Appropriate Occupational Therapy
according to yourpathophysiological conditions	 

Department of Rehabilitation
NHO Toneyama National Hospital (Japan)
http://www.toneyama-hosp.jp/	 

Occupational Therapy at Toneyama National Hospital -1-	 Do you have breathing difficulty when performing daily activities?
Do you consider that it is inevitable to suffer from it?
As shown in the following figure, breathing difficulty is closely associatedwith a decline in the level of activity:	 

＜A Negative Circle of Breathing Difficulty＞	 	 *Partly Revised	
Pulmonary impairment	 

Breathing difficulty	 

A decrease inactivity	 A decline in physicalperformance andmuscle strength	 
Aggravation of breathing difficulty	 

In order to prevent this negative circle of breathing difficulty, it is importantto perform each activity more comfortably.	 

Occupational Therapy at Toneyama National Hospital -2-	 

The first step is to identify activities in which you feel breathing difficulty.
Check which activities cause you breathing difficulty when performing, basedon the following list of the most common activities involving breathingdifficulty in people with pulmonary disease:※ Note: Activities involving breathing difficulty vary among individuals. 	 
１、Holding up the arm	 ⇒	 It limits thoracic movements;
e.g., washing the hair, stretching upwards to pick something up,drying the washing

２、Bending forward	 ⇒	 It limits breathing-related diaphragmatic and thoracic
movements;
e.g., wearing socks, washing the feet, stretching downwards topick something up	 Occupational Therapy at Toneyama National Hospital -3-	 ３、Holding the breath⇒	 It prevents sufficient oxygen uptake, leading to an unstablebreathing rhythm;e.g., washing the face, evacuating the bowels, lifting a heavy object	 

４、Repeating the same arm movement⇒	 Such a movement tends to accelerate, not in accordance withbreathing rhythms;
e.g., washing the body, brushing the teeth, using the vacuum
cleaner, cleaning the table, using a sieve

Occupational Therapy at Toneyama National Hospital -4-	 

Now you know which daily activities cause you breathing difficulty.
Enter them in detail in the following space:	 

★	

★	

★	

★	

★	

Occupational Therapy at Toneyama National Hospital -5-	 	 	 	 	 <Performing	 each	 activity	 slowly	 adopting	 an	 appropriate	 	 	 	 	 	 	 breathing	 method>	 	 	 	 Perform	 each	 activity	 continuously	 adopting	 an	 appropriate	 	 	 	 	 	 breathing	 method	 (such	 as	 pursed-lip	 and	 slow	 breathing	 methods).	 	 	 	 	 It	 is	 necessary	 to	 sufficiently	 train	 and	 practice	 in	 order	 to	 	 	 	 	 	 implement	 this	 method	 appropriately,	 as	 daily	 activities	 tend	 	 	 	 	 to	 be	 a	 combination	 of	 various	 movements.	 As	 the	 first	 step,	 	 	 	 	 	 concentrate	 on	 your	 breathing,	 and	 perform	 each	 movement	 slowly	 	 	 	 	 	 in	 accordance	 with	 your	 breathing	 rhythm.	 

<Performing	 each	 activity	 efficiently> 	 	 	 	 	 	 Daily	 activities	 consist	 of	 habituated	 movements.	 Such	 	 	 	 	 	 	 unconsciously	 performed	 movements	 are	 frequently	 inefficient.	 	 	 	 	 Review	 your	 usual	 movements	 to	 streamline	 them.	 Your	 movement	 	 	 	 	 	 efficiency	 may	 also	 be	 improved	 by	 changing	 procedures	 of	 each	 	 	 	 	 	 activity.	 	 	 	 	 	 <Taking	 a	 rest	 during	 activity>	 

Take	 a	 rest	 if	 you	 feel	 breathing	 difficulty	 during	 activity.	 	 	 	 	 	 It	 is	 also	 appropriate	 to	 take	 a	 rest	 between	 successively	 	 	 	 	 performed	 movements.	 The	 point	 is	 to	 initiate	 the	 next	 movement	 	 	 	 	 after	 your	 condition	 has	 stabilized	 all	 the	 time.	 It	 is	 necessary	 	 	 	 	 even	 for	 those	 without	 feeling	 breathing	 difficulty	 to	 take	 a	 	 	 	 	 	 rest	 on	 some	 occasions.	 	 	 	 	 <Arranging	 environments>	 	 	 	 	 Arrange	 your	 environments	 so	 that	 you	 can	 perform	 your	 activities	 	 	 	 	 more	 comfortably;	 for	 example,	 a	 chair	 in	 the	 dressing	 room	 may	 	 	 	 	 	 facilitate	 taking	 a	 rest	 after	 a	 bath.	 Frequently	 used	 items	 	 	 	 	 	 should	 be	 easily	 accessible.	 

Occupational Therapy at Toneyama National Hospital -6-	 Here are some good and bad examples of performing daily activities,
such as eating, self-care, toileting, dressing, and bathing, in terms ofenvironments and movements to examine effective methods toalleviate breathing difficulty during activity:	 

１、Environments	 
The shape and height of the chair, distance between the table and chair 	 ×	 ••◎	 Chairs without backInappropriate arrangements ofthe table and chair for eating••Chairs with backAppropriate arrangements ofthe table and chair for eating

Occupational Therapy at Toneyama National Hospital -7-	 

２、Movements
Breathing stops during each swallow, leading to an unstable breathing
rhythm. Further, continuous eating-related arm movements while chewing
tend to increase the physical burden.

