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The Effects of Inspiratory Muscle Training in Neuromuscular Disorders: Review Article Okta Hariza; Budiati Lasmitasari; Siti Chandra Widjanantie; Nury Nusdwinuringtyas
Indonesian Journal of Physical Medicine & Rehabilitation Vol 7 No 01 (2018): Indonesian Journal Of Physical Medicine and Rehabilitation
Publisher : Indonesian Journal of Physical Medicine & Rehabilitation

Introduction: Progressive inspiratory muscles weakness in neuromuscular disorders (NMD) can lead to respiratory impairments, from restrictive lung to respiratory failure. Inspiratory muscle training (IMT) is an exercise with a device to increase inspiratory muscles strength and/or endurance. This article wasaimed to review the effect and prescription of IMT in NMD subjects.Methods: Searching method was done in PubMed and Google Scholar using keywords: “inspiratory muscle training” AND “neuromuscular disorders” AND “MIP” OR “PImax”.Results: Seven related studies were found. These studies shown that IMT increased inspiratory muscles strength and/or endurance in chronic progressive NMD. Most studies used threshold type. The intensities varied from 30% through 70% of maximum inspiratory pressure (MIP), minimum twice a day. Therepetition for strengthening was 10 times with 20-seconds rest between repetitions. Endurance trainings were done in 10 cycles of 1-minute breathing or for total 20 m inutes.Conclusion: Several evidences reported that IMT significantly improve strength and endurance of inspiratory muscles in chronic progressive NMD. It was effective in earlier phase of NMD. The minimum load intensity was 30% MIP.Keywords: Inspiratory muscle training (IMT), neuromuscular disorders (NMD), maximum inspiratory pressure (MIP)

Active Cycle Breathing Exercise on Post Tuberculosis Bronchiectasis Ricky Gustian Halim; Siti Chandra Widjanantie; Selly C Anggoro
Indonesian Journal of Physical Medicine & Rehabilitation Vol 7 No 02 (2018): Indonesian Journal Of Physical Medicine and Rehabilitation
Publisher : Indonesian Journal of Physical Medicine & Rehabilitation

Introduction: Tuberculosis (TB) has remained as a major global health issue in Indonesia. Bronchiectasisfrequently occurs in healing process, followed by excessive phlegm and low physical activity.Methods: A case presentation of 49 years old female diagnosed as bronchiectasis post tuberculosis,difficulty to clear the phlegm, and inactive. Patient has undergone pulmonary rehabilitation by activecycle breathing exercise, 5 days a week, 30 minute/session, for 2 weeks.Results: There was no dyspnea, patient easily remove phlegm, and can be more active, after cyclebreathing exercise program.Conclusion: Active cycle breathing exercise effective to relieve dyspnea, improving patient ability toclearance the phlegm, and increase physical activity.Keywords: Bronchiectasis, active cycle breathing exercise, phlegm clearance, physical activity

Pulmonary Rehabilitation After Lobectomy On Pulmonary Aspergilloma: Case Report Andwi Setiawan Kokok; Selly Christina Anggoro; Siti Chandra Widjanantie
Indonesian Journal of Physical Medicine & Rehabilitation Vol 7 No 02 (2018): Indonesian Journal Of Physical Medicine and Rehabilitation
Publisher : Indonesian Journal of Physical Medicine & Rehabilitation

Introduction: Complete resection of aspergilloma in chronic pulmonary aspergillosis (CPA), may hasseveral health problem after surgery berupa sesak napas, batuk yang tidak efektif.Methods: A case presentation of 45 years old woman, after lobectomy on right upper of lung dueto aspergilloma, with history of cough and haemoptysis for 3 months. Pulmonary Rehabilitation werebreathing retraining exercise (BE), mobilization technique (MT), chest mobility exercise (CM), activecycle breathing technique (ACBT), postural correction exercise (PC) for three weeks.Results: There were dyspnea, peak flow rate (PFR:60-70-60), peak cough flow (PCF: 70-90-60 L/m),and abnormal chest expansion (CE: 2.5 – 3 – 2) cm. After three weeks of Pulmonary Rehabilitation,there were no dyspnea, increased the PCF: 193L/m, and CE: 2.5-4 -3.Conclusion: Pulmonary Rehabilitation programs for three weeks were relieved dyspnea, increasedcough capacity and CEKeywords: Aspergilloma, Lobectomy, Bell’s Palsy, Rehabilitation program, Cough capacity, Chestexpancy

