RU2845444C2 - Method for performing sound respiratory gymnastics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and pulmonology, particularly to a method for rehabilitation of the patients suffering severe and extremely severe acute respiratory infection and double-sided polysegmental pneumonia caused by Covid-19. Given invention is applicable for the patients on oxygen support in the resuscitation and anaesthesiology department following voice instructions. In all parts of the lesson, sound gymnastics is used in the warm-up, main and final parts. Persistent and positive result is provided in comparison of index SF=SpO₂/FiO₂ before and after the performed sound gymnastics.

EFFECT: method provides reducing acute respiratory failure ensured by improved pulmonary tissue drainage ensured by sound-induced vibration.

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Description

The invention relates to the field of medicine, in particular to a method for the rehabilitation of patients who have suffered from acute respiratory infection in severe and extremely severe form with bilateral polysegmental pneumonia, in particular caused by Covid-19, who are in the intensive care and anesthesiology department on oxygen support (high-flow, non-invasive and artificial ventilation of the lungs) and have vocal function.

The prior art discloses a method for performing health-improving sound breathing exercises (patent for invention No. 2526883, IPC A61H 1/00, patent holder Dilshad Museyb kyzy Gasanova), which includes the sequential performance of exercises that include the pronunciation of words and/or phrases in French:

Exercise 1: the words - parler, frapper, mari are pronounced in sequence, 10 times, in

at a calm pace, without changing intonation, in a sitting position, hands on knees, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 2: the words and phrase - travailler, cesîles, lesvilles are pronounced

sequentially, 5 times, vigorously, at the same pace, in a sitting position, arms down along the body, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 3: the words - chercher, marcher, cacher are pronounced sequentially, 5 times, in a whisper, energetically, with increasing intonation, changing facial expressions from fear to joy,

and vice versa, in a sitting position, hands on knees, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 4: the words - général, Gérard, geste are pronounced in sequence, 5 times,

energetically, without changing the tempo and intonation, with facial expressions from surprise to contempt, and vice versa, in a standing position, hands on the stomach, then a pause of 10 seconds, the whole cycle

repeat 5 times;

Exercise 5: the words gymnastique, jamais, jeudi are pronounced sequentially, 5 times, with increasing tempo, intonation and changing the melody to high tones, while walking at a calm pace, arms are raised above the head and then lowered along the body, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 6: the words aimer, amie, aider are pronounced sequentially, 10 times, with

increasing tempo, intonation, in a standing position, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 7: the words - répéter, espérer, adresser are pronounced sequentially, 10 times, at a slow pace, confidently, firmly, while walking at a medium pace with your head raised, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 8: the words fermer, terminer, arriver are pronounced sequentially, 10 times, with increasing tempo, energetically, with facial expressions from surprise to satisfaction, in a standing position, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 9: the words - aller, lebracelet, quitter are pronounced sequentially, 10 times, at a slow pace, energetically, with facial expressions ranging from anger to joy, while walking quickly, waving your arms, then a 5-second pause, the entire cycle is repeated 5 times;

Exercise 10: the words traverser, cesser, laisser are pronounced sequentially, 10 times, with increasing tempo and intonation, with facial expressions from fear to joy, while walking at an average pace in different directions, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 11: the words coeur, beurre, soeur are pronounced sequentially, 10 times, at a slow pace, calmly, without changing intonation, in a sitting position, hands on knees, then a pause of 10 seconds, the entire cycle is repeated 5 times;

exercise 12: phrases and word - elle a des amies, mes amies, fromage pronounce

sequentially, 5 times, at the same tempo, with a questioning intonation and facial expressions - surprise, in a standing position, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 13: the phrases - ilpleure, ilpleut, il a peur are pronounced sequentially, 5 times, at the same pace, energetically, while walking at a slow pace, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 14: the words - fleur, heure, leur are pronounced in sequence, 10 times, with

at an increasing pace, energetically, with facial expressions of joy, while walking at an average pace, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 15: The phrases - rest at the house, Paris is there, the city is beautiful are pronounced

sequentially, 5 times, at the same pace, energetically, with a questioning intonation, in a standing position, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 16: the words heureuse, délicieuse, fameuse are pronounced sequentially, 5 times, with increasing tempo and intonation, in a standing position, then a pause of 5 seconds, the entire cycle is repeated 5 times;

exercise 17: the phrase and words - lachambreclaire, lafenêtre, laSorbonne are pronounced sequentially, 5 times, at the same tempo and intonation, calmly, while walking at a calm pace, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 18: the words - rester, imiter, visiter are pronounced sequentially, 10 times, at the same tempo, energetically, with facial expressions of surprise, in a standing position, then a pause of 10 seconds, the entire cycle is repeated 5 times;