×••
•
•
•

◎

Eating too quickly
Preparing the next bite of food
while chewing
Placing the next bite of food in
the mouth before swallowing
Not taking a rest despite thepresence of breathing difficulty
Placing too much food into themouth at one time

•••
•

	 	 

Eating at an appropriate pace
Swallowing what is in themouth before preparing thenext bite of foodTaking a rest during a meal
Placing an appropriate
amount of food into the mouth
at one time

Occupational Therapy at Toneyama National Hospital -8-	 １、Environments
Use of a chair, arrangement of frequently used items

×◎	 

•
•

Performing morning care in astanding position
Placing frequently used items
not within arm’s reach••

Performing morning care in asitting or reclined position
Placing frequently used items
within arm’s reach

２、Movements	 
Tooth brushing and face washing tend to be performed with the arm up,
involving repeated movements. Such movements easily accelerate indiscord with breathing rhythms.	 	 

×••
•

◎	 	 

Holding up the elbow
Perform each movement tooquickly
Washing the face without thecannula•••

Maintaining the elbow down
Perform each movement
slowlyWashing the face with thecannula

Occupational Therapy at Toneyama National Hospital -9-	 １、Environments	 
Toilet style and location, use of a safety grab bar (for those who areunstable in a standing position)

×

◎	 ••

Japanese-style toilets
Toilets located too far fromthe main room
Toilets without a grab bar••••

Western-style toilets
Toilets located close tothe main room
Toilets with a grab bar

２、Movements
Stopping breathing when evacuating the bowels may lead to anincrease in the blood pressure and breathing difficulty. The risk ishigher in those who are constipated or with hard stools.

×◎	 •
•

Stopping breathing whenevacuating the bowels
Having hard stools••

Breathing out whenevacuating the bowels
Maintaining appropriatestools (through appropriate
diet and fluid consumption)

Occupational Therapy at Toneyama National Hospital -10-	 １、Environments	 
Use of a chair, clothing designs and storage	 	 ×••
•

	 ◎	 

Dressing in a standing position
Clothes difficult to wear
Placing clothes not within arm’s
reach

•
•
•

Dressing in a sitting position
Clothes easy to wear
Placing clothes within arm’s
reach

２、Movements
Breathing difficulty tends to worsen when holding up the arm to place itthrough the sleeve or bending forward to wear trousers and socks.	 

×◎	 ••••••

Holding up the arm less frequently
Avoid bending forward
Standing up less frequently

Holding up the arm frequently
Bending forward
Standing up frequently
Occupational Therapy at Toneyama National Hospital -11-	 １、Environments	 
Use of a chair and its height, use of a shower, disposition of necessary
items (such as shampoo, soap, shaver, towel, and washbasin),temperatures in- and outside the bathroom	 ×••
•
•

◎	 

Washing the body in a standing
position
Rinsing the body using awashbasin
Placing the necessary items onthe floor
A marked difference in thetemperature between in- andoutside the bathroom••••

Washing the body in a sitting
position
Rinsing the body using ashower
Placing the necessary items
within arm’s reach
Maintaining an appropriate
temperature in- and outside
the bathroom

Occupational Therapy at Toneyama National Hospital -12-	 ２、Movements
Body- and hair-washing activities tend to be performed with the arms up,
involving repeated movements. Such movements easily accelerate in discordwith breathing rhythms.	 	 ×••	 	 ◎	 

Performing each movement
quickly
Bending forward to wash the feet•

Performing each movement
slowlyCrossing the legs to wash thefeet without bending forward•

As the pulse rate increases when soaking the entire body in hot water,
half-body bathing (soaking up to the pit of the stomach in a bathtub) withwarm water is more recommended. If you become cold, use a shower tomaintain your shoulders warm.

×••	 	 	 ◎	 

Bathing with hot water
Soaking the entire bodyin a bathtub••

Bathing with warm water
Soaking up to the pit of thestomach in a bathtub

Occupational Therapy at Toneyama National Hospital -13-	 Drying off in a standing position or quickly to avoid catching a cold tends
to aggravate breathing difficulty. It is appropriate to take a rest after a bath,using a bathrobe to reduce drying movements.	 

×••

◎	 

Drying off in a standing position
Not taking a rest••

Using a bathrobe
Taking a rest in a sitting
position

Occupational Therapy at Toneyama National Hospital -14-	 

You have reviewed your daily activities in detail today.
Could you find appropriate methods to resolve your breathingdifficulty and perform each activity more comfortably?
It is important for people with pulmonary disease to recognize theiractual situations and become able to manage them by themselves.
Appropriate methods vary among individuals.
Please do not hesitate to consult our occupationaltherapists regarding any question or unclear point.

Occupational Therapy at Toneyama National Hospital -15-	 Edited byToshiko Kawabe OT, Chief Occupational Therapist
Hiroshi Yamamoto PT, Chief Physical Therapist, RT
Hiroko Yoshio RN, MSN
Touru Hiraga MD, Head, Department of Rehabilitation
Kenji Yosimura MD, Head, Department of RICU
Ryoji Maekura MD, Vice president,
NHO Toneyama National Hospital, Osaka, Japan
http://www.toneyama-hosp.jp/	 
Phone: 81-6-6853-2001
Fax: 81-6-6853-3127

Occupational Therapy at Toneyama National Hospital -16-