Chest Wall Mobility Research Articles

Visual feedback increases chest wall mobility measure: A cross-sectional study

Background: Visual feedback could optimize the evaluation of chest wall mobility. Objective: To compare chest wall mobility performed with and without visual feedback. Methods: Cross-sectional study, 64 healthy volunteers, average age 24 years old. The thorax circumference was measured at two locations, the axillary and xiphisternum regions, by a tape placed at the anterior axillary line and at the xiphoid process. The evaluations were performed: (i) after verbal explanation (without visual feedback), (ii) after verbal explanation plus visual feedback (with visual feedback); for this evaluation the volunteer remained in front of the computer, which provides visual feedback. Results: There was no difference between axillary measurement with vs. without feedback (7.5 ± 2.4 cm vs. 7.9 ± 3.3 cm, respectively, p = 0.215), but significant difference between xiphisternum measurement 7.1 ± 2.7cm with feedback vs. 6.5 ± 2.3cm without feedback, p = 0.043. Low intraclass correlation coefficients were observed for the axillary measurement [0.51 (0.19–0.72, p = 0.003) and for xiphisternum measurement [0.60 (0.35–0.76, p < 0.001) performed with and without feedback, respectively. Conclusion: Thoracic mobility presents great variability when compared with and without feedback, so the visual stimulus must be taken into account in this evaluation.

Elastic Stable Chest Repair as a Means of Stabilizing the Anterior Chest Wall in Recurrent Pectus Excavatum with Sternocostal Pseudarthrosis: An Innovative Fixation Device.

Open surgical procedures in the treatment of pectus excavatum (PE) involve predetermined incisions in the parasternal cartilage and the bony ribs. For some procedures, the ribs are even dissected from the sternum for better sternal mobilization and thus better elevation of the funnel. Secure restoration of the sternocostal junction is then required, with the consequence that healing may be quite impaired. Patients may also subsequently suffer from sternocostal nonunion, for example, pseudarthrosis, and dislocated ribs, as well as pain and a recurrence of PE. Patients underwent another open surgery with revision of the pseudarthrotic sternocostal junctions and sufficient mobilization of the anterior chest wall, followed by an open reduction and internal fixation using Matrix Rib titanium plates (Synthes, Oberdorf, Switzerland). This procedure consisted of elevating the anterior chest wall and fixing the ribs to the sternum. In 2011 and 2012, we studied this procedure, known as elastic stable chest repair (ESCR), in a series of 20 patients. The patients underwent clinical and ultrasound examinations and X-ray radiographs after the operation, after 6 weeks, and at 3- and 12-month intervals. Follow-up showed high patient tolerance, although a loose plate was observed in one patient and a broken plate in three patients. A stable union was achieved for all sternocostal pseudarthroses. PE improved highly significantly (p < 0.001), as the Haller index decreased from 3.6 (range: 2.7-6.6, standard deviation [SD]: 0.92) to 2.7 (range: 2.0-3.7, SD: 0.42). Pain in the anterior chest wall was significantly reduced after the operation in the majority of cases. All but one patient was mobilized already the day after the operation. ESCR in recurrent PE achieved functional stabilization of the anterior chest wall combined with satisfactory results.

Chest Wall Mobility Is Related to Respiratory Muscle Strength and Lung Volumes in Healthy Subjects