Exercise 19: the phrases - ecrirelalettre, lelivredePierre, ilaquatrefilles are pronounced sequentially, 5 times, with increasing tempo, energetically, in a sitting position, then a pause of 5 seconds, the entire cycle is repeated 5 times;

Exercise 20: the phrase and words - ungrandgarçon, gare, garder are pronounced

sequentially, 10 times, at the same pace, vigorously, in a standing position, then a 5-second pause, the entire cycle is repeated 5 times.

The disadvantage of this solution is that it cannot be used by people of all categories.

This set of exercises is designed for the category of people capable of learning French, and is not adapted for people with cognitive impairments or experiencing hypoxia. In addition, it does not take into account the patient's premorbid status, level of education, motivation, social status and the ability to correctly pronounce sounds during independent exercises or with relatives. This method is designed for mobile patients who can sit, stand, walk, and not for patients on non-invasive and artificial ventilation.

In addition, the French have a different method of articulation and sound reproduction (position of the larynx, tongue). Therefore, in order to perform this gymnastics, specific articulatory patterns must be formed that are difficult to reproduce for an untrained person who does not know French. Therefore, the proposed complex of pronunciation of sounds by the patient can cause him negativity and a violation of the psycho-emotional state, which will cause his refusal to perform this complex and lead to negative dynamics.

In addition, the vibration created by pronouncing the said sound combinations does not achieve the desired effect, since it is not transmitted to the upper and middle sections of the lung tissue, and therefore does not ensure sufficient discharge of sputum from the bronchial tree. This means that the state of lung ventilation does not improve.

Sound gymnastics that help with respiratory diseases is also known from the Internet:

http://my.mail.ru/community/////6E7B.BD9982ACC829.html, where it is disclosed that sound gymnastics is useful for diseases of the respiratory system, since when pronouncing sounds, the vocal cords begin to vibrate, and this vibration is first transmitted to the respiratory tract and lungs, and from them to the chest. With the help of such vibration, spasmodic bronchi and bronchioles relax. Sound exercises should be performed on the pronunciation of various vowels and consonants. At the initial stage, the vowels u, i, e, o are pronounced. Later, the consonants zh, z, r, s are used. Trained patients can use sh and shch. On inhalation, you can pronounce m-m-m, on exhalation pff. Pronunciation of these sounds causes

vibration of the vocal cords, which is transmitted to the trachea, bronchi, lungs, chest. This helps well to relax spasmodic bronchi and bronchioles.

With the sounds p, t, k, f the greatest force of the jet is developed, with the sounds 6, g, d, v, z - average, with the sounds m, k, l, r - the least.

On the exhale, it is recommended to pronounce a growling sound "r", lasting from 5-7 seconds at the beginning and up to 25-30 seconds after a long workout. Then on the exhale, you can use sounds such as bang, bat, bak, beh, bang, brroh, brruh, brrfh, drroh, drrfh, etc. It is also recommended to do breathing exercises together with physical exercises (walking, movement of the upper limbs). For example, a list of sounds is offered that should be pronounced every day: pfff - 3 times, mmm - 3 times and pffff - 1 time, brrrukh - 3 times and pfff - 1 time, vrruh - 3 times and pfff - 1 time, shrrukh - 3 times and pfff - 1 time, zrrukh - 3 times and pfff - 1 time, vrrot - 3 times and pfff - 1 time.

This sound technique is limited to its impact on the respiratory organs.

The disadvantages of this gymnastics are as follows:

- pronouncing the sounds mm-mm-m while inhaling can provoke a spasm in the respiratory muscles, which will lead to an aggravation of the condition of the patient with viral pneumonia;

- pronunciation of consonant sounds at the end of a sound combination leads to a break in the air stream, as a result of which the vital capacity of the lungs (VC) decreases;

- when performing exercises while walking and moving the upper limbs, the patient will perform the proposed exercises at a medium and fast pace, as a result of which his respiratory muscles will be increased, and the respiratory rate (RR) will also increase, which requires constant monitoring of the patient by a specialist.

