Effect of Video Game-Based Breathing Exercises on Respiratory Dysfunction in ACOS

Capnography

It will be used to evaluate whether ventilation is adequate and if the breathing pattern is appropriate. It is a monitoring device that continuously records the concentration of CO₂ in the exhaled gases during respiration graphically (in mmHg), providing information about the patient's respiratory rate per minute and the amount of CO₂ exhaled in each breath. It measures the partial pressure of CO₂ in the exhaled air, referred to as end-tidal CO₂ (ETCO₂), which is a reliable and time-sensitive clinical measurement of respiratory function. ETCO₂ shows good concurrent validity when compared directly with blood measurements. A value of 35 mmHg or below is commonly used as a cutoff point to define hypocapnia.

Hi-Lo Test

This is a clinical assessment used to evaluate the breathing pattern, specifically to determine whether thoracic (chest) or abdominal (diaphragm) movement is more dominant. The patient is seated comfortably, and the clinician stands or kneels slightly to the side in front of the patient. The clinician places one hand on the patient's sternum (breastbone) and the other hand on the upper abdomen (just below the rib cage). This allows the clinician to feel the movements of both the chest and abdominal areas during inhalation. The clinician observes and senses which area moves more with each breath, indicating whether the patient primarily uses chest or abdominal muscles for breathing. Five breathing cycles are assessed.

Manual Assessment of Respiratory Movements (MARM)

This method is used to evaluate and measure breathing patterns, particularly the distribution of respiratory movements between the upper and lower parts of the rib cage and the abdomen under various conditions. The 4th and 5th fingers of both hands are placed on the lower ribs, and the vertical and horizontal mobility of the fingers is assessed while the patient breathes in and out. If there is more vertical and upper rib cage movement, the upper line will be farther from the horizontal and closer to the apex. If there is more lateral and lower rib cage/abdominal movement, the lower line will be farther from the horizontal and closer to the base.

Posture Assessment - Posture Screen Application

Posture examination will be performed using the PostureScreen® Mobile application through a photographic method. This application essentially digitizes a valid posture assessment technique, namely the photographic method using a vertical plumb line or lead wire method. This examination is simple, quick, easily repeatable, and does not require in-depth knowledge of posturology. For cervical measurements, forward head tilt, cervical lordosis angle, and lateral deviations of the neck will be evaluated. For thoracic measurements, thoracic kyphosis angle, shoulder height difference, thoracic scoliosis, and scapular position will be assessed.

FEV₁ assesment

Pulmonary function will be assessed using the Cosmed Micro Quark spirometer in accordance with ATS and ERS criteria. Patients will be informed before the test, which will be performed in a seated position after 15 minutes of rest. With a nasal clip applied and mouthpiece in place, patients will be instructed to take a deep inspiration, exhale forcefully and rapidly, and then inhale deeply again. The test will be repeated three times, and the valid result will be accepted.Forced expiratory volume in one second (FEV₁) will be measured and recorded in liters (L).

Breath-Holding Time Test

It is a simple test commonly used to assess respiratory functions. The purpose is to measure how long a person can hold their breath after taking a normal breath

30-Second Sit-to-Stand Test

The individual will sit on a chair without armrests, approximately 43 cm high from the ground, with their back straight and feet flat on the floor. Their arms will be crossed over the chest. The test will begin from this position. After the "start" command is given, the individual will be asked to stand up fully and then sit back down repeatedly for 30 seconds. The total number of complete stands performed within 30 seconds will be recorded.

6-Minute Walk Test (6MWT)

For the test, patients will be asked to walk as fast as possible at their own pace for six minutes along a 30-meter hospital corridor. The 6MWT will be conducted twice on the same day. Before starting the test, patients will be informed that if they experience excessive shortness of breath, they can rest during the test, and this resting time will be included in the total test duration. During the test, the physiotherapist will walk alongside the patient and encourage them every 30 seconds using standard phrases such as "You're doing very well" or "Keep it up, you're doing great." Heart rate will be monitored before and after the test, and dyspnea perception will be assessed using the Modified Borg Scale (MBS). At the end of the test, the distance walked in six minutes will be recorded.