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease in Natural Disaster Setting Siti Chandra Widjanantie
Indonesian Journal of Physical Medicine & Rehabilitation Vol 8 No 01 (2019): Indonesian Journal Of Physical Medicine and Rehabilitation
Publisher : Indonesian Journal of Physical Medicine & Rehabilitation

Introduction: The frequency of natural disaster in Indonesia has increased recently, while there were still less capacity to overcome the respiratory problem as an impact of disaster. Subjects who havechronic obstructive pulmonary disease (COPD) need to have more attention in dealing with disaster setting.Methods: Literature reviews from the last ten years to find the data of the respiratory-related disease on disaster setting, which need pulmonary rehabilitation.Discussion: Subjects with COPD can get worse aftermath of natural disasters. The number of COPD exacerbation aftermath disaster was increased 1.5 fold. Pulmonary rehabilitation by trained patient forthe self-management of the symptoms was effective to reduce complication, increase the function and social integration.Conclusion: Pulmonary rehabilitation by optimizing community based training for self-management was effective as preparedness for COPD patients in natural disasters.Keywords: Chronic Obstructive Pulmonary Disease (COPD), Community based training, Natural Disaster, Pulmonary Rehabilitation

Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report Widjanantie, Siti Chandra; Ayuningtyas, Putu Duhita; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44, No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.597

Background: Chronic obstructive pulmonary disease (COPD) patients are at high risk for COVID-19 infection and severe pulmonary complications. Exercise-based pulmonary rehabilitation (PR) in outpatient settings is essential for COVID-19 survivors with COPD comorbidities, providing the most critical patient benefits, but it is challenging during the pandemic.Case: A sixty-four-year-old man with COPD since 2 years ago, a history of COVID-19 one month ago, and Pulmonary Tuberculosis since 1 year ago presented with chief complaints of tiredness, cough, and breathlessness after walking for more than 100 meters. We performed PR, including breathing retraining exercise, chest mobility exercise, active cycle breathing technique (ACBT), posture correction, and aerobic exercise with static ergo-cycle for 8 weeks.Discussion: After 8 weeks of PR, there was a 3% increase in the O2 saturation level from 94-95% room air to 98%, an increase of single breath counting test (SBCT) from 20 to 38 counts, improvement of peak cough flow from 100-110-100 to 420-435-425 L/minute, and peak flow meter from 140-150-145 to 380-400-400 L/minute. Before PR the patient could not perform the sit-to-stand test (STS) and a 6-minute walking test (6MWT), but after 8 weeks of PR, STS was 5 times in 30 seconds, and 6MWT maximum distance was 248 meters. COPD assessment test (CAT) score improved from 23 to 9, and the Modified Medical Research Council (mMRC) dyspnea scale improved from 3 to 2.Conclusion: Eight weeks of pulmonary rehabilitation showed benefits for the patient in reducing dyspnea and improving exercise tolerance and quality of life, especially in hospital-based settings.

