WMMC Pulmonary Rehab
Rick Kenney, MSM, RRT, RCP
Director
Respiratory Care Services
WMMC Pulmonary Rehabilitation Program (PR)
Making Friends in PR
WMMC GYM
Strength training is an essential part of PR
Definition of PR
• According to the 2006 American Thoracic
Society/European Respiratory Society statement
on PR, “PR is an evidence-based,
multidisciplinary, and comprehensive
intervention for patients with chronic respiratory
diseases who are symptomatic and often have
decreased daily life activities. Integrated into the
individualized treatment of the patient, PR is
designed to reduce symptoms, optimize
functional status, increase participation and
reduce health care costs through stabilizing or
reversing systemic manifestations of the disease”
AACVPR Statement
• Pulmonary rehabilitation is an integral
component of comprehensive medical therapy
for patients with chronic respiratory disease.
• In Genreal, PR provides the greatest
improvements in symptoms, exercise capacity,
and health-related quality of life of any therapy
available for patients with COPD.
• In light of this PR is now prominently placed in
virtually all major guidelines for treatment of
COPD
Condition’s Appropriate for PR
Obstructive Diseases
• COPD (including alpha-1 antitrypsin
deficiency)
• Persistent asthma
• Bronchiectasis
• Cystic Fibrosis
• Bronchiolitis obliterans
Restrictive Diseases
Interstitial diseases
– Interstital fibrosis
– Occupational or
environmental lung disease
– Sarcoidosis
Chest wall
diseases
 Kyphoscoliosis
 Ankylosing Spondylitis
Neuromuscular diseases
• Parkinson’s disease
• Postpolio syndrome
• Amyotropic lateral
sclerosis
• Diaphragmatic
dysfunction
• Multiple sclerosis
• Posttuberculosis
syndrome
Other Conditions
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Lung cancer
Primary pulmonary hypertension
Before and after thoracic and abdominal surgery
Before and after lung tranplantation
Before and after lung volume reduction surgery
Ventilator dependence
• Pediatric patients with respiratory disease
• Obesity-related respiratory disease
Patient Assessment
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Patient interview
Medical Hx
Physical exam
Diagnostic tests
Symptom assessment
Musculoskeletal and exercise assesment
Patient Assessment (cont.)
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Activities of daily living
Nutrition assessment
Education assessment (understanding disease)
Psychosocial assessment
Goal achievement
Pain assessment
Pulmonary Rehab Consent
White Memorial Medical Center
PULMONARY REHABILITATION PROGRAM
AGREEMENT TO PARTICIPATE AND GUIDELINES
1. DEFINITION
This program has been recommended to me by: Dr._________________
Pulmonary rehabilitation is an outpatient program provided for patients with chronic lung
Disease. It is designed to enhance the health status and quality of life of participants
through increase knowledge, better exercise tolerance, reduced respiratory symptoms,
and enhanced self-care and coping skills.
2. COMPONENTS
. PATIENT RESPONSIBILITIES
________ If you take nitroglycerin, I will bring and administer my nitroglycerin for chest pain.
I will also bring my glucometer to all sessions to check my blood sugar if needed.
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The program consists of up to 36 – 1 hour sessions. The best outcome is achieved by
regular attendance and participation in all activities. Contact pulmonary rehabilitation
staff if you are not feeling well &/or unable to make it to your scheduled class day at 209536-3726.
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Always report any unusual symptoms which you experience before, during or after
exercise, or that you notice in an exercising colleague.
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Do not exercise within 2hours after eating a large meal, drinking alcoholic or
caffeine containing beverages or smoking.
Some of the components of the program are
 Initial assessment of respiratory status
 Patient training (education)
 Exercise (monitoring of HR, SpO2, Pre-Post BP)
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possible dehydration.
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Do NOT exercise if you have fasted overnight or for longer than 5 hours during the
daytime. Small snacks will give you energy your body needs for exercise.
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NEVER exceed the prescribed level of exercise. If at any time you feel the exercise is
too hard or too easy you will inform the Pulmonary Rehab staff immediately so
adjustments can be made next session starts.
