DISSERTATION PROPOSAL

“ The Effectiveness of upper Extremity Training in COPD ”

-A comparative study

Submitted By :

PRAVEEN RANA R.S

1ST Yr M.P.T. Student

ShrideviCollege of Physiotherapy,

Sira Road, Lingapur

Tumkur-06

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA- BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the Students and Address / PRAVEEN RANA R.S
1ST Yr M.P.T. Student
ShrideviCollege of Physiotherapy,
Sira Road, Lingapur
Tumkur-06
2 / Name of the Institution / ShrideviCollege of Physiotherapy,
Sira Road, Lingapur
Tumkur-06
3 / Course and Subject / M.P.T in Cardio-Respiratory Disorders & Intensive Care
4 / Date of Admission to course / 03/05/2007
5 / Title of the Topic / “ The Effectiveness of upper Extremity Training in COPD ”
- A comparative study

6. Brief Resume of The Intended Work :

6.1 Need for the Study :

COPD is a diseased state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. COPD is a major public health problem. It is the 4th leading cause of chronic mortality in the united states and is projected rank 5th in 2020 as a world wide burden of disease according a study published by the world bank / WHO.

According to projection COPD will be the 5th leading cause of disability adjusted life year. COPD lost world wide in 2020 behind ischemic heart diseases major depression traffic and cerebero vascular disease. The risk factor for COPD includes both host factors and environmental exposures. The host factor that is best documented is rare hereditary deficiency of alphal antitrypsin. The major environmental factors are tobacco smoking, heavy exposure to occupational dust and chemical, indoor and out doors pollution cigarette smokers have a high prevalence of lung function abnormalities and respiratory symptoms a greater annual rate decline in FEV1.

The pathophysiological changes characteristics of the disease include mucus hyper secretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchanges abnormalities pulmonary hypertension and corpulmonale. They usually develop in the order over the course of the disease. The FEV1, FVC, FEV1/FVC falls progressively and many patients may have limited improvements in airflow. The lung volume such as TLC, RV and FRC are increased because of elastic recall.

The goals of effective COPD management are to prevent disease progression, revels symptoms and improves exercise tolerance, improve health status and prevent and treat complication exacerbations and reduce mortality.

Patients of COPD may use some muscles of the shoulder girdle to takepart in pulmonary ventilation, especially when the arms are anchored. These muscle can well provide support to pull on the ribcage. In addition, arm elevation increase oxygen uptake and carbon dioxide production in these patients and will also decrease the participation in ventilation of some of the muscles of the shoulder girdle. Arm training has the potential to improve arm exercise performance by decreasing ventilation demand during arm work and by improving arm endurance. When the arms are braced, arm training improves the ventilatory of those by increase shoulder gridle muscle strength. So arm exercises are safe and should be included in the rehabilitations programs for patients with COPD. The purpose of this study is to measure the effectiveness of upper extremity training in COPD patients.

6.2 Review of the Literature :

  1. The breathing pattern in COPD patients while performing simple task like combing hair, bathing and dressing which shallow irregular shallow rapid pattern of breathing.
  1. Most patients with severe chronic air flow limitations after their breathing pattern when performing unsupported arm exercise by shifting a portion of the ventilatory burden away from the inspiratory muscles to the ribcage to the diaphragm and to the muscles of the expiration.
  1. A study of patients with COPD randomized it either unsupported arm training or threshold resistance breathing training. Arm training increased arm exercise endurance and decreases the VE, VO2 and VCO2 during arm elevation. Where as ventilatory muscle trainees did not show any change in those values. Maximum inspiratory pressure increased significantly for both groups indicating that arm training may induce increase in force generation by those muscles of ribcage on shoulder.
  1. The study showed that upper extremity exercises leads to reduction in ventilatory requirement for simple arm elevation.

This type of program may allow patients with chronic air flow limitation to perform sustained upper extremity activities with less dyspnea.

  1. The study was compared training effects between arm ergometry and unsupported arm exercises, found that unsupported arm training decreased the metabolic requirement for exercised and concluded that simple arm elevation may help more than arm ergometry.
  1. He assessed the effect of inspiratory muscle training on dyspnea, exercise performance and HQRL in COPD patients. HQRL is this study measured using BD1/TD1 and CRQ.
  1. They assessed to investigate differences in work capacity of the arms and legs in patients with moderate to severe COPD. They conclude that arm work is reduced by 38 % that of the legs, while more modest reductions are noted for VO2 and VE suggesting greater mechanical efficiency for leg work as compared to arm work.

Hypothesis :

(H1) upper extremity training may or may not improve pulmonary function parameters in patients with COPD.

6.3)Objectives of Study :

1)To study the effectiveness of upper extremity training in COPD.

2)To observe pulmonary function values before and after upper extremity training.