The closest technical solution, taken as the closest analogue, is sound gymnastics known from the Internet https://www.sb.by/articles/zvukovaya-gimnastika-pri-zabolevaniyakh-organov-dykhaniya.html, authors: Tatyana Pristom, PhD, Andrey Pristom, MD, Associate Professor, Belarusian Medical Academy of Postgraduate Education, which is used for diseases of the respiratory system, including exercises with vowels and consonants pronounced in various combinations and in a certain sequence. When pronouncing sounds, the vibration of the vocal cords is transmitted to the trachea, bronchi and lungs and has a relaxing effect on the smooth muscles of the respiratory tract. All exercises are performed slowly, without strain.

Sound gymnastics helps to form the correct alternation of the phases of inhalation, exhalation and respiratory pause. Due to vibration, spasmodic bronchi relax, which helps to better evacuate sputum. By creating a small positive pressure on exhalation, the uniformity of alveolar ventilation increases and prevents early expiratory closure of the airways.

Rational breathing is taught as follows: the inhalation should be shallow, since a deep inhalation, irritating the bronchial receptors, can lead to aggravation and spread of the spasm. Inhale through the nose for a count of 1-2, then pause for a count of 1 and exhale through the mouth for a count of 1-2-3 or 1-2-3-4. When exhaling, the lips should be folded into a "tube". This way the exhalation will be longer than the inhalation. After finishing, pause for a count of 1-2-3 to reduce the flow of pathological impulses to the respiratory center. The inhalation after holding the breath should again be shallow.

1st lesson:

Exercise 1. Cleansing exhalation. PFF – 5–7 times.

2nd lesson:

Exercise 1. PFF – 3 times.

Exercise 2. Closed groan. MMM – 3 times. PFF – 1 time.

Exercise 3. BRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 3:

Exercise 1, Ex. 2, Ex. 3.

Exercise 4. GRUF (o, a, e, i) – 1 time each and PFF – 1 time.

4th lesson:

Exercise 1, Exercise 2, Exercise 3, Exercise 4 – repeat.

Exercise 5. DRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 5:

Exercise 6. RRR – 3 times and PFF – 1 time.

Exercise 7. BRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 6:

Repeat all previous exercises.

Exercise 8. PRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Exercise 9. ZHRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 7:

Repeat all previous exercises.

Exercise 10. KRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Exercise 11. TRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 8:

Repeat all previous exercises.

Exercise 12. FRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Exercise 13. CHRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 9:

Repeat all previous exercises.

Exercise 14. CRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Exercise 15. SHRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Ex. 16. HRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Lesson 10:

Repeat all previous exercises.

Exercise 17. BRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

Exercise 18. GRRUKH (o, a, e, i) – 1 time each and PFF – 1 time.

The disadvantage of this solution is that this complex does not include a warm-up section, which should prepare the articulatory and respiratory apparatus for further load exercises, which can become a risk of injury to the lung tissue, which will significantly aggravate the patient's condition.

In addition, the sound complex ends with the back-lingual sound [x], aimed at training the root of the tongue, the muscles of the soft palate and the back wall of the pharynx. As a result, the sound complex is interrupted and the possibility of free passage of the air stream is excluded. As a result, the vital capacity of the lungs does not increase, therefore, optimal ventilation of the lung tissues is not achieved, the condition does not improve.

In addition, when pronouncing complex sound combinations, the emphasis on the consonant sound is not emphasized, which does not stimulate the muscles of the chest and diaphragm, which are involved in the protective cough mechanism, and the accumulated sputum is not removed from the respiratory tract, which complicates the passage of the oxygen mixture into the lung tissue, which can result in hypoxia.

This complex includes breathing pauses, which in patients with acute respiratory viral infections who are on oxygen support will cause hypoxia, which will lead to an aggravation of the condition and will not give a positive effect.

The technical problem that the proposed solution is aimed at solving is to stabilize the condition and prevent respiratory decompensation by draining the lung tissue, reducing the frequency of respiratory movements, preventing psycho-emotional disorders caused by staying in the intensive care and anesthesiology department, and reducing the length of the patient's stay in the intensive care unit and specialized departments.