Physical Medicine and Rehabilitation Approach of Elderly with Atypical COVID-19 Symptoms Widjanantie, Siti Chandra; Burhan, Erlina; Susanto, Agus Dwi
Surabaya Physical Medicine and Rehabilitation Journal Vol. 6 No. 2 (2024): SPMRJ, AUGUST 2024
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v6i2.51713

COVID-19 has affected the older population disproportionately. These patients are prone to have more severe COVID-19. Clinical manifestation of COVID-19 in the geriatric can be atypical and differs from the younger population. We report an 80-year-old male with atypical presentation of COVID-19. In this case report, we describe a COVID-19 patient with anorexia and gastrointestinal symptoms. We also describe the multidisciplinary aspect of physical medicine and rehabilitation management of the patient. Clinical manifestations in geriatric with COVID-19 can be atypical. Symptoms experienced may include anorexia and gastrointestinal tract symptoms. A multidisciplinary approach is needed to manage more seniors with COVID-19 and maximize their functional abilities.

Respiratory Rehabilitation for A Loss to Follow-Up Pulmonary Tuberculosis Patient with Bilateral Hydropneumothorax: A Case Report Isdyanta, Rezky Achmad; Widjanantie, Siti Chandra
Respiratory Science Vol. 5 No. 2 (2025): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v5i2.147

Background: Tuberculosis (TB) is a preventable and treatable disease. However, without treatment, mortality from TB is 50%, whereas with treatment, 85% of people with TB can be cured. Incomplete treatment of pulmonary TB can lead to various complications, one is hydropneumothorax, which is an abnormal picture of air and fluid in the pleural cavity. Complications of this condition can lead to long-term impairment of lung function with varying degrees of severity. Pain and shortness of breath are clinical features that interfere with daily activities and are associated with a decreased quality of life. Pulmonary rehabilitation is a crucial component in managing respiratory diseases, including pneumothorax, which aims to restore respiratory muscle strength, optimize lung expansion, and prevent complications such as atelectasis, pleural adhesions, or chronic respiratory insufficiency. Case: A 26-year-old woman presented to the emergency department with moderate dyspnea. She was diagnosed with loss to follow-up (LTFU) TB with bilateral hydropneumothorax and malnutrition. She was in the third month of a four-drug anti-TB regimen and had a chest tube with water shield drainage (WSD) placed in both the right and left chest walls. The rehabilitation problems in these patients are dyspnea, pain in the chest tube insertion area, immobilization, and partial dependency. Discussion: A pulmonary rehabilitation program was initiated during hospitalization and continued in the outpatient rehabilitation clinic, including energy conservation techniques, breathing exercises, relaxation, splinted cough, chest wall mobilization, respiratory muscle stretching, and laser therapy for pain management. Barthel Index (BI) shows improvement from 10 to 45 due to pain reduction. Visual Analog Scale (VAS) 7-8 to 5, allowing the patient to use her right upper extremity for daily activities. Conclusion: Pulmonary rehabilitation is a cost-effective therapy that can improve symptoms and quality of life in patients with post-TB hydropneumothorax. It also reduces spasms, dyspnea, and pain.

Combined Institutional and Telerehabilitation Programs for A Post-Tuberculosis Lung Disease Patient with Low Cardiorespiratory Endurance: A Case Report Widjanantie, Siti Chandra; Agustin, Heidy; Handayani, Diah; Burhan, Erlina; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 45 No 4 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497//jri.v45i4.719

Background: Post-tuberculosis lung disease (PTLD) can lead to long-term respiratory issues and impaired lung function, which can impact quality of life. Pulmonary rehabilitation (PR) is a personalized strategy designed to address these problems and improve overall well-being. It is administered by a diverse team of experts. Case: A 28-year-old female patient with a history of tuberculosis (TB) presented with breathing difficulty. The physical examination revealed decreased chest expansion, shoulder asymmetry, a slight forward neck, and a rounded shoulder. The radiologic findings and bronchoscopy showed PTLD, atelectasis in several parts of the right lung, and regional destruction of the right lung. Discussion: The patient underwent pulmonary rehabilitation (PR), which included endurance exercises, strength training, several types of breathing exercises, breath-stacking exercises, thoracic expansion exercises, physical agents for rehabilitation modalities, education on posture correction, and energy conservation in daily activities. The patient was also monitored remotely through telerehabilitation from home. There were significant improvements in pulmonary function tests. Measurement of FVC, FEV1, the six-minute walking test (6MWT), and the PCF after two weeks of follow-up. After eight weeks of training, there were improvements in cardiopulmonary endurance, muscle endurance, and reduced dyspnea. Conclusion: Comprehensive pulmonary rehabilitation programs, including a combination of institutional and telerehabilitation synchronous approaches, can help improve cardiopulmonary endurance, muscle strength-endurance, and the overall patient's functional life who was suffering from chronic respiratory diseases, such as post-TB sequelae.

