Echniques of Chest Physiotherapy

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
FET Thoracic expansion

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.
Motivation
Patient’s goals
Physician/caregiver’s goals Effectiveness
( of considered technique Patient’s age
Ease (of learning and of teaching)
Skill of therapist/teachers Fatigue or
work required
Need for assistants or equipment
Limitations of technique based on
disease type and severity
Costs (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 Major
Sternocleido mastoid
Trapezius
Serratus 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 1
Identify all the factors underlying the pathology causing deficits
in oxygen supply.
 Step 2
Determine 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 3
Match the appropriate mobilization or exercise stimulus to

patient's oxygen transport capacity.
 Step 4
Set the intensity within therapeutic and safe limits of the patient's
oxygen transport capacity.
 Step 5
Combine the various body positions especially in the erect

position with the following maneuvers:
 Step 6
Set 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 7
Repeat the mobilization session as often as possible based on its

beneficial effects and on is being safely tolerated by the patient.
 Step 8
Increase 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
PARAMETERSFOR 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. pea
k
of drug potency and effects (e.g., pain, reduced sedation.
reduced neuromuscular blockade)
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techniques.docx
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

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TECHNIQUES OF CHEST

 Mobilization and Exercises

 Active cycle of breathing technique

 Positive expiratory pressure

 High frequency chest compression

 Exercises for airway clearance

FET Thoracic expansion

 Respiratpry muscle weakness

 Neonatal respiratory distress syndrome

 Recent gross hemoptysis related to recent lung

 Techniques of teaching effective coughing

self assisted coughing

 Mobilizing the thorax

 Facilitating the accessory muscles of respiration

 Glossopharyngeal breathing technique

 Pursed lip breathing

 It depends on the patient’s condition

Determine whether mobilization and exercise are indicated and if

Match the appropriate mobilization or exercise stimulus to

Combine the various body positions especially in the erect

Repeat the mobilization session as often as possible based on its

Increase the intensity of the mobilization stimulus. duration of the

 Define parameters of treatment based on history,

 Request for additional supportive information. tests, and

 ..\Desktop\The active cycle of breathing

 Physiotherapy for respiratory and cardiac

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