Chest wall mobility is often measured in clinical practice, but the correlations between chest wall mobility and respiratory muscle strength and lung volumes are unknown. We investigate the associations between chest wall mobility, axillary and thoracic cirtometry values, respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure), and lung volumes (expiratory reserve volume, FEV(1), inspiratory capacity, FEV(1)/FVC), and the determinants of chest mobility in healthy subjects. In 64 healthy subjects we measured inspiratory capacity, FVC, FEV(1), expiratory reserve volume, maximum inspiratory pressure, and maximum expiratory pressure, and chest wall mobility via axillary and thoracic cirtometry. We used linear regression to evaluate the influence of the measured variables on chest wall mobility. The subjects' mean ± SD values were: age 24 ± 3 years, axillary cirtometry 6.3 ± 2.0 cm, thoracic cirtometry 7.5 ± 2.3 cm; maximum inspiratory pressure 90.4 ± 10.6% of predicted, maximum expiratory pressure 92.8 ± 13.5% of predicted, inspiratory capacity 99.7 ± 8.6% of predicted, FVC 101.9 ± 10.6% of predicted, FEV(1) 98.2 ± 10.3% of predicted, expiratory reserve volume 90.9 ± 19.9% of predicted. There were significant correlations between axillary cirtometry and FVC (r = 0.32), FEV(1) (r = 0.30), maximum inspiratory pressure (r = 0.48), maximum expiratory pressure (r = 0.25), and inspiratory capacity (r = 0.24), and between thoracic cirtometry and FVC (r = 0.50), FEV(1) (r = 0.48), maximum inspiratory pressure (r = 0.46), maximum expiratory pressure (r = 0.37), inspiratory capacity (r = 0.39), and expiratory reserve volume (r = 0.47). In multiple regression analysis the variable that best explained the axillary cirtometry variation was maximum inspiratory pressure (R(2) 0.23), and for thoracic cirtometry it was FVC and maximum inspiratory pressure (R(2) 0.32). Chest mobility in healthy subjects is related to respiratory muscle strength and lung function; the higher the axillary cirtometry and thoracic cirtometry values, the greater the maximum inspiratory pressure, maximum expiratory pressure, and lung volumes in healthy subjects.

Efeito de um programa de exercícios direcionados à mobilidade torácica na DPOC

INTRODUÇÃO: A Doença Pulmonar Obstrutiva Crônica produz alterações mecânicas na caixa torácica que desencadeiam disfunções físicas limitantes das atividades de vida diária e da qualidade de vida. OBJETIVOS: Avaliar os efeitos de um programa de exercícios para readequação do complexo toracopulmonar na mobilidade da caixa torácica, capacidade de exercício e qualidade de vida em pacientes com DPOC. MATERIAIS E MÉTODOS: Este estudo avaliou 13 pacientes com DPOC por meio de Espirometria, Teste da Caminhada dos Seis Minutos (TC6min), Cirtometria e Questionário de Qualidade de Vida Saint George (SGRQ). O programa foi elaborado com base em exercícios que objetivam o aumento da mobilidade de caixa torácica, tolerância ao exercício e melhora na resposta subjetiva em relação à qualidade de vida. RESULTADOS: Após 12 semanas de tratamento, verificou-se um aumento significativo na mobilidade da região inferior da caixa torácica (expansibilidade da região xifoide: de 3 ± 2 cm para 7 ± 4 cm, p = 0,01), na região abdominal (expansibilidade umbilical: de 2 ± 1 cm para 6 ± 4 cm, p = 0,01) e melhora na distância percorrida no TC6min (391 ± 117 m inicial para final de 442 ± 124 m, p = 0,04). Na avaliação pelo SGRQ, houve uma tendência sem significância estatística de melhora nos três domínios (sintomas: 37 ± 22 para 26 ± 21; atividades: 64 ± 15 para 62 ± 19; e impacto: 42 ± 16 para 38 ± 16). CONCLUSÃO O programa de exercícios respiratórios direcionados ao aumento da mobilidade da caixa torácica melhorou a expansibilidade torácica e abdominal e a capacidade de exercício.