7. Materials and Methods :

7.1Source of Data

The study will conducted from the COPD patients from the ShrideviHospitaland Govt,. district Hospital, Tumkur

7.2Method of Collection of Data : ( Including sampling procedure if any)

Sample of the Study :

This study consists of thirty COPD patients.

Methods of Sampling :

The sample will be selected based on simple random sampling method.

Criteria for the study :

a)Inclusion Criteria :

i)Patients aged 35- 60 years

ii)FEV1/FVC>40% ( mild to moderate)

iii)A history of may or may not be a cigarette smoke.

b)Exclusion Criteria :

i)Unstable cardiac disease

ii)Neuro musculo skeletal diseases

iii)Corpulmonale

iv)An acute illness

v)Current psychiatric illness

Study Design :

Experimental study design 30 subjects will divided into 2 groups

Group 1 : Experimental : Upper extremity training under supervision of Therapist

Group 2 : Controlled :Upper extremity training

Materials used :

  • Spiro meter
  • Ball
  • Bean Bag
  • Overhead pulleys
  • Wire and ring

Parameters :

  • FEV1
  • FEV1/FVC ratio
  • FEF 25 – 75

Procedure :

Written consent will be obtained from the patients . Each patient will undergo formal evaluation of inclusion into the study . PFT prior to the study will performed following the standards outlined by ATS.

The patients under experimental group are treated for 1 hour 3 times per week for 8 weeks and were supervised by the physiotherapist.

The patients will undergo 10 min of general warm up, 20 min of upper limb circuit training and 10 min of cool off.

The training includes :

  • Throwing the ball against the wall with arms above horizontal
  • Passing a bean bag over the head.
  • Exercises on overhead pulleys in sitting
  • Moving the ring across a wire without touching the wire while arm is above horizontal in sitting position.

Each exercise are performed for 40 sec followed by a 20 sec rest and was repeated 3 times in 3 min.

Exercise will be progressed by one more repletion for every 2 weeks post evaluation will be performed immediately after 8 weeks of study. The FEV1 , FEV1/FVC and FEF (25-75) will be measured Spiro metrically.

7.3 Data Analysis :

Descriptive statistics including mean and standard of dependent variables namely FEV1 , FEV1/FVC and FEF (25-75) will be calculated before and after the upper extremity training group and controlled group.

Inferential statistics was done with the unpaired t- test. The formula used is

X1 - X2

. t = ______

(n1-1) s12 + (n2-1) s22

n1 + n2 -21/n1 + 1/n2

All data will be analyzed with statistics for preventive social sciences package version 10.0 using unpaired ‘t’ – test to compare before and after the response to training for all the out come measures, to find out which group had better results.

7.3) Assessment Procedures :

All the patients will be assessed by using general cardio respiratory assessment.

7.4Does the study require any investigation to be conducted on patients

Yes, This study need to be conducted investigation on 40 COPD patients.

7.5) Has ethical clearance been obtained from you institution.

The main study will conduct after the approval of research committee permission will be obtained from the concerned head of institutions. The purpose and other details of the study will be explaining to the study subjects and will be inform consent obtained from them. Assurance will be given to the study subjects on the confidentially of the data collection from them.

List of Reference :

  1. World Health Report, World health Organization, Geneva. 2000 Available from URL Https/
  1. Tangri S , Woolf C K. The breathing pattern in chronic obstructive lung disease during performance of some common daily activities. Chest 1973;63:126-27
  2. Bartalome R Cell, Rasrsulo J, Make B J.

Dyssynchronious breathing during arm but not leg exercises in patients with chronic air flow limitation. N Engl J Med 1986;314 : 1485-90.

  1. Epstein S S, Bresline E, Roa J, Celli B R. Impact of unsupported arm training (AT) and ventilatory muscle training (UMT) on metabolic and ventilatory consequences of unsupported arm elevation (UE) and exercise (UAEX) in patients with chronic airflow obstruction (CAO) Arm Rev Respir Dis 1991; 143 A: 81.
  1. James K, stoler, Redento Ferranti and Alvan RF Further specification and evaluation of a new clinical index for dyspnea Arm rev respire Dis 1986; 134 : 1129-34.
  1. Martinez F J, Voger PD, Dupont DN Beamis J F stan Oponlos 1 : Supported arm exercise Vs unsupoorted Arm exercise in rehabilitation of patients with chronic airflow obstruction. Chest 1993; 103:1397-1402.
  2. Carter R, holiday D B, Stocks J, Triep B. Peak physiological responses to Arm and Leg ergometry in male and female patients with Air flow obstruction, chest 2003, 124;511-18
  3. Test book of pulmonary diseases. Murray and Nodal.
  1. Berry J M, Norman E Kenneth S Quniby A and Lever HA. An inspiratory muscle training and whole body reconditioning in chronic obstructive disease.