Chest physiotherapy involves external chest manipulation techniques like percussion, vibration, and postural drainage to help mobilize pulmonary secretions in patients who have difficulty coughing effectively. The goals are to move secretions into the central airways using gravity and different body positions, and then eliminate the secretions through coughing or suctioning. Common techniques include postural drainage, percussion, vibration, and having the patient perform active coughing. Chest physiotherapy is used to treat various respiratory conditions associated with excessive secretions like cystic fibrosis, bronchitis, and asthma.

1. Chest Physiotherapy &
postural drainage

2. Definition:
• Chest physiotherapy (CPT) is a group of therapies
for mobilizing pulmonary secretions.
• These therapies include chest percussion, vibration
and postural drainage.
• CPT is followed by productive coughing or
suctioning of a patient who has a decreased ability
to cough.
• This is especially helpful for patients with large
amount of secretions or ineffective cough.

3. Goals of CPT :
• To move bronchial secretions to the central airways via
gravity.
• External manipulation of the chest.
• To eliminate secretions by cough or aspiration with a
catheter.
• Improved mobilization of bronchial secretions
contributes to improved ventilation-perfusion
matching .
• To normalization of the functional residual capacity.

4. Techniques of chest physiotherapy
1. Airway clearance techniques.
2. Facilitating airway clearance technique with
effective coughing techniques.
3. Technique to facilitate ventilation pattern.
4. Mobilization and Exercises.

5. Airway clearance technique:
1. Postural drainage
2. Percussion
3. Vibration/shaking
4. Manual hyperinflation
5. Active cycle of breathing technique
6. Autogenic drainage
7. Positive expiratory pressure
8. High frequency chest compression
9. Exercises for airway clearance

6. Postural drainage:
It is getting in positions that make it easier for mucus to drain.
Chest physiotherapy is gently "clapping" parts of the body to
remove mucus from the lungs.
They are often used together in conditions such as cystic fibrosis or
a spinal cord injury (SCI) to help loosen and remove mucus from the
lungs.

7. Indication of chest physiotherapy:
1. Cystic fibrosis
2. Atelectasis
3. Asthma
4. Respiratory muscle weakness
5. Bronchiectasis
6. Mechanical ventilation
7. Neonatal respiratory distress syndrome

8. Contraindications:
1. Intracranial pressure (ICP) > 20 mm Hg
2. Head and neck injury until stabilized
3. Active haemorrhage with hemodynamic instability
4. Recent spinal surgery or acute spinal injury
5. Active haemoptysis
6. Large pleural effusions
7. Pulmonary embolism
8. Aged, confused, or anxious patients
9. Rib fracture with or without flail chest
10. Surgical wound or healing tissue

9. general instructions for chest physiotherapy and
postural drainage:
Be sure back is covered. Wear a shirt or blouse, or cover back
with a towel.
Hold each position for 5 minutes to help the mucus drain from
lungs.
For each position, claps back quickly and rhythmically.
When claps, you should hear a hollow sound. If you hear a
slapping, the hand is not cupped enough.
Do not clap over the spine.