Efeito da fisioterapia sobre os parâmetros ventilatórios e a dinâmica tóraco-abdominal de crianças respiradoras bucais

Este estudo objetivou avaliar o efeito da fisioterapia nos parâmetros ventilatórios e na dinâmica tóraco-abdominal de crianças respiradoras bucais. Dez crianças respiradoras bucais foram submetidas a um programa de reeducação respiratória e correção postural durante 20 sessões de exercícios de alongamento e fortalecimento muscular sobre a bola suíça, estimulação diafragmática e alongamento dos músculos acessórios da inspiração. Os dados coletados foram as medidas de pressões inspiratórias e expiratórias máximas (PIM e PEM), capacidade inspiratória (CI), pico de fluxo expiratório (PFE), mobilidade torácica por meio do coeficiente respiratório (Cr) nos níveis axilar (CrA), xifoide (CrX) e umbilical (CrU) e análise biofotogramétrica do ângulo de Charpy. Estes foram verificados antes e após 10 e 20 atendimentos. Os dados foram submetidos a uma análise de variância (ANOVA) e, nas diferenças encontradas entre as médias, aplicou-se o Teste de Tukey com nível de significância de 5% (p&lt;0,05). Houve melhora para as medidas referentes ao ângulo de Charpy (p=0,048), CI (p=0,037), PFE (0,002), PIM (0,007), CrA (p=0,008) e CrX (p=0,041). A PEM e o CrU, apesar da melhora nos valores absolutos, não apresentaram resultados estatisticamente significativos. O programa de fisioterapia respiratória e postural produziu efeitos positivos sobre a função ventilatória de crianças respiradoras bucais.

Reference Values for Chest Expansion among Adult Residents in Ile-Ife

Background: Chest excursion measurements are used to evaluate a patient’s baseline status, treatment effectiveness, and progression of disease with regards to chest wall mobility and respiratory muscle function, although current research regarding normal chest expansion measurements, consistent patient position and site of measurement is limited. This study was designed to access chest expansion of healthy adults resident in Ile-Ife, Nigeria. Methods: Four hundred and twenty-eight (200 males, 228 females) volunteers were recruited for the study. Their age ranged between 20 and 70 years. Participants were apparently healthy and non smoking individuals who are recruited by purposive sampling technique. Data was obtained by measuring chest expansion of both upper and lower thoracic excursion using an inelastic tape with measurement taken twice and the average being recorded. Measurements were taken at the height of maximal inspiration and expiration. For the upper thoracic excursion, the tape measure was placed at the level of the fifth thoracic spinous process and the third intercostals space at the midclavicular line and for the lower thoracic excursion, the tape measure was placed at the level of the 10th thoracic spinous process and the tip of the xiphoid process. The difference of the two measurements was recorded as chest excursion. Data was analyzed with descriptive and inferential statistics. Level of significance was set at 0.05 α-level. Results: Results showed that male participants have significant higher chest expansion than female participants in upper thoracic (2.6+1.4cm, 2.2+1.2cm) for male and female respectively and at lower thoracic (2.3+1.2cm, 1.7+1.1cm) (p< 0.05) for male and female respectively. Chest expansion of male and female participants at both upper and lower thoracic peak at age 20-29 and decreases thereafter with increasing age. The result showed that chest expansion was negatively correlated with age in male (r= -0.370; p<0.05); r= -0.153; p<0.05); and in female (r= -0.319; p<0.05); r= -0.458; p<0.05) for both upper and lower thoracic respectively. In female participants, chest expansion was significantly correlated with BMI (r= -0.141, 0.197; p<0.05). For the entire participants, values less than 25th, between 25-75th and greater than 75th are considered to be poor, moderate, and good excursion respectively. For the upper expansion and lower expansion, the values are 1.4 cm, 3.1 cm, 5.1 cm and 1.0 cm, 2.7 cm and 4.3 cm respectively. Conclusion: It was concluded that chest expansion of both upper and lower thoracic increase with age increases until the 3rd decade of life, and then steadily declines after this. Male chest expansion was significantly higher than female participants.

