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TECHNIQUES OF CHEST PHYSIOTHERAPY
WHAT IS CHEST PHYSIOTHERAPY…??
TYPES OF TECHNIQUES
Airway clearance techniques Facilitating airway clearance technique with
effective coughing techniques Technique to facilitate ventilation pattern Mobilization and Exercises
AIRWAY CLEARANCE TECHNIQUE
Postural drainage Percussion Vibration/shaking Manual hyperinflation Active cycle of breathing technique Autogenic drainage Positive expiratory pressure High frequency chest compression Exercises for airway clearance
POSTURAL DRAINAGE
PERCUSSION
VIBRATION/SHAKING
MANUAL HYPERINFLATION
ACTIVE CYCLE OF BREATHING TECHNIQUE
Breathing control
Thoracic expansion
FET
AUTOGENIC DRAINAGE
POSITIVE EXPIRATORY PRESSURE
HIGH FREQUENCY CHEST COMPRESSION
EXERCISES FOR AIRWAY CLEARANCE
Borg’s scale
INDICATIONS AND CAUTIONS
Cystic fibrosis Atelectasis Asthama Respiratpry muscle weakness Bronchiectasis Mechanical ventilation Neonatal respiratory distress syndrome
CONTRAINDICATIONS
Intracranial pressure (ICP) > 20 mm Hg Head and neck injury until stabilized Active hemorrhage with hemodynamic instability Recent spinal surgery (e.g .• laminectomy) or
acute spinal injury Active hemoptysis Empyema Bronchopleural fistula Large pleural effusions Pulmonary embolism Aged, confused, or anxious patients Rib fracture. with or without flail chest Surgical wound or healing tissue
Trendelenburg Position is Contraindicated for the Following: .
Patients in whom increased ICP is to be avoided
Uncontrolled hypertension Distended abdomen Esophageal surgery Recent gross hemoptysis related to recent
lung carcinoma Uncontrolled airway at risk for aspiration
Subcutaneous cmphysema Recent epidural spinal infusion or spinal
anesthesia Recent skin grafts, or flaps, on the thorax Burns. open wounds. and skin infections of the thorax
Recently placed pacemaker Suspected pulmonary tuberculosis Lung contusion Bronchospasm Osteomyelitis of the ribs Osteoporosis Coagulopathy Complaint of chest-wall pain
TREATMENT PRESCRIPTION.
MotivationPatient’s goalsPhysician/caregiver’s goalsEffectiveness ( of considered techniquePatient’s ageEase (of learning and of teaching)Skill of therapist/teachersFatigue or work requiredNeed for assistants or equipmentLimitations of technique based on disease type and severityCosts (direct and indirect)Desirability of combing methods
FACILITATING AIRWAY CLEARANCE WITH EFFECTIVE COUGHING TECHNIQUE
What is cough….??? Stages of cough Techniques of teaching effective coughing self assisted coughing manual coughing
SELF ASSISTED COUGHING TECHNIQUE
MANUAL COUGHING TECHNIQUE
TECHNIQUE TO FACILIATE VENTILATION PATTERN
Body positioning Breathing technique Mobilizing the thorax Facilitating the accessory muscles of
respiration
BODY POSITIONING
Standing upright position Erect sitting (self supported or with assist) with
feet moving (e.g., active, active assisted or passive cycling motion)
Erect silting (self-supported or with assist) with feet dependent
Lean forward sitting with arms supported and feet dependent
24S degree sitting with legs dependent Erect long sitting (legs non dependent) < 4S degrees sitting (legs non dependenl) Prone and semi prone/side lying Supine
BREATHING TECHNIQUES
Diaphragmatic breathing pattern Segmental expansion Glossopharyngeal breathing technique Pursed lip breathing
DIAPHRAGMATIC BREATHING
SEGMENTAL BREATHING
PURSED LIP BREATHING
FACILITATING THE ACCESSORY MUSCLES OF RESPIRATION
Pectoralis MajorSternocleido mastoid TrapeziusSerratus anterior
INDICATIONS
To increase ventilation Respiratory muscle weakness
MOBILIZATION AND EXERCISES
What is mobilization.? Mobilization is defined as the therapeutic and
prescriptive application of low-intensity exercise in the management of cardiopulmonary dysfunction usually in acutely ill patients.