The technical result of the proposed invention consists in reducing the recovery time of a patient in the intensive care and anesthesiology department on oxygen support (high-flow, non-invasive and artificial ventilation of the lungs).

In all parts of the lesson, the main and final, sound gymnastics is used in the warm-up. A stable and positive result is ensured by comparing the SF index = SpO ₂ /FiO ₂ before the lesson and after the sound gymnastics. SF is the index of the ratio of oxygen saturation to the fraction of inhaled oxygen; SpO ₂ is blood saturation, FiO ₂ is the fractional concentration of oxygen in the inhaled gas mixture.

Teaching the patient to do independent activities.

The result is based on a study of the results of the proposed gymnastics on patients who had suffered an acute respiratory infection.

The following tasks were set:

- stabilization of the condition and prevention of respiratory decompensation, drainage of lung tissue, reduction of respiratory rate (respiratory rate);

- prevention of psycho-emotional disorders caused by staying in the intensive care unit (ICU);

- teaching the patient independent activities.

The authors of the invention conducted studies on patients who had suffered from the new coronavirus infection and were in extremely serious condition in the intensive care unit.

From January to December 2021, 45 patients with a laboratory-confirmed test for NCVI (new coronavirus infection) took part in the study, with whom classes were held using sound gymnastics. The average age was 67±7 years, 53.3% were women, 12 patients with diabetes mellitus and 1 patient with asthma. The number of patients with lung tissue damage according to CT (computed tomography) results was: CT1 - 5 people (14.3%); CT2 - 12 (34.3%); CT3 - 11 (31.4%) and CT4 - 7 (20%). All rehabilitation measures began 24 hours after the patient's admission to the intensive care and anesthesiology department. According to the data obtained before and after sound gymnastics sessions with patients, the difference in SF (oxygen saturation to inhaled oxygen fraction ratio) in days 1-3 was from 2.5 to 3.75%. On the first day of classes, the average was 117.50% before and 120.00% after the session using sound gymnastics (p=0.001), and on the third day of classes, before 118.75% and after 122.50% (p=0.002).

To solve the technical problem, the following set of exercises is proposed, including:

- a warm-up in which:

1. The patient takes a deep breath through the nose and, until exhaling completely, alternately draws out the sounds (the root of the tongue is raised) [a], [o], [u], [i] (preparing the patient and his respiratory muscles, articulatory apparatus for more complex exercises).

- the main part:

2. The patient takes a deep breath through the nose and pronounces the combination of sounds ТРРА – ТРРО – ТРРУ – ТРРИ – ТРРЭ – ТРРИ (repeat 1-2 times).

3. The patient takes a deep breath through the nose and pronounces the combination of sounds DRRA – DRRO – DRRU – DRRY – DRRE – DRRI (repeat 1-2 times).

4. The patient takes a deep breath through the nose and pronounces the combination of sounds KRRA – KRRO – KRRU – KRRY – KRRE – KRRI (repeat 1-2 times).

5. The patient pronounces the combination of sounds PRRA – PRRO – PRRU – PRRY – PRRE – PRRI (repeat 1-2 times).

6. The patient takes a deep breath through the nose and pronounces the combination of sounds BRRA – BRRO – BRRU – BRRY – BRRE – BRRI (repeat 1-2 times).

7. The patient takes a deep breath through the nose and pronounces the sound combination HA (repeat 5-7 times, with aspiration).

8. The patient takes a deep breath through the nose and pronounces the sound combination MMMA with a firm attack (repeat 5-7 times), controlling the vibration in the chest (placing the hand on the sternum).

9. The patient takes a deep breath through the nose and pronounces the sounds [k] – [k´] (repeat 5 – 7 times, without phonation on exhalation), checking the inclusion of the diaphragm.

10. The patient takes a deep breath through the nose and pronounces the sounds [t] – [t´] (repeat 5 – 7 times, without phonation on exhalation), checking the inclusion of the diaphragm.

11. The patient takes a deep breath through the nose and pronounces the sound [m] until completely exhaling: lips closed, teeth open (repeat 3-5 times), control the vibration in the chest (place your hand on the sternum).

- The final part:

The patient, together with the specialist, takes a deep breath through the nose, then smoothly exhales through the mouth (5–10 times).

