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
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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
66
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
• 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
Faculty of Physical Therapy Beni Suef University
Cairo, Egypt
Diaphragmatic Excursion
ultrasonography device applied on chest and used to measure the vertical movement of diaphragm unite of measure is centimeter (cm)
Time frame: all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
Diaphragmatic thickness
ultrasonography device applied on chest and used to measure diaphragmatic thickness and change of flexibility of the diaphragm unite of measure is millimeter (mm)
Time frame: all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
Level of Dyspnea
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.
Time frame: all assessment will be performed two times one pretreatment and then will be repeated post treatment almost 2 months
Oxygen saturation (%)
Oxygen saturation (%)
Time frame: assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
Resting Heart rate
Resting Heart rate
Time frame: assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
Pulmonary function test (spirometry)
* 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
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* 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.
Time frame: all assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
maximum heart rate
maximum heart rate
Time frame: assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months
heart rate recovery at first and second minutes
heart rate recovery
Time frame: assessment will be performed two times one pretreatment and will be repeated post treatment almost 2 months