Charity Tillemann-Dick: Re-learning how to breathe

After giving a wonderful performance in part 1, the soprano Charity Sunshine Tillemann-Dick tells us why breath is life, a fact we take for granted all too often. The soprano tells of re-learning to breathe, one gasp at a time. A recipient of two double lung transplants, she speaks and performs frequently at concerts, conferences and events around the United States.

How to breathe, full lung exercises

So simple and funny, but extremely important for hospitalized patients..!

Diaphragmatic breathing

It is really important for a Physical Therapy student to understand the action and range of motion of the diaphragm muscle. This will help him/her in the deeper understanding of the physical therapy for the respiratory system.

Assessment & treatment guidelines_2

After "Assessment & treatment guidelines_1", I am posting the next file with assessment and treatment guidelines for the following cases:

Cervical radicular syndrome
Lumbar radicular syndrome
Collum femoris fracture
Esophagectomy
Coronary artery bypass
WAD
COPD
Scoliosis
L4 fracture
Subcapital humerus fracture
Acute myocardial infarction

The truth about mucus

By Stephanie Watson

WebMD Feature

Mucus is something everyone has, and some people wish they had a lot less of the stringy, gooey stuff.  Sure, it can be gross to blow globs of snot into tissue after tissue when you have a cold or sinus infection, but mucus actually serves a very important purpose.

"Mucus is incredibly important for our bodies," explains Michael M. Johns, III, MD, director of the Emory Voice Center and assistant professor of otolaryngology -- head and neck surgery at Emory University. "It is the oil in the engine. Without mucus, the engine seizes."

How much mucus is normal, and how much is too much? What does its color tell you about your health? Can you just get rid of it, or at least cut down on it, and how should you do that? Here are answers.

Mucus' Mission

Mucus-producing tissue lines the mouth, nose, sinuses, throat, lungs, and gastrointestinal tract. Mucus acts as a protective blanket over these surfaces, preventing the tissue underneath from drying out. "You have to keep them moist, otherwise they'll get dry and crack, and you'll have a chink in the armor," says Neil L. Kao, MD, associate professor of medicine at the University of South Carolina School of Medicine.

Mucus also acts as a sort of flypaper, trapping unwanted substances like bacteria and dust before they can get into the body -- particularly the sensitive airways. "You want to keep that environment, which is a sterile environment, free of gook," says Johns. "Mucus is kind of sticky and thick. It's got viscosity to it that will trap things."

But mucus is more than just sticky goo. It also contains antibodies that help the body recognize invaders like bacteria and viruses, enzymes that kill the invaders it traps, protein to make the mucus gooey and stringy and very inhospitable, and a variety of cells, among other things.

Why Am I Making So Much Mucus?

Even when you're healthy, your body is a mucus-making machine, churning out about 1 to 1.5 liters of the stuff every day. Most of that mucus trickles down your throat and you don't even notice it.

However, there are times when you do notice your mucus -- usually not because you're producing more of it, but because its consistency has changed.

"Typically, the mucus changes character. It gets thicker," Johns says. "When it has mass effect you feel it, and when you feel it, you want to hock." Some people just naturally have thicker, stickier mucus than others.

It generally takes a bad cold, allergy, or contact with something irritating -- like a plate of nuclear-hot Buffalo wings -- to throw your body's mucus production into overdrive.

For instance, during an allergic response to an offending trigger, such as pollen or ragweed, mast cells in your body squeeze out a substance called histamine, which triggers sneezing, itching, and nasal stuffiness. The tissue of the mucus membranes starts leaking fluid, and your nose begins to run.

Drinking milk may also make some people produce more mucus. Kao says that's due to gustatory rhinitis, a reflex reaction that's triggered by eating. Gustatory rhinitis is also why your nose runs when you eat hot peppers. Milk proteins cause the same type of response in some people. But although you may feel like you have more phlegm, you're not going to worsen a cold by drinking a glass of milk, Johns says.

Why Does My Mucus Change Color?

If you've ever stopped to look at the contents of the tissue after you've blown your nose, you may have noticed that your mucus isn't always perfectly clear. It may be yellow, green, or have a reddish or brownish tinge to it. What do those colors mean?