Warm-up exercises help prepare the respiratory and articulatory muscles for further exercise, and also coordinate breathing and speech exhalation.

The exercises in the main part of the lesson help improve drainage of the lung tissue and also train diaphragmatic breathing. The combination of sounds leads to vibration of the lung tissue, which improves the discharge of sputum from the bronchial tree and also stimulates the cough reflex.

The sounds "rr" create an optimal vibration in the vocal cords, which is transmitted to the lung tissue. The inclusion of the sounds "T, P, D, B" helps to engage the diaphragm, the lung tissue straightens out (expands) better, the volume of inhaled and exhaled air increases and drainage of the lung tissue occurs faster. The patient's condition improves.

The exercises in the final part normalize physiological breathing and also prevent psycho-emotional disorders (panic attacks, delirium).

The proposed complex provides a reduction in acute respiratory failure as a result of improved drainage of lung tissue due to vibration created by sounds. There is an impact on the upper and middle sections of the lung tissue, which leads to the discharge of sputum and a decrease in the frequency of respiratory movements. Before classes with sound gymnastics 30±8 (movements/min) and after 27±5.

The proposed set of exercises has been tested on patients who have had the new coronavirus infection (Covid-19) and are in extremely serious condition in the intensive care unit.

From January to December 2021, 45 patients with a laboratory-confirmed test for NCVI (new coronavirus infection) took part in the study, with whom classes were held using the proposed sound gymnastics. The average age of patients was 67±7 years, 53.3% were women, with 12 patients with diabetes mellitus and 1 patient with asthma. The number of patients with lung tissue damage according to CT (computed tomography) results was: CT1 - 5 people (14.3%); CT2 - 12 (34.3%); CT3 - 11 (31.4%) and CT4 - 7 (20%).

All rehabilitation activities began 24 hours after the patient's admission to the intensive care and anesthesiology department. According to the data obtained before and after sound gymnastics sessions with patients, the difference in SF (oxygen saturation to inhaled oxygen fraction ratio) in days 1-3 ranged from 2.5 to 3.75%. On the first day of classes, the average was 117.50% before and 120.00% after the session using sound gymnastics (p=0.001), and on the third day of classes, it was 118.75% before and 122.50% after (p=0.002).

A positive result is ensured by comparing the SF index = SpO ₂ /FiO ₂ before and after the sound gymnastics. SF is the index of the ratio of oxygen saturation to the fraction of inhaled oxygen; SpO ₂ is blood saturation, FiO ₂ is the fractional concentration of oxygen in the inhaled gas mixture.

The use of the proposed sound gymnastics for patients with a new coronavirus infection (Covid-19) in the intensive care unit led to an increase in the oxygen saturation index to the fraction of inhaled oxygen, which in turn reduced hypoxia and increases the possibility of reducing non-invasive and high-flow oxygen therapy.

Claims (13)

A method for the rehabilitation of patients with acute respiratory viral infection who are on oxygen support, including sound breathing exercises, characterized in that it includes a warm-up, controlling the movement of the diaphragm, while the patient takes a deep breath through the nose and until a full exhalation alternately draws out the sounds [a], [o], [u], [i], after which he performs exercises that include pronouncing a combination of sounds in the following sequence while inhaling deeply through the nose 1-2 times: - TRRA-TRRO-TRRU-TRRY-TRRE-TRRI, - DRRA-DRRO-DRRU-DRRY-DRRE-DRRI, - KRRA-KRRO-KRRU-KRRY-KRRE-KRRY, - PRRA-PRRO-PRRU-PRRY-PRRE-PRRI, - BRRA-BRRO-BRRU-BRRY-BRRE-BRRY, after which he also takes a deep breath through his nose and pronounces a combination of sounds: - HA - with aspiration, 5-7 times; - MMMA - on a solid attack 5-7 times while controlling the vibration in the chest, placing your hand on your chest, - [k]-[k]- 5-7 times at the output without phonation, controlling the inclusion of the diaphragm, - [t]-[t] - 5-7 times at the output without phonation, controlling the inclusion of the diaphragm, - draws out the sound [m] until the exhalation is complete with lips closed and teeth open – 3-5 times, and At the final stage, the patient takes a deep breath through the nose followed by a smooth exhalation through the mouth 5-10 times.