The Role of Spinal Manipulation, Soft-Tissue Therapy, and Exercise in Chronic Obstructive Pulmonary Disease: A Review of the Literature and Proposal of an Anatomical Explanation

The premise that lung function can regulate chest wall mobility is an accepted concept. Descriptions of the primary and accessory respiratory structures do not usually include spinal components as a part of these classifications. The case for including these components as a part of the respiratory mechanism and their role in the development of dyspnea and chest wall rigidity in chronic obstructive pulmonary disease (COPD) is reviewed. Mechanical impairment of the chest wall is a contributing factor in the prognosis of COPD. Reducing this impairment improves prognosis. Because spinal manipulation and soft-tissue therapy increase joint mobility and decrease muscle hypertonicity, respectively, applying these interventions to the chest wall in COPD could reduce chest wall rigidity, thereby improving breathing mechanics. Improvements in breathing mechanics reduce the work of the respiratory muscles and delay the onset of dyspnea. Exercise capacity is reliant on the ability to overcome activity-limiting dyspnea, which usually occurs prior to maximum exercise capacity being reached. Delaying the onset of dyspnea permits more exercise to be performed before dyspnea develops. Spinal manipulation and soft-tissue therapy have the potential to deliver such a delay. Because exercise tolerance is considered to be a strong predictor of quality of life and survival in COPD, any increase in exercise capacity would therefore improve prognosis for the disease.

Commentary on “Effects of Positioning on Respiratory Measures in Individuals With Cerebral Palsy and Severe Scoliosis”

“How can I apply this information in my clinical practice?” Clinical measures of respiratory rate, heart rate, and chest wall excursion do not require expensive equipment or training. An inexpensive pulse oximeter provides therapists with clinically important oxygen saturation and heart rate measures. The number of hospitalizations for respiratory illnesses may also serve as a marker of respiratory health. Therapists can use positioning to promote expansion in areas of limited chest wall mobility, such as the lateral or posterior aspects. Chest physical therapy techniques are valuable augments to positioning. Adaptive physical activity may also improve cardiorespiratory function. Therapists can apply this information to persons with multiple disabilities in settings such as home care, group homes, schools, and skilled nursing facilities. “What should I be mindful about in applying this information?” Therapists should be mindful that the rationale for positioning persons with cerebral palsy with severe mobility limitations and scoliosis should include not only respiratory function but also function of other internal organ systems, skin integrity, soft tissue extensibility, bone density, and comfort. Position changes may also accommodate functional needs, such as using vision and performing cognitive tasks. Using a variety of positions is beneficial. Prone positioning may promote improved respiratory function. Supported standing is another option. Upright positioning may promote social interaction, alertness, vocalization, and use of vision. Although sitting may improve respiratory function, prolonged sitting may compromise muscle length and skin integrity. In assessing vital signs, laying hands on the patient may change parameters such as breathing pattern or depth. The effect of a thoracolumbosacral orthosis must also be considered. The authors noted that these individuals' primary breathing pattern was diaphragmatic. Measuring upper chest, mid-chest, and abdominal expansion may demonstrate the full effects of position changes on chest wall excursion. Therapists should also be mindful of signs of distress, such as changes in facial expression, increased muscle tone, flushing, or pallor. Blood pressure may also need to be monitored. The clinical bottom line for this article may be that persons with cerebral palsy with limited mobility and respiratory compromise should be transitioned into a variety of positions throughout the day. The respiratory status of each individual requires ongoing monitoring to determine optimal positioning. Margaret Barry Michaels, PT, PhD, PCS Slippery Rock University, Slippery Rock, Pennsylvania Theresa M. Crytzer, DPT, ATP Western Pennsylvania School for the Blind University of Pittsburgh, Pittsburgh, Pennsylvania

