Abstract
We recently encountered a patient with chronic obstructive pulmonary disease who showed postural instability in the left posterior direction and shortness of breath while walking, and thus, had difficulty carrying a portable oxygen cylinder. Shortness of breath seemed to be due to respiratory insufficiency that was caused because of reduced motility of the right lower part of the thorax. On analyzing the patient's posture while walking, trunk flexion, lateral bending to the right, posterior inclination of the pelvis, and unstable gait were noted when the left heel was off the ground. Because of this, the patient tended to raise the right shoulder girdle to shift the center of gravity in the right anterior direction. This motion intensified forced respiration. This tendency seemed to be attributable to shortening of right obliquus abdominis and right lumbar quadrate muscles, resulting in reduced activity of the right obliquus abdominis muscles. We attempted to control respiratory insufficiency by targeting the reduced activity of the right lower thoracic segment. The instability while walking was controlled by targeting the shortened right obliquus abdominis and right lumbar quadrate muscles as well as the reduced activity of the right obliquus abdominis muscles when the left heel was off the ground. In addition, the patient was advised to shift his center of gravity in the right anterior direction when the left heel was off the ground. With these approaches, the patient adopted a diaphragm-predominant respiration pattern, resulting in the alleviation of his shortness of breath while walking. The instability with the left heel remaining off the ground was reduced following alleviation of trunk flexion, lateral bending to the right, and posterior inclination of pelvis when the left heel was off the ground. Furthermore, stabilization of his walk allowed the patient to shift his center of gravity in the right anterior direction, resulting in a reduction of the tendency to raise the right shoulder girdle, which further alleviated his shortness of breath.