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Keep all follow-up appointments with your family doctor and/or pulmonologist,
3. POTENTIAL BENEFITS
While there is no guarantee that this program will benefit you directly in any way,
widespread experience indicates substantial improvement in many areas, depending on
the individual situation. These areas include:
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Increased exercise capacity.
Improved ability to perform activates of daily living.
Decreased respiratory symptoms.
Decreased anxiety and depression.
Reduction in hospitalizations.
Enhanced quality of life.
Improved ability to be gainfully employed.
4. POTENTIAL RISK AND DISCOMFORTS
Although the staff will make every effort to minimize risks during the sessions by
performing a comprehensive preliminary assessment and by maintaining close
observation during the sessions, there exists the possibility of unexpected changes during
exercise. These include:
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Equipment problems (e.g. falling off treadmill)
Abnormal blood pressure response.
Lightheadedness of fainting.
Disturbance in heart rhythm.
Chest pain, heart attack, or even death (rare).
For increased safety, various vital signs, such as pulse, blood pressure, and oxygenation will be
monitored on a prescheduled basis and/or as needed. Emergency equipment is available, and
staff is trained to deal with unusual situations, which may arise.
Adequate hydration before, during and is important after exercise to minimize
who will continue to be responsible for medical care.
6. MEDICAL RECORDS / CONSENT;
Your medical records will not be released to any other person without your consent. The
information contained, therein, however, may be used for statistical or scientific purpose (as
long as it does not identify my person or provide facts that could lead to my identification), or
for insurance reimbursement.
In the event I am injured or become ill while attending the program, consent is herby given to
provide emergency treatment as deemed necessary by a physician until such time as other
appropriate care can be arranged by my family and primary care physician.
I acknowledge that I have read this form in its entirety, or that it has been read to me, that I
have had the opportunity to discuss it with a rehabilitation team representative, and that I
understand the nature of this pulmonary rehabilitation program. I accept the rules and
regulations set forth, and consent to participate. I also agree to be treated for any
complications or emergencies that may arise. I understand that I can withdraw from the
program ay any time and that doing so will not effect further medical care.
_________________________
Pt. Signature / Date
___________________________
Witness / Date
Plan of Care
• After the intial evaluation is done the
therapist and patient come up with goals and
objectives the patient wants at the end of the
program.
• Once done Dr. Abboy will meet with the
patient to give the go ahead for this individual
plan of care.
Education
• Collaborative self-management education is
an essential component of comprehensive PR.
Self-management education promotes
learning by doing and taking advantage of
teachable moments. Recommended content
should be patient-specific, yet it is imperative
to include early recognition and treatment of
exacerbations, including the use of an action
plan, for all patients. (AACVPR 4th edition)
Chronic Bronchitis/Emphysema
PR Exercise Tests
6 minute walk test: Walk with patient and
monitor heart rate and oxygen saturations.
Documents distance walked, oxygen sats, and
dypsnea.
Exercise Assesment
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Muscle strength and endurance
Joint range of motion limitations
Postural abnormalities (example: Kyphoscoliosis)
How is the patient with oxygen equipment
Subjective endurance and work tolerance
Dyspena
Lack of understanding of fitness and exercise
Fear of exertion
Ability to pace activities and energy conservation
Balance abnormalities, gait instability, or increased risk of falling
Pain levels and locations
Ability to perform ADL’s (household chores, grooming, climbing stairs)
Exercise Program
The importance of an exercise training program cannot be
overemphasized. But before a safe exercise program can be
provided, a through assessment needs to be done to evaluate
exercise tolerance, formulate and appropriate exercise training
prescription, detect exercise-induced hypoxemia or
bronchospasm, and detect occult cardiac or other nonpulmonary
limitations to exercise. The benefits of exercise training are well
documented and include decreased dyspnea, increased physical
capacity, and improved quality of life. Exercise is an essential
component of a comprehensive PR program
AACVPR 4th Edition
PR is for any age
COPD Age Group
From COPD.com
COPD and Gender
From COPD.com
Psychosocial Needs
A strong, trusting bond must be established with patients early
in PR to ensure successful outcomes.
Patients experiencing substantial impairments in psychosocial
functioning need to be referred to a mental health provider.