Musculoskeletal Dysfunction and Pain in Adults with Asthma

Background. The mechanical alterations related to the overload of respiratory muscles observed in adults with persistent asthma might lead to the development of chronic alterations in posture, musculoskeletal dysfunction and pain; however, these changes remain poorly understood. Objective. This study aimed to assess postural alignment, muscle shortening and chronic pain in adults with persistent asthma. Methods. This cross-sectional and controlled study enrolled 30 patients with mild (n = 17) and severe (n = 13) persistent asthma. Fifteen non-asthmatic volunteers were also assessed. Asthma was classified by the Global Initiative for Asthma (GINA) guidelines. Postural alignment and muscle shortening were evaluated by head and shoulder positions, chest wall mobility, and posterior (trunk and lower limb) muscle flexibility. In addition, the measures used were previously tested for their reproducibility. Pain complaints were also assessed. Results. In comparison with non-asthmatic subjects, patients with mild or severe persistent asthma held their head and shoulders more forward and had lower chest wall expansion, decreased shoulder internal rotation, and decreased thoracic spine flexibility. Chronic lower thoracic, cervical, and shoulder pain was significantly increased in patients with mild or severe asthma compared with non-asthmatic subjects (p < 0.05). Conclusion. Adults with persistent asthma have musculoskeletal dysfunction and chronic pain that is independent of the severity of their disease but that might be related to their age at the onset of disease symptoms.

Acquired Deformities of the Anterior Chest Wall

Acquired chest wall deformities are difficult to describe and to classify. We propose the following classification and treatment options. We observed 11 patients with acquired deformities (AD) that required surgical correction. AD of the chest can be classified into 4 groups: (1) AD resulting from a pathological process within the thorax (heart enlargement, mediastinal tumors), (2) AD resulting from chest wall disease (rib osteomyelitis or tumors), (3) iatrogenic deformities (following rib graft harvesting, acquired Jeune's syndrome), and (4) post-traumatic deformities. Group 1 requires treatment of the pathological process. Group 2 is guided by oncological or infectious disease principles. Groups 3 and 4 require chest wall reconstruction. Iatrogenic AD usually occur after pectus excavatum repair with rib cartilage extirpation in young patients, which results in a reduced, restricted thorax. Post-traumatic AD often have pathological chest wall mobility owing to pseudo-articulation of injured ribs. To prevent AD formation and to protect thoracic growth and mobility, costosternal and costochondral junctions should be preserved during cartilage resection. Substernal suturing of the perichondrium should be avoided.

Effects of 8-Week, Interval-Based Inspiratory Muscle Training and Breathing Retraining in Patients With Generalized Myasthenia Gravis

To assess the effect of interval-based inspiratory muscle training (IMT) combined with breathing retraining (BR) in patients with generalized myasthenia gravis (MG) in a partial home program. A randomized controlled trial with blinding of outcome assessment. A secondary-care respiratory clinic. Twenty-seven patients with generalized MG were randomized to a control group or a training group. The training group underwent interval-based IMT associated with BR (diaphragmatic breathing [DB] and pursed-lips breathing [PLB]) three times a week for 8 weeks. The sessions included 10 min each of DB, interval-based IMT, and PLB. Interval-based IMT consisted of training series interspersed with recovery time. The threshold load was increased from 20 to 60% of maximal inspiratory pressure (P(Imax)) over the 8 weeks. Lung function, respiratory pattern, respiratory muscle strength, respiratory endurance, and thoracic mobility were measured before and after the 8 weeks. The training group improved significantly compared to control group in P(Imax) (p = 0.001), maximal expiratory pressure (P(Emax)) [p = 0.01], respiratory rate (RR)/tidal volume (V(T)) ratio (p = 0.05), and upper chest wall expansion (p = 0.02) and reduction (p = 0.04). Significant differences were seen in the training group compared to baseline P(Imax) (p = 0.001), P(Emax) (p = 0.01), maximal voluntary ventilation (p = 0.02), RR/V(T) ratio (p = 0.003), Vt (p = 0.02), RR (p = 0.01), total time of RR (p = 0.01), and upper chest wall expansion (p = 0.005) and reduction (p = 0.005). No significant improvement was seen in lower chest wall or lung function. The partial home program of interval-based IMT associated with BR is feasible and effective in patients with generalized MG. Improvements in respiratory muscle strength, chest wall mobility, respiratory pattern, and respiratory endurance were observed.

