Search

The authors analized the effect of reeducation on patients with an exacerbated bronchial stasis and mucostasis. The group studied was composed of 103 patients suffering from chronic bronchitis, with or without pulmonary emphysema, bronchial asthma and bronchiectasis. Examination methods and breathing reeducation methods were briefly reported. Values measured before and after reeducation enabled by comparison the appreciation of this as an independent method. The rates of pulse (P less than 0.005), of breathing (P less than 0.001) and of systolic pressure (P less than 0.05) were influenced favourably by reeducation. The average quantity of sputum per day increased by 69% (P less than 0.001) specially in asthmatic patients, in itself an important improvement. After exercise there was a slight decrease of PaO2 and SaO2, but after 2 hours of rest, improved values for PaO2 (P less than 0.05), SaO2 (P less than 0.05) Raw (P less than 0.05) and SGaw (P less than 0.05) were noted. The transitory decrease was probably due to tired respiratory muscles and auxillary respiratory muscles. Breathing reeducation favourably affected the clinical conditions, the sputum production, mucostasis, blood-gases exchange, and decreased the airways obstruction. For a greater objectivity, different methodological approaches should also be considered.

The modern lung hospital offers favorable conditions for the rehabilitation of patients suffering from chronic obstructive pulmonary diseases. In the years from 1972 to 1976 2398 patients suffering from chronic bronchitis, bronchial asthma and pulmonary emphysema were subjected to a rehabilitation process at the central hospital for heart and lung diseases Bad Berka. A long-term therapy plan based on a most accurate investigation possible of all the factors which trigger off the complaint in each case was used as baseline. An account is given of the resulting diagnostic and therapeutic program carried out. In the case of chronic obstructive pulmonary diseases it is particularly difficult to assess the effectiveness of rehabilitation measures. One aspect dealt with is the restoration of working capacity. 56.7% of the men and 56.8% of the women were capable of working when they were dismissed. 31.6% of male and 26.4% of female patients were invalids, 11.7% and 16.8% respectively were old age pensioners. Rehabilitation success depended on variables such as age, degree of cardio-pulmonary limitation in performance, as well as on certain concomitant diseases and the patient's cooperation. A decisive factor in some cases was also whether suitable employment could be found for these patients whose age ranges between 40 and 60.

Geriatric rehabilitation is described according to the theory of Steinmann and is divided into three categories. Firstly, into the actual preventive rehabilitation of the outpatient with the aim of slowing down, possibly even stabilizing or retarding partly normal, partly pathological changes occurring as a function of the aging process. The old person who is not confined to an institution should thus be given an opportunity to lead an active life inspite of certain age related infirmities. Secondly, the general rehabilitation of the sick, comprising the treatment of age illnesses by means of medication and what could be described as "activating care or therapy". Thirdly, the specific rehabilitation which deals with these old age diseases through sophisticated and expensive team in a highly specialized clinic. The approach of the therapeutic team of a geriatric clinic ist described on the basis of the example of the treatment of hemiplegic patients.

The use of negative charge ionized air as a technique of respiratory rehabilitation has been examined. After some introductory remarks on the biological action of this climatic factor, literature references are reviewed and personal experience reported. The importance of negative ionization of air is stressed, especially in acute and chronic inflammatory forms of the airways.

Respiratory rehabilitation in patients with pulmonary emphysema should be focussed first on the prevention and elimination of harmful inhalative factors, e.g. smoking habits and environmental or occupational pollution. In addition, distinct therapeutical procedures are mostly effective in preventing a progressive course of the disease and interrupting the vicious circle of dyspnea, physical inactivity and overall disability as well. In patients with advanced disease, mostly complicated by features of chronic respiratory insufficiency and cor pulmonale, long-term administration of oxygen often relieves symptoms, increases physical performance and may even reduce hospital admissions for a longer period. As a consequence, most patients with severe disability also suffer from severe psychological and social problems which should be considered more attentively within the concept of the overall rehabilitation program.

Report on 14 years experience with the day sanatorium belonging to the 4th pulmonary department of the János-Hospital in Budapest. Therapeutic results correspond to those of the hospital department. The day department has proved a success for examination and treatment of patients with pulmonary disease. In the recent years its importance of treatment of patients with non-specific pulmonary diseases has significantly increased. The day sanatorium is enjoying great popularity as well with the patients as in the Chest Clinics.

The diaphragm of the emphysematous patient is low and limited in its excursions, producing an increased functional residual capacity and decreased pulmonary ventilation. This report describes our experiences with a new technique for 1) the training of abdominal-diaphragmatic (A-D) breathing and 2) the relaxation of accessory respiratory muscles in emphysematous patients. Abdominal muscle contraction during expiration has been shown to increase diaphragmatic excursions and, hence, pulmonary ventilation. Use of this technique has been limited, however, because of the difficulty in learning this breathing pattern. Through continuous audio and visual feedback of myoelectric potentials (myofeedback) from abdominal muscles, 12 patients learned A-D breathing. The lower rectus abdominis muscle was found to be the most suitable muscle for obtaining the myoelectric potentials. Similarly, by providing the patients with myofeedback from their accessory muscles, they decreased the use of these muscles, thus increasing their respiratory efficiency. With myofeedback, patients appear to learn new breathing patterns effectively and in fewer sessions than with conventional procedures.

Despite the magnitude of the public health problem presented by respiratory diseases, there have been few studies concerned with vocational rehabilitation (VR) potential of patients with chronic obstructive pulmonary disease (COPD). Certain physiologic variables which show a high degree of relationship to VR success are identified. The three independent variables which most highly correlate with the VR potential of patients with COPD are the percentages predicted for the first-second forced expiratory volume (FEV(1.0)), forced expiratory flow between 25 and 75 percent of the forced vital capacity (FEF(25-75 percent)), and maximum voluntary ventilation (MVV). The mean "cutting" percentages for inclusion in VR programs were 50, 27, and 40, respectively. The emotional variables studied do not differentiate potential VR success or failure as clearly as the physiologic factors. The criteria set forth not only can be used by rehabilitation workers but could serve as a basis for future demonstration studies.