Rehabilitation Management for Sarcopenia in Chronic Obstructive Pulmonary Disease: A Literature Review Widjanantie, Siti Chandra; Lestari, Fiona; Nusdwinuringtyas, Nury; Susanto, Agus Dwi
Respiratory Science Vol. 4 No. 3 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i3.136

Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating chronic respiratory condition that not only affects the lungs but has far-reaching systemic consequences; one such consequence is the heightened risk of developing sarcopenia, a condition characterized by progressive loss of skeletal muscle mass and strength. Recent studies have highlighted the significant prevalence of sarcopenia among COPD patients, with rates ranging from 7.9% to 66.7%. This association underscores the importance of early identification and intervention to mitigate the adverse outcomes related to both conditions. Managing COPD patients with sarcopenia is fraught with challenges, primarily due to the multifaceted nature of both conditions. Sarcopenia exacerbates the decline in respiratory function and physical performance in COPD patients, complicating treatment and management strategies. The complexity is further amplified by the need for personalized treatment plans that address these conditions' pulmonary and musculoskeletal aspects. Precise assessment and re-evaluation are essential to ensure optimal outcomes and enhance physical and functional well-being. Rehabilitation for COPD patients with sarcopenia involves a multidisciplinary approach, focusing on exercise training, nutritional support, and pulmonary interventions. Pulmonary rehabilitation programs, tailored to individual patient needs and capabilities, have shown promise in improving exercise capacity, functional performance, and overall health status, thereby enhancing the quality of life for these patients. In this literature review, we will discuss the elevated risk of sarcopenia in COPD patients, highlight the significance of rehabilitation management, and emphasize the pivotal role of precise assessment and re-evaluation in optimizing the care provided to this population.

Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report Widjanantie, Siti Chandra; Ayuningtyas, Putu Duhita; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44 No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.597

Background: Chronic obstructive pulmonary disease (COPD) patients are at high risk for COVID-19 infection and severe pulmonary complications. Exercise-based pulmonary rehabilitation (PR) in outpatient settings is essential for COVID-19 survivors with COPD comorbidities, providing the most critical patient benefits, but it is challenging during the pandemic.Case: A sixty-four-year-old man with COPD since 2 years ago, a history of COVID-19 one month ago, and Pulmonary Tuberculosis since 1 year ago presented with chief complaints of tiredness, cough, and breathlessness after walking for more than 100 meters. We performed PR, including breathing retraining exercise, chest mobility exercise, active cycle breathing technique (ACBT), posture correction, and aerobic exercise with static ergo-cycle for 8 weeks.Discussion: After 8 weeks of PR, there was a 3% increase in the O2 saturation level from 94-95% room air to 98%, an increase of single breath counting test (SBCT) from 20 to 38 counts, improvement of peak cough flow from 100-110-100 to 420-435-425 L/minute, and peak flow meter from 140-150-145 to 380-400-400 L/minute. Before PR the patient could not perform the sit-to-stand test (STS) and a 6-minute walking test (6MWT), but after 8 weeks of PR, STS was 5 times in 30 seconds, and 6MWT maximum distance was 248 meters. COPD assessment test (CAT) score improved from 23 to 9, and the Modified Medical Research Council (mMRC) dyspnea scale improved from 3 to 2.Conclusion: Eight weeks of pulmonary rehabilitation showed benefits for the patient in reducing dyspnea and improving exercise tolerance and quality of life, especially in hospital-based settings.

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