the Effectivness of the Thoracic Cage Mobilization on COPD Patients
Condition: Chronic Obstructive Pulmonary Disease
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      the study aims to investigate effectiveness of thoracic cage mobilizations on the chronic
      obstructive pulmonary diseases.
    

Detailed description: 
      COPD is a term for airflow restriction and growing shortness of breath caused by
      physiological deterioration. Elderly persons endure reduced respiratory function, stiffness
      in the joints and connective tissues of the rib cage, and increased thoracic Kyphosis as a
      result of COPD .breathlessness, cough, and sputum production are the most prevalent symptoms
      of COPD, while wheezing, chest tightness, and chest congestion are less common but
      nevertheless bothersome. The reported frequency, on the other hand, varies depending on the
      patient demographic and the severity of the disease. COPD is now the world's fourth greatest
      cause of mortality, but it is expected to rise to the third position by 2020.

      Due to the obstruction and exhalation airflow is reduced, resulting in air trapping and
      hyperinflation. When the rate of minute ventilation or respiration is increased, for as
      during exercise, this becomes more apparent. Hyperinflation puts more strain on the
      respiratory muscles, forcing them to function in a restricted range of motion with a negative
      pressure/effort ratio, resulting in fatigue and increased shortness of breath. COPD patients
      avoid physical activity and adopt a more sedentary lifestyle than healthy older adults in
      order to prevent the distressing feeling of breathlessness. This, in turn, causes a vicious
      cycle of decreased exercise capacity, increased breathlessness during exercise, and more
      avoidance of exercise, and so on.

      Active expiration, slow and deep breathing, pursed lips breathing, relaxation therapy, body
      positions such as forward leaning, inspiratory and expiratory muscle training, and
      diaphragmatic breathing are all examples of breathing techniques. Improvement of (regional)
      ventilation and gas exchange, decrease of dynamic hyperinflation, enhancement of respiratory
      muscle function, reduction of breathlessness, and improvement of exercise tolerance and
      quality of life are some of the goals of these procedures. Exercise capacity is impaired in
      COPD, both peak exercise capacity and functional exercise capacity. Besides lung
      hyperinflation and physical inactivity, ventilation-perfusion mismatch, hypoxemia,
      cardiovascular problems and muscular changes Reduced exercise capacity is a factor. One of
      the most important predictors of morbidity and mortality in COPD is functional exercise
      ability. and has a direct connection to everyday physical activities. Because rib cage
      mobility tends to be diminished with obstructive lung illness, PT appears to have a specific
      goal of rib cage joint mobility. Chest wall mobilization enhances chest wall mobility, lowers
      respiratory rate, raises tidal volume, improves ventilation gas exchange, reduces
      breathlessness, reduces work of breathing, and helps you relax. The rib cage mobilization is
      applied in three positions, supine ling, side lying and siding with arm abducted of the side
      to be mobilized.
    

Intervention name(s): conventional treatment; thoracic mobilization
Intervention type(s): Other; Other
Intervention description(s): the patient will be asked to make pursed lip breathing (Breathe in for 2 seconds through his nose and Breathe out for 4 seconds through pursed lips)for 5-10 min ,3-4 times , 8-10 rep each cycle then asked to make diaphragmatic breathing exercise (Lie on his/her back and Inhale deeply through his/her nose for a count of three)for 5-10 min , 3-4 times , 8-10 repetition then postural drainage , furthermore the patient takes different position (prone to make percussion on lower lobes, side lying on anterior basal segment then sitting position on the upper lobe). After that a vibration on the chest (place a flat hand firmly atop the lung segment to be drained., and should apply light pressure and create a rapid, shaking movement) 1 min inhale and 5 time of repetition at the exhale and finally asked the patient to make productive cough for 5 times to get out the sputum.; we will use A SNAG to mobilization using type 3 oscillatory and sustain for 90 second, at first put the patient in 3 position (side lying to make mobilization of upper 6 ribs in downward direction then make on lower 6 ribs ,furthermore flexion of the thoracic and next rotation toward the midline then ask the patient to transfer to supine lying position and mobilize the sternum in downward direction the next mobilize the clavicle and ask the patient to take sitting position and put his hand on his head in adduction position and make extension on the thoracic vertebrae with inward mobilize with the investigator knees ,take each 4 vertebrae along the 12 thoracic vertebrae.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: comparison between two groups one receive conventional treatment and other receives conventional treatment and thoracic mobilization
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Thoracic cage mobilization; conventional treatment