Inform the patient carefully about relevant anatomy/physiology, the causes and effects of the disease and of its chronic nature. Afford the patient the opportunity of having questions answered. If the patient uses spray medicaments, the spray technique should be tested.
Resistors are fitted in the blue (inspiration) nozzle. Hold the mask tightly over nose and mouth. The breathing should be regular, not forced. With the hand on the epigastrium the physiotherapist can check that the diaphragm is active during the inspiration.
On expiration the epigastrium is pulled inwards whereby the position of the diaphragm is optimal for the subsequent inspiration. Expiratory resistor 3.5 to 4 mm will facilitate this (to be fitted in the white nozzle).
During the full training period the inspiration resistor (fitted in the blue nozzle) should be sub-maximum. If the patient can use the RMT-set without effort for 2 minutes, the resistance should be increased by using an inspiration resistor with a smaller diameter. In case of diaphragm failure, use of auxiliary respiratory muscles is allowable once or twice during a 2-minute training session.
Check the treatment results continously. Check the radius of action by stair walking, constitutional or by an ergometric bicycle. A simple exercise programme to strengthen the foot and leg muscles and neck and shoulder regions should supplement RMT.
The patient must train with his RMT-set for five 2-minute periods, a total och 10 minutes, 3 times daily. The inspiratory resistance should be adjusted fortnightly for the initial 6 weeks and then on a monthly basis. The optimum treatment result ought to be reached after approxiamately 3 months. From then on the patient should be able to maintain the treatment result independently, with the personal RMT-set.
Adapt the starting position of RMT to each patient individually. However, check that the body is kept erect so that the free movement of the diaphragm is not unduly restricted.