Primarily, the goal of mobilization is to exploit the acute effects of exercise to optimize oxygen transport.
Even a relatively low intensity mobilization stimulus can impose considerable metabolic demand on the patient with cardiopulmonary compromise.
In addition, mobilization is performed in the upright position, that is the physiologic position, whenever possible,
to optimize the effects of being upright on central and peripheral hemodynamics and fluid shifts.
Thus mobilization is prescribed to elicit both a gravitational stimulus and an exercise stimulus
EXERCISE
What are the exercises given Exercise is the term used to describe the
therapeu tic and prescriptive application of exercise in the management of subacute and chronic cardiopul monary and cardiovascular dysfunction. Primarily, the goal of exercise is to exploit the cumulative ef fects of and adaptation to long-term exercise and thereby optimize the function of all steps in the oxy gen transport pathway.
TREATMENT PRESCRIPTION FOR MOBILIZATION AND EXERCISES
It depends on the patient’s condition Whether the patient is in patient or in out
patient department Also it depends on the functionality of the
patient at the present stage It is decided on the basis of the exercise
testing protocol Also on the basis of METs
Step 1Identify all the factors underlying the pathology causing
deficits in oxygen supply. Step 2Determine whether mobilization and exercise are
indicated and if so, which form of either will specifically address the oxygen transport deficits identified in Step I.
Step 3Match the appropriate mobilization or exercise stimulus to
patient's oxygen transport capacity. Step 4Set the intensity within therapeutic and safe limits of the
patient's oxygen transport capacity. Step 5Combine the various body positions especially in the erect
position with the following maneuvers:
Step 6Set the duration of the mobilization sessions based on the
patient's responses (i.e., changes in measures and indices of oxygen transport) rather than time.
Step 7Repeat the mobilization session as often as possible
based on its beneficial effects and on is being safely tolerated by the patient.
Step 8Increase the intensity of the mobilization stimulus.
duration of the session, or both comml!l1surate with the patient's capacity to maintain optimal oxygen transport when confronted with an increased mobilization stressor, and in the absence of distress; monitored variables to remain within predetermined threshold range.
HEIARCHY OF TREATMENT FOR OXYGEN SUPPLY TREATMENT
PREMISE: Position of optimal physiological function is being upright and moving. Mobilization and Exercise
Body Positioning Breathing Control Maneuvers Coughing Maneuvers To minimize the work of breathing. of the
heart. and oxygen demand overall ROM Exercises (Cardiopulmonary indications) Postural Drainage Positioning Manual Technique Suctioning
PARAMETERS FOR TREATMENT PRESCRIPTION IN THE MANAGEMENT OF CARDIOPULMONARY PATIENTS
Define parameters of treatment based on history, laboratory investigations, tests, and assessment
Treatment type Intensity (if applicable) Duration Frequency Instruct patient in "between treatment"
treatment, and if applicable the nurse. a family member. or both
Reassessment every treatment Modify as necessary within each treatment Progress between treatments as indicated
Define treatment outcomes Determine when treatment is to be discontinued Request for additional supportive information. tests, and
investigations as indicated Predict time course for optimal effects and course of
treatment to determine treatment efficacy; modify as necessary
In conjunction with other interventions (e.g., medical, surgical, nursing, respiratory therapy (weaning oxygen supplementation.
sympathomimetic drugs, ADLs, balance with sleep and rest periods. peak of nutrition and feeds. Peak energy times. peak of drug potency and effects (e.g., pain, reduced sedation. reduced neuromuscular blockade)
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REFERENCES
Principles and practice of cardiopulmomary physical therapy 3rd edition Donna Frownfelter
Tidy’s physiotherapy Physiotherapy for respiratory and cardiac
problems 3rd edition by Jenifer A Pryor
Thank you