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Respiratory Rehabilitation Service

Respiratory Rehabilitation for Chronic Obstructive Pulmonary Diseases | Respiratory Rehabilitation for Neuromuscular Diseases

Rehabilitation for Chronic Obstructive Pulmonary Diseases

Rehabilitation Centre's Respiratory Rehabilitation Service is designed to help persons with chronic lung disease increase their ability to live independently in the community and overcome the physical limitations resulting from their disease.

Services are provided in both official languages.

Chronic Obstructive Pulmonary Diseases Rehabilitation is targeted to include patients with any chronic lung disease:

Chronic obstructive pulmonary diseases (e.g., emphysema, chronic bronchitis, bronchiectasis, asthma; sleep disordered breathing);
Restrictive pulmonary disorders (pulmonary fibrosis; farmer's lung; asbestosis);
Pre-post surgery (e.g., lung transplant, lung volume reduction, pulmonary complications of cancer);
Adult Cystic Fibrosis.

What are the Goals of Respiratory Rehabilitation?

The goals of respiratory rehabilitation are to:

optimize quality of life
reduce the intensity, and the fear of shortness of breath
restore highest possible level of functioning and sense of well-being
prevent or reduce hospitalizations

These goals are often met by:

increasing activities through exercise training
reducing and gaining control of symptoms, primarily shortness of breath
education covering all aspects of chronic lung disease
improving psychosocial and emotional well-being
encouraging independence through self-management and control over daily activities

The American Thoracic Society definition of respiratory (pulmonary) rehabilitation is:

"Pulmonary Rehabilitation is a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy." (American Thoracic Society, 1999)

How Does the Service Work?

Comprehensive assessment identifies appropriate rehabilitation candidates and allows tailoring of a rehabilitation program to individual patient needs. It includes a medical and exercise evaluation with a general assessment of the activities of daily living, an overview of the psychological, social and emotional well-being of the candidate that will allow the person to participate in the respiratory rehabilitation program.

Appropriate patients participate primarily in exercise endurance training supplemented with breathing retraining and lung secretion clearance techniques. Group and individual education sessions pertaining to all respiratory goals contribute to improved management of the disability associated with the chronic lung condition.

The initial clinical assessment will determine if the patient is admitted to the service as either an outpatient or as an inpatient.

Most patients participate on an outpatient basis. The program is usually 12 weeks of primarily exercise training, 2 days per week for 1-2 hours per session. Consultation and group education sessions with various team members are included if needed.
Inpatient beds are available for patients who need to be admitted. The program is 4 weeks of exercise training, twice a day, Monday to Friday. Consultation and group education sessions with various team members are included. Patients return home each weekend to put into practice the techniques and knowledge acquired each week. This allows patients to give feedback to team members and receive ongoing follow-up.

Who is Eligible?

Respiratory Rehabilitation may benefit people with chronic lung disease whose daily activities and quality of life are restricted by the following symptoms:

frequent cough
increased sputum and wheezing
breathlessness on moderate exertion

To be a potential candidate for Respiratory Rehabilitation a person needs to be referred by a physician, be 18 years of age or older and have a respiratory diagnosis and any of the following:

have been hospitalized or visited an emergency department due to shortness of breath
would like to improve your quality of life now limited by shortness of breath
is motivated and committed to initiate and maintain an exercise program
is able and willing to learn how to better manage the condition
has an FEV1 less than or equal to 70%
is supplemental oxygen dependent
is able to participate in self care, i.e. dressing, toileting
is able to return home every weekend (this applies to inpatients)
is able to attend multiple appointments in a day

A person is not ready for Respiratory Rehabilitation this person:

is still smoking *
is acutely ill
has other serious medical conditions which would interfere with safe participation in a physical exercise program (e.g. cardiac, severe arthritis or dementia -- this will be assessed on initial consult with the Respirologist)
FEV1 less than 20%
*Smoking cessation is provided on site by the clinical education nurse however, community programs should be accessed first.

Who are the Member of the Team?

Our Respiratory Rehabilitation Team utilizes an interdisciplinary approach that is client and family centred. The Team includes:

Respirologist
Nursing
Respiratory Therapist
Physiotherapist
Occupational Therapist
Pharmacist
Psychologist
Clinical Dietitian
Social Worker

Other health care specialists are available as required.

The Rehabilitation Team works in a collaborative fashion to assist patients in attaining and maintaining their identified goals.

What are the Components of the Services?

Respiratory Rehabilitation consists of Endurance Training, Education and Disease Symptom and Disability Management. These are over-lapping activities which together contribute to improved quality of life, reduced disability, increased independence and reduced respiratory-related hospitalizations.

In response to patient-identified goals the team develops an individualized program to be carried out in both group and one to one settings. This includes participation in assessment and training of:

Endurance: walking, treadmill, stationary cycling, walker evaluation;

Pacing: stairs, walking, of daily functional activities;

Strengthening: light weight training for arms and legs

Lung Secretion Clearance: effective coughing, trial of techniques to loosen secretions such as steaming, trunk flexibility exercises, flutter valve

Breath Control: technique to improve pattern of breathing, shortness of breath, flutter valve.

