This powerpont will inform about the chest PNF with its definition, principles,aims, indications & contraindications and its effects. It will lighten up the knowledge of techniques of chest PNF with its observatory findings and its mechanism

1. CHEST PNF
DR.ANERI PATWARI
MPT
CARDIORESPIRATORY

2. CONTENT
 Introduction
 Definition
 Principles
 Aims
 Indications
 Contraindications
 Effects
 Techniques
 References
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3. INTRODUCTION
 Respiration: Essential part lung
 Breathing: Under control of CNS
 Respiratory rhythmicity: central pattern generator (CPG)
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4. INTRODUCTION
 PNF: Facilitation make easier
 Neuromuscular facilitation: Process by which response of neuromuscular mechanism
is made easier
 Developed by: dr.Herman Kabat and Miss Mrgaret Knott
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5. DEFINITION
 Neurophysiological facilitation of respiration is the use of selective external
proprioceptive and tactile stimuli that produce reflexive movement response in the
ventilatory apparatus to assist respiration.
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6. PRINCIPLES
 PNF Use the stretch reflex to facilitate the initiation of inhalation continue with
repeated stretch through range (repeated contraction) to facilitate an increase
Inspiratory volume.
 Appropriate resistance strengthen the muscle and guide to the chest motion
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8. AIMS
• To facilitate normal mechanical respiratory movement pattern
• To decrease muscle spasm
• To maintain thoracic mobility
• To produce reflex involuntary respiratory movement reaction
• To activate the diaphragm
• To facilitate Inspiratory motor neuron activity
• To facilitate deeper breathing swallowing and mouth closure
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9. INDICATIONS
DIRECT
 Inadequate ventilation
 Retention of secretions
 Need of frequent suctioning
INDIRECT
 Chest mobilization
 Trunk and shoulder mobility
 Relief of pain
 Relaxation
 Decrease Spasticity
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10. CONTRAINDICATIONS
 Fracture to the ribs, sternum or face.
 Respiratory failure.
 Floating ribs.
 Patients with Hyperinflated lungs.
 Sensitive mammary tissue in female patients.
 Active TB
 Children under the age of 7 years because of differences in the anatomy,
physiology and neurology of respirationrispfrdtfol
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11. EFFECTS
• Visibly deeper respiration – larger expansion of the ribs and increased epigastric
excursion
• Increased visible tone in abdominal muscles
• Change in respiratory rate
• Involuntary coughing
• More normal respiratory pattern
• Rapid return of mechanical stability
• Change in breath sound on auscultation
• Retention of improved respiratory pattern after treatment period
• Apparent increase in the level of consciousness
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12. TECHNIQUES
PERIORAL
STIMULATION
THORACIC
VERTEBRAL
PRESSURE
INTER
COASTAL
STRETCH
CO-
CONTRACTION
OF ABDOMINAL
PRESSURE
MODERATE
MANUAL
PRESSURE
ANTERIOR
STRETCH
LIFTING
OF
POSTERIO
R BASAL
LIFT
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13. TECHNIQUES
TECHNIQUE METHOD OBSERVATION MECHANISM
PERIORAL
STIMULATION
By applying pressure with the
therapist's finger on the top lip
between the nose and lip. The
pressure is maintained for the
length of time that the therapist
wishes the patient to breathe in the
activated pattern. (wearing of
surgical gloves is advised).
1. Expanded epigastric movement
2. As the stimulus is maintained
the epigastric excursions may
increase so that movement is
transmitted to the upper thorax
and the patient appears to be
deep breathing
Initiates the
primitive reflex
of sucking and
swallowing
CO-
CONTRACTION
OF ABDOMEN
Provided by the therapist by
pressing adequate pressure on the
lower ribs and pelvis on the same
side, so that pressure is applied at
right angles to the patient.
1. Expanded epigastric movement
2. Muscle contraction increased
Abdominal
muscles
activated by
stretch
receptors
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14. TECHNIQUES
TECHNIQUE METHOD OBSERVATION MECHANISM
INTER
COASTAL
STRETCH
REFLEX
By applying pressure to the upper
border of a rib in order to stretch
the intercostal muscle in a
downward(not inward) direction.
The stretch position is then
maintained while the patient
continues to breathe in his/her usual
manner.
Can be performed unilaterally or
bilaterally on any rib.
1. Stretched area results increased
movement
Intercostal
stretch reflex
receptors
MODERATE
MANUAL
PRSSURE
Mild pressure of the open hand(s) is
maintained over the area in which
expansion is desired
1. Gradually increased movement
of the rib under the area of
pressure
Stretch reflex
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15. TECHNIQUES
TECHNIQUE METHOD OBSERVATION MECHANISM
ANTERIOR
STRETCH
LIFTING OF
POSTERIOR
BASAL LIFT
Basal lift is applied by placing the
hands under the posterior ribs of the
supine patient and lifting gently
upwards.
The lift is maintained and provides
a maintained stretch and pressure
posteriorly and stretch anteriorly as
well.
1. Expansion posterior basal area
2. Expanded epigastric movements
Stretch
receptors in
intercostals.
back muscles
THORACIC
VERTEBRAL
PRESSURE
vertebral pressure high - manual
pressure applied to thoracic
vertebrae in the region T2 - T5
vertebral pressure low - manual
pressure applied to thoracic
vertebrae in the region T9 - T1
1. vertebral pressure high
2. Expanded epigastric movements
3. Deep-breathing
4. vertebral pressure low
5. Increased respiratory movements
of the apical thorax
Dorsal-root-
mediated
intersegmental
reflex
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16. REFERENCES
1. Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac
problems. 2nd edition. Churchill Livingstone. 1998
2. M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd.
2002
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