Medical Physiotherapy Respiratory therapist Chest PNF

1. Neurophysiological
Facilitation of Respiration
Evidence based study| Chest PNF technique, define, types, indication,
contraindications with recent evidences
VNSGU, College of Physical therapy
Masters of Physiotherapy in Cardio-Pulmonary sciences

2. Definition:
● NPF is the use of selective external
proprioceptive and tactile stimuli that produce
reflex respiratory movement responses and that
alter the rate and depth of breathing.

3. Indication:
● Neurologically impaired adult patients who are
hypoventilating or have retained secretions.
● Used to alter the respiratory patterns and relieve the
symptoms of hyperventilation syndrome.
● Unconscious and non-alert patients.
● To improve short term ventilation with lower
consciousness.

4. Contraindications:
● Fracture to the ribs, sternum or face.
● Respiratory failure.
● Floating ribs.
● Patients with Hyperinflated lungs.
● Sensitive mammary tissue in female patients.

5. Techniques:
● There are 6 techniques used in NPF:
1. Perioral
pressure
2. Intercostal stretch
3. Vertebral
pressure
4. Co-contraction of
abdomen
5. Maintained
manual pressure
6. Anterior
stretch- lifting
of the posterior
basal area

6. 1. Perioral pressure:
● Perioral pressure is
provided by applying
pressure with the
therapist's finger on the
top lip between the nose
and lip.

7. Observation:
● Increased epigastric excursion
● Deep breathing
● Sighing
● Mouth closure
● Swallowing
● Snout phenomena
Mechanism:
● Primitive reflex response related to sucking.

8. 2.Intercostal stretch:
● Intercostal stretch is
provided by applying
pressure to the upper
border of a rib in order to
stretch the intercostal
muscle in a downward(not
inward) direction.

9. Observation:
● Increased movement of area being stretched.
Mechanism:
● Intercostal stretch receptors.

11. 3.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 T7 - T10.

12. Observation:
● Vertebral pressure high:
- Expanded epigastric movements
- Deep breathing
● Vertebral pressure low:
- Increased respiratory movement of apical thorax.
Mechanism:
● Dorsal root mediated intersegmental reflex.

13. 4.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.

14. Observation:
● Increased epigastric movements
● Increased muscle contraction
● Depression of umbilicus
● Increased firmness to palpation
Mechanism:
● Abdominal muscle activated to stretch receptors.

16. 5.Maintained manual pressure:
● Mild pressure by the
open palm is maintained
over the area in which
expansion is desired.

17. Observation:
● Gradually increased movement of area under contact.
Mechanism:
● Cutaneous receptors.

19. 6.Anterior stretch -lifting of the posterior basal area:
● Basal lift is applied by
placing the hands under the
posterior ribs of the patient
in supine and lifting gently
upwards.

20. Observation:
● Expansion of posterior basal area.
● Increased epigastric movements.
Mechanism:
● Stretch receptors of intercostal, back muscles.

22. Reference of articles used:
● Hetal M Mistry, Rutuja V Kamble. Immediate effect of Chest Proprioceptive Neuromuscular
Facilitation on Respiratory Rate, Chest Expansion and Peak Expiratory Flow Rate in patients
with Chronic Obstructive Pulmonary Disease. Int J Physiother Res 2021;9(1):3723-3729. DOI:
10.16965/ ijpr.2020.175
● Suraj k, Gowrishankar P, Sangh M, Ajay K, Pramod K, Shailendra P. Correlation of dyspnea with
age and spo2 levels in covid-19 and effectiveness of neurophysiological facilitation in the
management of dyspnea. EJPT. Sept 2020; 4:25-31.
● Mohamed, R. A., Mohamed, E. S. H., Habshy, S. M., & Aly, S. M. (2021). Impact of two different
pulmonary rehabilitation methods in children with down syndrome. Journal of Bodywork and
Movement Therapies, 27, 512–521. https://doi.org/10.1016/j.jbmt.2021.04.009
● Ashtankar , A., Kazi, A. (2019). Comparative Effect of Proprioceptive Neuromuscular Facilitation
(PNF) and Chest Physiotherapy with Chest Physiotherapy Alone on SP02, Heart Rate,
Respiratory Rate, & Lung Compliance in Mechanically Ventilated Patient, 11(10),
3514–3518.

23. References:
● Pryor, J. A., & Prasad, A. S. (2014). Physiotherapy for
respiratory and cardiac problems: Adults and paediatrics
(4th ed.). Churchill Livingstone Title.
● Jones, M., & Moffatt, F. (2002). Cardiopulmonary
Physiotherapy. Taylor & Francis Group.
● https://www.physio-pedia.com/Neurophysiological_Facil
itation_of_Respiration_(NPF)