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How to Breathe Deeply After Surgery

Doctor of Physical Therapy Students and Faculty Investigate Positions for Incentive Spirometer Use

November 01, 2016
Students at Touro College School of Health Sciences investigated the best positions for using an incentive spirometer. From left to right: David Gindi, Dr. Ted Marks, Shimon Nefas-Kalimi, Chava Berger, Amarinder Parmar and Joe Calamonici.
Students at Touro College School of Health Sciences investigated the best positions for using an incentive spirometer. From left to right: David Gindi, Dr. Ted Marks, Shimon Nefas-Kalimi, Chava Berger, Amarinder Parmar and Joe Calamonici.

The Incentive Spirometer is given to most post-surgical patients. Typically, the device — a simple cylinder with a piston, mouthpiece and measurements for air pressure — is used by doctors to encourage patients to breathe deeply after operations.

Dr. Ted Marks, Assistant Professor of Physical Therapy in the SHS DPT program and primary investigator on the project, explained:

“People come out of surgery and they don’t want to breathe deeply,” said Marks. “Folks aren’t going to cough since it’s going to cause discomfort. But if patients aren’t breathing deeply or coughing they’re at risk for pneumonia.”

The Incentive Spirometer offers an easy way to encourage and measure the strength of airflow. However, little literature exists about best practice for using this device.

“We have this incredibly common tool that we use, yet we haven’t really substantiated how it works best,” said Marks.  

SHS faculty members Dr. Marks and Dr. Ralph Garcia, together with five third-year DPT students, tested 80 healthy subjects using the device in a variety of positions: sitting unsupported; sitting supported; lying on their left side or lying on their right side; or reclining semi-fowler (on a hospital bed with the head of the bed raised approximately 30 to 45 degrees).

“We found that seated unsupported at the edge of a table or bed yielded the highest value,” said Joseph Calamonici, a class of 2016 DPT graduate and one of the students conducting the research.

The lowest value occurred with subjects who used the device while lying on their left side. The team was awarded the Research Award for Excellence in Research in the Doctor of Physical Therapy Program at the SHS graduation ceremony on Sept. 13. Their findings will be delivered as a platform presentation at this year’s American Physical Therapy Association Combined Sections Meeting conference in San Antonio.

“As a student physical therapist, I referred to a lot of research studies to better understand the efficacy of techniques,” stated Amarinder Parmar, SHS DPT ’16, who was part of the research team. “It helps to tell a patient I’m doing this because there is research behind this.”

“Health care is not stagnant,” added Calamonici. “It’s always changing and we’re taught to use evidence-based practice and you can’t do that without research studies like this.”