The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

1. Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth. 2. The rare condition of fused ribs and congenital scoliosis may result in a three-dimensional thoracic deformity with adverse effects on thoracic growth and function with development of thoracic insufficiency syndrome. 3. The normal thorax is defined by two characteristics: normal, stable volume and the ability to change that volume. Volume depends on the width and depth of the rib cage, and the thoracic spine provides height. The ability to change volume, termed thoracic function, is provided by the diaphragm and the secondary muscles of respiration. 4. On radiographs, the loss of the vertical height of the lung of the concave, restricted hemithorax is defined by the percentage of space available for the lung. 5. Spine rotation causes a windswept thorax, with both restriction of the volume of the convex hemithorax and restriction of the motion of the involved ribs. 6. Constrictive three-dimensional deformity of the thorax may cause extrinsic, restrictive lung disease. 7. Progressive thoracic insufficiency syndrome is diagnosed on the basis of clinical signs of respiratory insufficiency, loss of chest wall mobility as demonstrated by the thumb excursion test, worsening indices of three-dimensional thoracic deformity on radiographs and computed tomography scans, or a relative decline in percent predicted vital capacity due to thoracic "failure to thrive," as demonstrated by pulmonary function tests. 8. Treatment of progressive thoracic insufficiency syndrome should provide an acute increase in the thoracic volume with stabilization of any flail chest-wall defects and maintain these improvements as the patient grows, without the need for spine fusion.

Pediatric thoracic trauma.

Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries, and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology, and injury patterns change with age may expedite the evaluation of the pediatric chest after trauma. Differences in pulmonary functional residual capacity, blood volume, chest wall and spinal soft-tissue mobility, and cardiac function may translate into problems or benefits of important consequence. For example, although more predisposed to hypoxemia, young children may remain well compensated hemodynamically, despite significant blood loss. Rare injuries in children, such as cardiac and great vessel trauma, may remain undiagnosed precisely because of their scarcity and protean symptoms.

Chest Wall Expansion Values in Supine and Standing Across the Adult Lifespan

PURPOSE: Chest expansion measurements are used to assess a patient's baseline status, treatment effectiveness, and progression of disease with regards to chest wall mobility and respiratory muscle function. The purpose of this study was to describe values for upper and lower chest wall expansion in subjects without impairment.SUBJECTS: This study included men and women (n = 120) without impairment ages of 20–70+ years.METHODS: We measured chest expansion, the difference in maximal and minimal chest girth, during vital capacity breaths. For each subject, we measured chest expansion in two positions (supine, standing) and at two sites (axilla, xiphoid).ANALYSIS: We used descriptive statistics and linear regression analysis to describe chest expansion values based on age, measurement site, and subject position.RESULTS: Values for subjects age 20–29 years were 5.1 ± 6.2 cm, whereas chest expansion values for subjects age 70 + years were only 2.5 ± 2.9 cm. We found significant linear regressions between age and chest expansion for each measurement site and subject position.CONCLUSION: Use of chest expansion measurements to determine a diagnosis of disease or impairment is not recommended in patients over 65 years of age. Chest expansion measurements may be useful as an indicator of change in impairment level in specific patient populations.

Chest Wall Expansion Values in Supine and Standing Across the Adult Lifespan

PURPOSE: Chest expansion measurements are used to assess a patient's baseline status, treatment effectiveness, and progression of disease with regards to chest wall mobility and respiratory muscle function. The purpose of this study was to describe values for upper and lower chest wall expansion in subjects without impairment.SUBJECTS: This study included men and women (n = 120) without impairment ages of 20–70+ years.METHODS: We measured chest expansion, the difference in maximal and minimal chest girth, during vital capacity breaths. For each subject, we measured chest expansion in two positions (supine, standing) and at two sites (axilla, xiphoid).ANALYSIS: We used descriptive statistics and linear regression analysis to describe chest expansion values based on age, measurement site, and subject position.RESULTS: Values for subjects age 20–29 years were 5.1 ± 6.2 cm, whereas chest expansion values for subjects age 70 + years were only 2.5 ± 2.9 cm. We found significant linear regressions between age and chest expansion for each measurement site and subject position.CONCLUSION: Use of chest expansion measurements to determine a diagnosis of disease or impairment is not recommended in patients over 65 years of age. Chest expansion measurements may be useful as an indicator of change in impairment level in specific patient populations.

