1. Lung-2015 Baltimore, USA July 13 - 15, 2015
Orna Yariv

2. EASY AIR - Pulmonary Rehabilitation Telemedicine
Mrs Orna Yariv
BPT Pulmonary Physiotherapist
July 2015

3. EASY AIR - Pulmonary Rehabilitation Telemedicine
Lungs disease's patients difficulties.
Pulmonary Rehabilitation.
Exercises benefits.
Telemedicine.
EasyAir.
In the coming lecture I will present my experience in expanding the role of pulmonary rehabilitation.

4. What Is The Problem???

5. Energy Demands for Breathing
Rest: 1-2% of total body energy
Effort: 8%
Severe Respiratory Condition 40%
Lungs patients

6. Physiological & Metabolic Problems
CHRONIC HYPOXEMIA
GAZ DIFFUSE
Sputum
Bronchospasm
fibrosis
Hyperinflation
CYTOKINES Plus KATABOLISM
OXYDATE Enzyms
BREATHING EFFORT
High energy demands
Muscles weakness
Myopathy

7. Physiological & Metabolic Problems
Muscles weakness
blood supply
toxins
Myopathy
fibers
type 1
disuse
hypoxemia
medications

8. EARLY ANAEROBIC THRESHOLD
CO2
ANAEROBIC Tracks
LACTIC ACID
EARLY ANAEROBIC THRESHOLD
ENDURANCE
SHORT TERM ACTIVITIES
RESTS
DECONDITIONING
QOL

9. Deconditioning
Muscle Weakness
Dyspnea

10. Pulmonary Rehabilitation
AIM ?
Improve function
& QOL !!!
HOW?
Tailored -
Individual Program .

11. Pulmonary Rehabilitation-DEFINITION
ERS and ATS definition of PR: ‘‘an evidence-based multidisciplinary and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease’’
Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient C- ACPR, Volume 64 Number Suppl I | THORAX May 2009

12. Pulmonary Rehabilitation-
ACPR Guidelines:
exercise training of the muscles of ambulation.
incorporate strength training of upper and lower limbs & Inspiratory muscle training.
Information, advice and education should be integral to pulmonary rehabilitation.
Pulmonary rehabilitation should be made available to all appropriate patients with COPD.
כשאת מביאה מראה מקום של מאמר מספיק לכתוב: מחבר ראשון ולהוסיף et al אם יש עוד מחברים, אפשר את שם המאמר, שם ירחון ושנה.
Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient C- ACPR, Volume 64 Number Suppl I | THORAX May 2009

13. Pulmonary Rehabilitation
“PR has proven benefits on exercise tolerance, dyspnea and health-related quality of life, as well as improvements in healthcare utilization and psychosocial outcomes… “
Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient C- ACPR, Volume 64 Number Suppl I | THORAX May 2009

14. Exercise benefits Well being! !QoL O2 diffusion & delivery↑
Blood volume↑
Hgb↑
SV↑
Peripheral use of O2↑
Muscle strength↑
Aerobic enzymes↑
Neuro-coordination↑
Well
being!
!QoL
דרך אגב QOL כותבים QoL בקיצור.
18 נובמבר 18

15. Exercise benefits trained Non trained Ml/beat 110 Ml/beat 70 Rest SV
Max SV 8L 5L
blood vol
l/min
l/min
Max Q
Reduced
Increased each stage
O2 sub max
33%
25%
O2 utilization from blood
Ml/kg/min 82
Ml/kg/min 45
max O2 consumption
0.5 l
Rest TV L
2.5 L
TV max
L/M
100 L/M
VE max
50+ Resp muscles 35
RR max
The heart is a muscle. After training it receives more blood supply which comes with more O2. The O2 diff is more eff. There r more fibers which r stronger. As a result the SV increases its volume of output

16. Strengthening breathing muscles
training
Strengthening breathing muscles
Increasing TV
Reducing RR
Delay Fatigue
Prolonged activities
Exercise benefits
מה הכוונה בתמונה שמתחת? - סירטון