Smoking cessation is part of PR. A combination of behavioral
and pharmacological approaches is recommended to maximize
success with long-term smoking cessation.
Interdisciplinary Approach
Core Team Members:
The Patient/Family
Medical Director – Dr. Ramadas Abboy
Department Director – Rick Kenney
Department Assistant – Tara Chadwick
Respiratory Therapists
William Rodriguez
Johanna Reyes
Should include as needed:
Behavioral Health
Case Managers
Diabetes Educator
Dietician
Nurse
Pharmacist
Physical/Occupational Therapy
Restrictive Lung Disease
Patients with restrictive diseases are
seen one-on-one per CMS guidelines.
Because the disease process is more
advanced and requires strict
monitoring of the patient while in our
care.
Obstructive Lung Disease
This patient can be seen in a group
setting.
Benefits of group setting is
“competition” among other group
members by pushing each other to do
better
WMMC Patient Work Out
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Warm up stretching
Upper extremities – with or without weights
– Biceps
– Triceps
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Lower Extremities
o Leg lifts
o Squats
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Arm ergometer
• Stationary Bike
• Treadmill
• NuStep
• Cool down period
Extreme Monitoring Of The Patient
We are here to save the day!!!
Admitting your patient into
Outpatient
Pulmonary Rehab at WMMC
 A prescription from MD
 Pulmonary Function Test (within 1
year
 Insurance Card
 List of current medications
 Complete ALL paperwork
 Not Smoking
WMMC PR Patients
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70 Year old Female
Persistent Asthma
HTN/Status Post CABG
Multiple ER visits before = Zero visits since PR
Six Minute Walk – More than doubled their
distance!
• Comments from patient: “need more tissue. A
assest to your PR department is William”
WMMC PR Patient
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72 Year old Female
Persistent asthma/chronic bronchitis
Admitted 3 times in early 2013 (less than 30 days x 2)
Six Minute Walk – Doubled distance
No admissions or ED visits since PR
Patient Comment: “I am very happy that with God’s
grace this therapy has made me feel a lot better. My
therapist explained everything very well. Thank you
so much”
Contact
WMMCPulmonary Rehab
Internally Ext. 2789
Externally (323) 268-5000 Ext 2789
Fax: 323-881-8609
Hours of operation
Monday – Thursday 0700 – 1630
Closed Fridays and Holidays
Eric Lawson, former Marlboro Man, dies of smoking-related disease
A smoker since age 14, actor appeared in print Marlboro ads from 1978 to 1981
Famous People
Loni Anderson
Tallulah Bankhead
Samuel Beckett
Leonard Bernstein
Walter Brennan
William F. Buckley, Jr.
Harry Carey
Johnny Carson
Fyodor Dostoyevsky - Russian Novelist (1821-1881)
King Edward VII
T. S. Eliot – Novelist/Publisher (1866 – 1965)
Alan Ford - Actor
King George V of England
Arthur Godfrey
Frank Gorshin – Actor (The Joker on tv show Batman)
John Huston
Don Imus
Spike Jones
Boris Karloff
Dean Martin
Robert Mitchum
Garry Moore - Entertainer from the 50’s
Alfred Newman – Composer (not the Mad comic book)
Pat Nixon
Johnny Paycheck
Vincent Price
Jerry Reed – Actor/Singer (best known as truck driver on Smokey and the Bandit)
Del Reeves – Country/Western Singer
R.J. Reynolds, Jr.
R.J. Reynolds III
Dusty Rhodes – Professional Wrestler
Norman Rockwell
Chris Schenkel - Sports Caster
Allan Sherman – Musician and Comedian in 60’s/70’s
Barbara Stanwyck - Actress (Big Valley)
Maureen Stapleton - Actress
Gene Tierney – Actress (40’s/50’s)
Ernest Tubb – Country/Western
Forrest Tucker – Actor (F-Troop)
Christy Turlington – Model (father passed from lung cancer)
Bill Wilson – Co-Founder of Alcoholics Anonymous
Amy Winehouse – Diagnosed with emphysema at 24
Dick York – Actor (Husband on Bewitched)
Questions?