Preliminary Report of the Effects of Respiratory Muscle Stretch Gymnastics on Chest Wall Mobility in Patients With Chronic Obstructive Pulmonary Disease

Preliminary Report of the Effects of Respiratory Muscle Stretch Gymnastics on Chest Wall Mobility in Patients With Chronic Obstructive Pulmonary Disease

Relation between chest expansion, pulmonary function, and exercise tolerance in patients with ankylosing spondylitis.

Thirty three patients with definite ankylosing spondylitis (AS) were examined to establish the relation between restriction of chest expansion, limitation of lung function, and working capacity or exercise tolerance. As in previous studies there was a significant association between chest expansion and lung vital capacity. There was also a significant association between vital capacity and exercise tolerance as measured by a subject's maximum oxygen capacity (VO2max). Both vital capacity and VO2max were expressed as a percentage of predicted normal values using patients' height before disease. In this study chest expansion did not have a significant effect on exercise tolerance. The results suggested that patients who took a modest amount of exercise regularly could maintain a satisfactory work capacity despite very restricted spinal and chest wall mobility. It is recommended that greater emphasis should be given to encouraging patients with AS to maintain cardiorespiratory fitness as well as spinal mobility.

Pathokinesiology—The Clinical Implications from a Cardiopulmonary Perspective

Do we really need our own area of science or do we just want it? Do we have it, can we find it or create it, or are we just renaming areas of existing science and study and applying them to our framework? Are we prepared to modify our existing educational structure to reflect clearly this area of science: kinesiology-pathokinesiology from the cellular level to the person level to include all relevant systems? If we adopt the science of pathokinesiology as the basis for physical therapy, will that direct the physical therapists who execute and publish research studies evaluating the effects of positioning, postural drainage, or phase one cardiac rehabilitation programs to study patient populations rather than college student groups? We cardiopulmonary therapists can fit within this pathokinesiological framework if the profession is able to answer many of the questions raised in this discussion. Those answers should illuminate the best fit for the patient without discernable movement dysfunction after coronary bypass graft surgery or the patient with an abcessed right middle lobe of the lungs who has no increase in chest wall mobility after treatment but does demonstrate a decrease in temperature and improved chest roentgenogram findings. The overriding question that I have as a clinician is, does the term pathokinesiology help our professionalism or simply create a new and different framework within which we need to explain physical therapy once more to ourselves, the medical community, our patients, our reimbursers, and the public at large?

Respiratory treatment of the adult patient with spinal cord injury.

The respiratory program of the Spinal Injury Service at Rancho Los Amigos Hospital has demonstrated effective respiratory treatment to be a prerequisite for comprehensive rehabilitation. To facilitate program planning, patients are classified according to functional neurosegmental levels and residual respiratory muscles. Breathing mechanics are the basis of evaluation and treatment. Evaluative elements are strength of residual respiratory muscles, respiratory rate, vital capacity, breathing pattern, chest expansion, and cough. Respiratory functions of patients with spinal injury are compared with respiratory functions of healthy subjects. Treatment objectives are prepared according to the individual patient's functional classification and evaluation. Specific methods are discussed, including strengthening, chest wall mobilization, external support devices, and bronchial hygiene.

Mobilization of chest wall for fixed chest in ankylosing spondylitis

Mobilization of chest wall for fixed chest in ankylosing spondylitis