapist places the thenar eminence of each hand to the pectoral region and infra clavicular and the other fingers were spread around the thoracic cage and angled toward the body's side to create consistent, compressive force across the thoracic cage The participant was then allowed to breathe in deeply and breath out. The therapist slowly reduced the compressive force and withdrew the participant. * During breath out rhythmic oscillatory compression in the posterior and caudal direction was applied to the chest wall. * By the end of the expiratory phase, the compressive force was maintained, and ask to take another deep breath. In this way, the participant encountered some resistance equivalent to the chest-wall movement during inspiration. The maneuver was repeated for 5 respiratory cycles, then hands to allow for full inspiration.
Sponsors
Beni-Suef University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
60 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* include Stable COPD patients * include Constant medication between the treatments. * include Aged from 60 TO 75 YEARS OLD * include moderate to severe COPD * include Smoker index \<400 * exclude Rib or vertebral fracture * exclude Skin disorder or scar in chest region or recent abdominal surgery. * exclude Unwilling to complete in study * exclude Cancer * exclude Cognitive impairment to understand orders * exclude severe osteoporosis * exclude Smoker index \>400
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic Excursion | all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | ultrasonography device applied on chest and used to measure the vertical movement of diaphragm unite of measure is centimeter (cm) |
| Diaphragmatic thickness | all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | ultrasonography device applied on chest and used to measure diaphragmatic thickness and change of flexibility of the diaphragm unite of measure is millimeter (mm) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Level of Dyspnea | all assessment will be performed two times one pretreatment and then will be repeated post treatment almost 2 months | Modified BORG Dyspnea Scale which measures level of dyspnea - Patients are asked "How much difficulty is your breathing?" and got a score 0 Nothing at all, 0.5 very very slight (just noticeable), 1 Very slight, 2 Slight, 3 Moderate, 4 Somewhat severe, 5 Severe, 7 Very severe, 9 Very, very severe (almost maximal), 10 Maximal. |
| Oxygen saturation (%) | assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | Oxygen saturation (%) |
| Resting Heart rate | assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | Resting Heart rate |
| Pulmonary function test (spirometry) | all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | * patients will be asked to breathe in slowly and as deeply as possible, a breath out forcefully, then repeat 3 trials and will take the highest score during this will measure the following: Forced vital capacity (FVC) ,Forced expiratory volume first second (FEV1) as a percentage from predicted ,(FEV1/FVC) ratio ,Vital capacity (VC) ,Peak expiratory flow ,Forced expiratory flow 25%to75% * And ask patient to breath in and out as deep and fast as possible for 12 to 15 seconds to measure maximum voluntary ventilation unite of measurements: all measurements are taken as a percentage from predicted |
| maximum heart rate | assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | maximum heart rate |
| heart rate recovery at first and second minutes | assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months | heart rate recovery |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORSHERIN Hassan, PROF.DR.
FACULTY OF PHYSICAL THERAPY Beni suef university
Outcome results
None listed