Effectiveness of Breathing Exercises as a Play Way Method in Terms ofImproving Clinical Parameters of Pneumonia among Children

INTRODUCTION

Children constitute principle assets of any country. Children’s Development is as important as the development of material resources and the best way to develop national human resources is to take care of children. India has the largest child population in the world. All efforts are being made by India for the development and welfare of children. Now a day’s children are prone to get some life threatening conditions such as diarrhea, anemia, and some respiratory diseases due to child poverty, lack of education and family dysfunction.¹

Pneumonia is an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is characterized primarily by inflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen).The symptoms of pneumonia can develop suddenly (over 24-48 hours) or may come on more slowly, over several days. Common symptoms of pneumonia are likely to have a cough which can be dry, or may produce phlegm (thick mucus) that is yellow, green, brownish or bloodstained and breathing difficulty, wheezing and chest tightness where the rate will be high and the rhythm will be rapid and shallow .Two vaccines are available to prevent the pneumonia disease.² The Pneumococcal Polysaccharide Vaccine (PPV23) and Pneumococcal Conjugate Vaccine (PCV13)

One of the best therapeutic exercises for pneumonia treatment is breathing exercises. Breathing techniques are helpful for reducing breathing difficulty. The ultimate goal is for children to be able to relax quickly when faced with stressful situations. Breathing exercise as an integral part plays a significant role in airway clearance and parenchyma expansion by improving the efficiency of respiratory muscles. Modified breathing exercise is mandatory in children because they might not co-operate like adults. The principle is to attract children and not to create boredom. It can be accompanied by musical tone that would evince interest in a child. Various modified forms of breathing exercises like group exercises, running, and balloon blowing, abduction, adduction and forward movement of upper limbs, blowing air into the water with a straw, blowing a trumpet, flute and mouth organ playing are found effective in children.³  

The play way method is a more spontaneous one, which demands creativity in which it may not be a structured and documented system but more an adaptation of best practices from across the world, with a greater emphasis on physical activities such as role-play, music and movement, art and crafts, stories. Although a child is born breathing deeply abdominal, they will usually become a chest breather by 6 years. Breathing with the chest restrains the amount of oxygen that enters the body. Therefore, it is important to teach a child how to breathe properly.4 This study aimed to evaluate the effect of Breathing Exercises as a pay way methods in terms of improving clinical parameters of children with pneumonia

OBJECTIVES 

1. To assess the pretest and posttest level of clinical parameters of pneumonia among children.

2. To find the effectiveness of breathing exercises as a play way method in terms of improving clinical parameters of pneumonia among children.

3. To find the association of posttest level of clinical parameters pneumonia among children with their selected demographic variables.

METHODOLOGY

A Pre experimental-one group pre test post-test design was selected for the study. The study was conducted in the paediatric ward at RajaRajeswari Medical College Hospital, Bangalore. Ethical committee clearance was taken prior to the data collection and informed consent was taken from the parents and children. A total of 30 children with the diagnosis of pneumonia were included in the study. On day 1 investigator established good rapport and written consent was obtained from the parents after explaining the importance and purpose of study. Acute illness observation scale was used for data collection. Samples of 2-3 were selected by using purposive sampling technique, per day and 30-40 minutes were taken for conducting interview. Baesline clinical measures were measured before and after treatment. In the present study the base measures were to assess the clinical parameters of pneumonia using a standardized scale (Acute Illness Observation Scale). After pre test the investigator administered breathing exercises in play way methods like candles and flowers activity, balloon blowing for 10-30 minutes. Children were made to repeat the exercises daily three times under the supervision of the parents The post test was conducted after 5 days using the Acute Illness Observation Scale.

Candle and Flower activity: This exercise allows a child to relax with deep breaths as he uses his imagination. Make the child to start by making a fist out of his or her left hand, imagining he or she is holding a flower. Have him or her form a fist with the right hand as well, pretending that he or she is clutching a candle. Tell the child to inhale deeply as he or she sniffs the flower. Then, instruct the child to blow out the candle. Encourage the child to really inhale the scent of the flower and make sure the candle is completely blown out.⁵

Balloon blowing: This activity encourages deep breathing, allowing a child’s body to relax. Explain the child that this exercise will help him or she can feel more relaxed. Make the child to imagine that he/she is blowing up a balloon. Ask him/her to take in a deep breath, and steadily and slowly blow up the huge balloon. See the balloon getting bigger, and bigger, and bigger. Now ask the child to close the eyes and imagine the balloon floating into the air. Let the child continue blowing of balloons until he or she gets relaxed and calm.⁵

RESULTS

1. Pretest level of clinical parameters of pneumonia among children

In pretest the level of clinical parameters of pneumonia was severe in 83.3% children and moderate in 16.7% children. . Where as in the post test the clinical parameters of children with pneumonia were mild in majority (66.7%), moderate in 26.7% and severe in 6.6% children. 

II. Effectiveness of breathing exercise as a play way method

In pretest clinical parameter mean score was 19.13±2.96.Where as in posttest the mean score was 10.53±2.96. There was significant difference between pre and post intervention score with ‘t’ value of 10.48 which was found to be significant at p<0.001 level. Further domain wise analysis of clinical parameter too showed a statistically significant difference between pretest and posttest scores.This indicated that the breathing exercise as play way method was highly effective in improving the clinical parameters of pneumonia among children (Table 1)

III. Association of posttest level of clinical parameters of pneumonia among children with their selected demographic variables.

There was a significant association between posttest levels of clinical parameters scores with the demographic variables such as age of the child (X2=6.89 p=0.03* df=2, t=5.99 ) and residential area, (X2=6.50 p=0.04* df=2; t=5.99 ) at p<0.05 level of significance. No association was found between the others demographic variables and clinical parameter scores.

DISCUSSION

In pretest the level of clinical parameters of pneumonia was severe in 83.3% children and moderate in 16.7% children. . Where as in the post test the clinical parameters of children with pneumonia were mild in majority (66.7%), moderate in 26.7% and severe in 6.6% children. 

There was significant difference between pre and post level score with the‘t’ value of 10.48 which was found to be significant at p<0.001 level. Further domain wise analysis of clinical parameter too showed a statistically significant difference between pretest and posttest scores.This indicated that the breathing exercise as play way method was highly effective in improving the clinical parameters of pneumonia among children. This finding was congruent with the finding of a study by Shally, Kumar Y and Kaur P on effectiveness of breathing exercises as therapeutic play on respiratory status among children undergoing nebulization therapy with lower respiratory tract disorders wherein the major findings revealed that the mean respiratory status in experimental group improved significantly from pre-intervention to post-intervention as compared to comparison group. The computed t value in post-intervention 1st (t=1.17, p=0.24), in post-intervention 2nd (t=2.47, p=0.01) and in post-intervention 3rd (t=6.27, p=0.001), was found to be significant in post-intervention 2nd and post-intervention 3rd at 0.05 level of significance. It was concluded from the study that breathing exercises along with pharmacological therapy is an effective technique to improve the respiratory status among children⁶.

CONCLUSION

Breathing exercises like candles and flowers activity and balloon blowing as a play way method is effective in terms of improving the clinical parameters of pneumonia among 6-12 years pneumonic children.It is helpful to reduce the long term complications and prolonged hospital stay. The study findings highlights the significance of simple non-pharmacologic therapies such as breathing exercises in improving the respiratory status of children suffering from lower respiratory tract infection.