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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 techni...
AIRWAY CLEARANCE TECHNIQUE
 Postural drainage
 Percussion
 Vibration/shaking
 Manual hyperinflation
 Active cycle of ...
POSTURAL DRAINAGE
PERCUSSION
VIBRATION/SHAKING
MANUAL HYPERINFLATION
ACTIVE CYCLE OF BREATHING TECHNIQUE
Breathing control
Thoracic expansionFET
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
 Mechan...
CONTRAINDICATIONS
 Intracranial pressure (ICP) > 20 mm Hg
 Head and neck injury until stabilized
 Active hemorrhage wit...
 Trendelenburg Position is Contraindicated for
the Following: .
 Patients in whom increased ICP is to be avoided
 Uncon...
 Subcutaneous cmphysema
 Recent epidural spinal infusion or spinal anesthesia
 Recent skin grafts, or flaps, on the tho...
TREATMENT PRESCRIPTION.
Motivation
Patient’s goals
Physician/caregiver’s goals
Effectiveness ( of considered technique
Pat...
FACILITATING AIRWAY CLEARANCE WITH
EFFECTIVE COUGHING TECHNIQUE
 What is cough….???
 Stages of cough
 Techniques of tea...
SELF ASSISTED COUGHING TECHNIQUE
MANUAL COUGHING TECHNIQUE
TECHNIQUE TO FACILIATE VENTILATION
PATTERN
 Body positioning
 Breathing technique
 Mobilizing the thorax
 Facilitating...
BODY POSITIONING
 Standing upright position
 Erect sitting (self supported or with assist) with feet
moving (e.g., activ...
BREATHING TECHNIQUES
 Diaphragmatic breathing pattern
 Segmental expansion
 Glossopharyngeal breathing technique
 Purs...
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 applicat...
 In addition, mobilization is performed in the
upright position, that is the physiologic position,
whenever possible,
 t...
EXERCISE
 What are the exercises given
 Exercise is the term used to describe the
therapeu tic and prescriptive applicat...
TREATMENT PRESCRIPTION FOR
MOBILIZATION AND EXERCISES
 It depends on the patient’s condition
 Whether the patient is in ...
 Step 1
Identify all the factors underlying the pathology causing
deficits in oxygen supply.
 Step 2
Determine whether m...
 Step 6
Set the duration of the mobilization sessions based on the
patient's responses (i.e., changes in measures and ind...
HEIARCHY OF TREATMENT FOR OXYGEN
SUPPLY TREATMENT
 PREMISE: Position of optimal physiological
function is being upright a...
PARAMETERS FOR TREATMENT PRESCRIPTION
IN THE MANAGEMENT OF CARDIOPULMONARY
PATIENTS
 Define parameters of treatment based...
 Define treatment outcomes
 Determine when treatment is to be discontinued
 Request for additional supportive informati...
 ..Desktop748.full.pdf
 ..Desktoppep on cystic fibrosis.pdf
 ..DesktopS231.full.pdf
 ..DesktopThe active cycle of brea...
REFERENCES
 Principles and practice of cardiopulmomary
physical therapy 3rd edition Donna Frownfelter
 Tidy’s physiother...
Thank you
Techniques of chest physiotherapy
Techniques of chest physiotherapy
Techniques of chest physiotherapy
Techniques of chest physiotherapy
Techniques of chest physiotherapy
Techniques of chest physiotherapy
Techniques of chest physiotherapy
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Techniques of chest physiotherapy

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Techniques of chest physiotherapy

  1. 1. TECHNIQUES OF CHEST PHYSIOTHERAPY
  2. 2. WHAT IS CHEST PHYSIOTHERAPY…??
  3. 3. TYPES OF TECHNIQUES  Airway clearance techniques  Facilitating airway clearance technique with effective coughing techniques  Technique to facilitate ventilation pattern  Mobilization and Exercises
  4. 4. 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
  5. 5. POSTURAL DRAINAGE
  6. 6. PERCUSSION
  7. 7. VIBRATION/SHAKING
  8. 8. MANUAL HYPERINFLATION
  9. 9. ACTIVE CYCLE OF BREATHING TECHNIQUE Breathing control Thoracic expansionFET
  10. 10. AUTOGENIC DRAINAGE
  11. 11. POSITIVE EXPIRATORY PRESSURE
  12. 12. HIGH FREQUENCY CHEST COMPRESSION
  13. 13. EXERCISES FOR AIRWAY CLEARANCE Borg’s scale
  14. 14. INDICATIONS AND CAUTIONS  Cystic fibrosis  Atelectasis  Asthama  Respiratpry muscle weakness  Bronchiectasis  Mechanical ventilation  Neonatal respiratory distress syndrome
  15. 15. 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
  16. 16.  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
  17. 17.  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
  18. 18. 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
  19. 19. FACILITATING AIRWAY CLEARANCE WITH EFFECTIVE COUGHING TECHNIQUE  What is cough….???  Stages of cough  Techniques of teaching effective coughing self assisted coughing manual coughing
  20. 20. SELF ASSISTED COUGHING TECHNIQUE
  21. 21. MANUAL COUGHING TECHNIQUE
  22. 22. TECHNIQUE TO FACILIATE VENTILATION PATTERN  Body positioning  Breathing technique  Mobilizing the thorax  Facilitating the accessory muscles of respiration
  23. 23. 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
  24. 24. BREATHING TECHNIQUES  Diaphragmatic breathing pattern  Segmental expansion  Glossopharyngeal breathing technique  Pursed lip breathing
  25. 25. DIAPHRAGMATIC BREATHING
  26. 26. SEGMENTAL BREATHING
  27. 27. PURSED LIP BREATHING
  28. 28. FACILITATING THE ACCESSORY MUSCLES OF RESPIRATION Pectoralis Major Sternocleido mastoid Trapezius Serratus anterior
  29. 29. INDICATIONS  To increase ventilation  Respiratory muscle weakness
  30. 30. 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.
  31. 31.  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
  32. 32. 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.
  33. 33. 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
  34. 34.  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:
  35. 35.  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.
  36. 36. 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
  37. 37. 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
  38. 38.  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)
  39. 39.  ..Desktop748.full.pdf  ..Desktoppep on cystic fibrosis.pdf  ..DesktopS231.full.pdf  ..DesktopThe active cycle of breathing techniques.docx
  40. 40. 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
  41. 41. Thank you

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