Education: The program offers individual and group sessions using a variety of teaching strategies. We encourage all respiratory patients and their families to attend. A wide range of topics are covered such as:

Lung anatomy and physiology: How your lungs work
Pathophysiology of Lung Disease: What's wrong with your lungs
Lung Hygiene Management: Making the best of your lungs
Medical management
Medications
Oxygen Assessment
Nutrition and Diet
Energy Conservation and Work Simplification: Changing your lifestyle
Disease Symptom and Disability Management
Family Sessions and Family Conferences
Breathing Training Strategies
Anxiety, Symptom and Self-Management Skill Training

What is Expected the Patients?

Active participation the program
Involve the family in the rehabilitation process
Read the materials provided. Ask questions. Make the program suit their situation and needs
Put into practice what they have learned in the program to their home situation with their family and friends
Make plans to maintain the gains made during Rehabilitation

How to Patient Enter the Program?

A family physician or specialist must refer the patient. Once we receive a referral or consultation letter from the physician, the patient can expect the following:

A telephone call by our clinic nurse to arrange an initial consultation appointment at The Rehabilitation Centre;
The first visit will include an assessment by the Respirologist followed by pulmonary function testing (breathing tests). This assessment will determine whether the person can benefit from rehabilitation;
The person will then be booked for a screening stress test using a stationary exercise bike;
Respiratory rehabilitation candidates participate in an Interdisciplinary Assessment process. The Service Nurse Clinician initiates the assessment by collecting information relevant to the person’s health, physical abilities and present level of functioning. The purpose of this comprehensive assessment is to work with the patient to identify rehabilitation goals;
Based on these assessments the person will be enrolled into the respiratory rehabilitation program, Outpatient or Inpatient, best suited to your needs.

How Can A Patient Contact the Service?

Main office telephone number: 613-737-7350 ext. 75318
FAX number: 613-736-9054

What Is The Cost Of This Service?

The cost of medical and professional care is covered for patients with a valid Ontario Health Insurance Plan (OHIP) card. Out-of-province patients are seen in accordance with the provisions and entitlements of their provincial health care plans.
Patients are responsible for their parking and transportation costs.

Respiratory Rehabilitation for Neuromuscular Diseases

Patients with neuromuscular diseases and spinal cord injuries generally have weak breathing and coughing muscles. The patients breathing status is minimally affected by daily activities until infection is present or the disease becomes more advanced.

Preventative airway management measures initiated at an early stage can prevent unnecessary hospital emergency visits and intensive care unit admissions.

Patients suffering from a neuromuscular weakness including spinal cord injury and who are respiratory compromised are seen specifically by the Pulmonary Assessment Unit. These patients require a variety of respiratory muscle aids which differ from clients with lung diseases.

Who Is Eligible?

Patients are 18 years of age or older and have the following diagnosis:

muscular dystrophies
myopathies
neurological disorders
- amyotrophic lateral sclerosis and other motor neuron diseases, poliomyelitis, neuropathies, diaphragm paralysis, Guillain-Barré syndrome, multiple sclerosis, Friedreich's ataxia, spinal cord injuries
skeletal disorders
- kyphoscoliosis

How Do Patients Enter The Service?

Most of our services are entirely on an outpatient basis. Spinal cord injured or neuromuscular disease patients may be referred by any physician to the Respirologist and Pulmonary Clinic for an assessment. Clients who are inpatients on other rehabilitation services may access the services of the Pulmonary Assessment Unit upon referral by the attending physician.

What Are The Services Offered?

A comprehensive neuro respiratory assessment performed by a respirologist, respiratory therapist and nurse, determines the therapeutic interventions best suited to improve the patient’s condition. This includes a baseline pulmonary function test, the measurement of the cough efficiency and evaluation of sleep disturbances and/or need for breathing support.

The long-term goal for patients with neuromuscular diseases and spinal cord injuries is to increase lung volume and lung/rib cage suppleness, improve cough efficiency and prevent infections. This is achieved by introducing lung volume recruitment with a modified resuscitation bag, the CoughAssist machine or mouth piece ventilation with a home mechanical ventilator.

Patients requiring breathing support at night or 24 hours per day are introduced to various breathing apparatuses primarily non-invasively. A skilled respiratory therapist will assess the appropriateness of various interfaces and modes of ventilation to prevent the need for a tracheostomy.

PIC - Mouth Piece interface for daytime breathing support

Education sessions are offered to facilitate ventilation decision making and training of patients/caregivers on the use of breathing respiratory muscles aids.

Related links to respiratory muscle aids available to achieve lung volume recruitment and assisted cough:

Modified resuscitation bag
CoughAssist (Mechanical In-exsufflation)
Volume ventilator
Glossopharyngeal breathing
Assisted cough

What is the Cost?

The cost of medical and professional care is covered for patients with a valid Ontario Health Insurance Plan (OHIP) card.

Ontario residents with a valid Ontario Health Insurance Plan (OHIP) card may have access to the provincial Assistive Devices Program (ADP) and the Ventilator Equipment Pool (VEP) for financial assistance to help with the cost of some medical equipment.

Out-of-province clients are seen in accordance with the provisions and entitlements of their provincial health care plans.