17. ACSM Exercise Recommendations July 2011
Cardiorespiratory:
150 minutes of moderate intensity exercise per week. 
30-60 minutes 5 days per week/20-60 minutes vigorous-intensity exercise 3 days per week.
Resistance :
2-3 days each week.
Flexibilty:

18. EASY AIR - Pulmonary Rehabilitation Telemedicine
Where? Home,clinic, hospitalized, camps, accompaniment transplantation Treatments :
Drainage
Training
Education
Support
For the past 26 years I've been treating patients between the ages of 1 week and 100 years old, with respiratory dis.

19. EASY AIR - Pulmonary Rehabilitation Telemedicine
The biggest challenge and the most important role in my work is in guiding, educating and supporting my patients To improve QOL

20. EASY AIR - Pulmonary Rehabilitation Telemedicine
Expand this roll of pulmonary rehabilitation
by telemedicine
I realized that I can

21. At the same time telemedicine was developing & expanding

22. Telemedicine- definition
American Telemedicine Association : medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status .

23. EASY AIR - Pulmonary Rehabilitation Telemedicine
At the same time, An impressive technology development There is a growing use of medical devises using telemedicine

24. EASY AIR - Pulmonary Rehabilitation Telemedicine
I wanted to create an easy available treatment to lungs patients

25. EASY AIR - Pulmonary Rehabilitation Telemedicine
The “highlights” of the updated ATS/ERS statement on pulmonary rehabilitation
combination of
“exercise and education”

26. Education
SOB
Self drainage
Inhalation 2O
Home exercises
Adjusting House
ADL

27. EASY AIR – See each other
During the treatment-training the physiotherapist & the patient see each other on the screen. 
The patient sees the physiotherapist demonstrating the exercises & then,
they both perform them together at the same time. The patient can ask personal questions & the physiotherapist can correct mistakes of the patient.   

28. EASY AIR - Pulmonary Rehabilitation Telemedicine
“Longer- term rehabilitation, education and strength training are beneficial.”
Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient C- ACPR, Volume 64 Number
Suppl I | THORAX May 2009

29. EASY AIR - Methods:
Mail/ phone / facebook / website:
Booking Skype-appointment.
Sending medical information.
Sessions of 45 min each( Skype-appointment).

30. EASY AIR- 1st Appointment:
Medical history
What disturbs most.
Level of functionality. Building a patient-tailored rehabilitation program based on traditional Pulmonary Rehabilitation. Following appointments :
Education , training, and a questions time .

31. Walk the dog…

32. EASY AIR - Pulmonary Rehabilitation Telemedicine Case study
Name: Z. Sh. Age: 83 Diagnosis: Severe Restrictive Dis. d/t Severe Kypho-Scoliosis My patients improve their walking distance and amount of upclimbing stairs

33. EASY AIR - Pulmonary Rehabilitation Telemedicine
Telemedicine enables me to treat my patients in a variety of locations, times, and conditions; their home, the hospital, when they are on vacation or even at work. Reaching patients who live in rural areas or patients who are housebound.

34. EASY AIR - Pulmonary Rehabilitation Telemedicine
The Tele-Rehabilitation therapy does not replace traditional pulmonary rehabilitation, it enhances providing an additional way to treat, ease, and expand the way I help my patients.

35. Medical-professional
comfortable
Reliable
Medical-professional
Easy to reach
Easy to contact
Easy to receive

36. The Future
I hope that in the future ….

37. THANK YOU Mrs Orna Yariv BPT Pulmonary Physiotherapist July 2015
Contact :

38. Lung & Respiratory Care – 2016 Website: lung.conferenceseries.com
Meet the eminent gathering once again at Lung & Respiratory Care Manchester, UK August , 2016
Lung & Respiratory Care – 2016 Website: lung.conferenceseries.com