Neurophysiological fascilitation of respiration is a technique to improve ventilation in unconscious patient in acute care. It is a short term management to improve cost of breathing.

1. Neurophysiological facilitation of
respiration
Dipalee Parikh(MPT-cardiopulmonary)

2. Introduction
Neurophysiological facilitation of respiration is the terminology used to describe
externally applied proprioceptive and tactile stimuli that produce reflex respiratory
movement responses and that appear to alter the rate and depth of breathing.
Indication:
● Unconscious patient
● Inadequate ventilation
● When PD is not possible
dipaleeparikh@gmail.com

3. Techniques
There are 7 techniques of respiratory PNF.
1. Perioral stimulation
2. Intercostal stretch
3. Thoracic vertebral pressure
4. Co contraction of the abdomen
5. Applied manual pressure
6. Anterior stretch- lifting posterior basal area
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

4. Perioral stimulation
Method: Apply pressure with finger; maintain it.
Response: Epigastric movement, deep breathing,
“Snout phenomena”
Mechanism: Primitive reflex of sucking
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

5. Intercostal stretch
Method: providing stretch with fingers on upper
border of rib in downward and outward direction
and maintain it. (Uni/Bilateral)
Response: Increased movement in stretched area
Mechanism: Stretch reflex (intercostal stretch
receptors)
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

6. Thoracic vertebral pressure
Vertebral pressure high:
Method: in supine position put pressure with hand on
upper thoracic vertebrae
Response: Increased epigastric movement
Vertebral pressure low:
Method: In supine position put pressure with hand on
lower thoracic vertebrae
Response: Increased movement in apical thorax
Mechanism: Dorsal root mediated intersegmental reflex
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

7. Co-contraction of the abdomen
Method: Provide lateral pressure over lower ribs and
pelvic (alternate left and right)
Response: Increase epigastric movement, depression
of umbilicus
Mechanism: Stretch reflex (abdominal stretch
receptors)
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

8. Applied manual pressure
Method: Moderate pressure with open hand on area
which needs to expand
Response: Increase movement of that area
Mechanism: Stretch reflex
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

9. Anterior stretch lifting posterior basal area
Method: Gentle lifting of lower ribs in upward
direction
Response: expansion of posterior basal area
Mechanism: Stretch receptors of intercostal and back
muscles.
dipaleeparikh@gmail.com
dipaleeparikh@gmail.com

10. REFERENCES
1. Pryor JA, Prasad AS. Physiotherapy for respiratory and cardiac problems: adults and
paediatrics. Elsevier Health Sciences; 2008 Mar 6.
2. Jones M, Moffatt F. NEUROPHYSIOLOGICAL FACILITATION OF RESPIRATION (NPF). In
Cardiopulmonary Physiotherapy 2002 Jun 15 (pp. 129-131). Routledge.
dipaleeparikh@gmail.com

11. You can post your questions on
dipaleeparikh@gmail.com