You might have heard that yellow or green mucus is a clear sign that you have an infection, but despite that common misperception, the yellow or green hue isn't due to bacteria.

When you have a cold, your immune system sends white blood cells called neutrophils rushing to the area. These cells contain a greenish-colored enzyme, and in large numbers they can turn the mucus the same color.

But "you can have perfectly clear mucus and have a terrible ear and sinus infection," Kao says. If you do have an infection, you'll likely also have other symptoms, such as congestion, fever, and pressure in your face, overlying the sinuses, Johns says.

Multi-hued mucus also relates to concentration of the mucus. Thick, gooey mucus is often greenish, Kao says.

Mucus can also contain tinges of reddish or brownish blood, especially if your nose gets dried out or irritated from too much rubbing, blowing, or picking. Most of the blood comes from the area right inside the nostril, which is where most of the blood vessels in the nose are located. A small amount of blood in your mucus isn't anything to worry about, but if you're seeing large volumes of it, call your doctor.

Glossopharyngeal breathing

Glossopharyngeal breathing (GPB, also called frog breathing) is a means of forcing extra air into the lungs to expand the chest and achieve a functional cough. The technique involves the use of the glottis to add to an inspiratory effort by gulping boluses of air into the lungs. It can be beneficial for individuals with weak inspiratory muscles and no ability to breathe normally on their own.

The technique was first observed in the late 1940s in polio patients at Rancho Los Amigos Hospital, in Los Angeles, by Dr Clarence W Dail and first described by Dr. Dail in 1951 in the journal California Medicine.

It is not commonly known today amongst physiotherapists and physical therapists.

The American Thoracic Society

ABOUT ATS

The roots of the American Thoracic Society reach back to 1905, when a small group of physicians decided that the best way to improve care for tuberculosis patients was to share their experiences and discoveries. Today, the ATS has grown into an international society with more than 15,000 members. In this introductory section, you will find information about the people and programs that make the ATS the world's leading medical association dedicated to advancing our clinical and scientific understanding of pulmonary diseases, critical illnesses and sleep-related breathing disorders.

Better in, better out - the essence of preoperative physical therapy for the frail

“Better in, better out”, the motto of preoperative physical therapy, appears to be as simple as it is true: the better the patient comes into the hospital, the better and quicker he or she leaves the hospital. There is ample evidence in the literature that the functional status of the patient prior to the operation contributes to the risks of complications during the postoperative course. The physical therapist who is experienced in screening, diagnosing and optimising the functional status of the patient can play a key role in interdisciplinary preoperative care.

Text: Jaap Dronkers, Erik Hulzebos, Nico van Meeteren

Source: http://www.eunaapa.org/

Mechanism of cough reflex

The cough reflex has both sensory (afferent) and motor (efferent) components. Pulmonary irritant receptors (cough receptors) in the epithelium of the respiratory tract are sensitive to both mechanical and chemical stimuli. Stimulation of the cough receptors by dust or other foreign particles produces a cough, which is necessary to remove the foreign material from the respiratory tract before it reaches the lungs.

The cough receptors, or rapidly adapting irritant receptors are located mainly on the posterior wall of the trachea, pharynx, and at the main carina, the point where the trachea branches into the main bronchi. The receptors are less abundant in the distal airways, and absent beyond the respiratory bronchioles. When triggered, impulses travel via the internal laryngeal nerve, a branch of the superior laryngeal nerve which stems from the vagus nerve (CN X), to the medulla of the brain. This is the afferent neural pathway.

The efferent neural pathway then follows, with relevant signals transmitted back from the cerebral cortex and medulla via the vagus and superior laryngeal nerves to the glottis, external intercostals, diaphragm, and other major inspiratory and expiratory muscles.

source: wikipedia

And here you can see some nice techniques for respiratory and cough facilitation:

ICU & Acute Care Physical Therapy

This video shows the rewarding fields of acute care physical and occupational therapies helping a patient who was bedridden for several weeks in ICU due to respiratory failure and sepsis. It captures her recovery from the initial assessment in ICU, when Phyllis could barely move, to the final outcome after her rehab stay.