NPF involves using selective external stimuli to reflexively assist respiration in unconscious patients. It can be used for those who are unconscious, have neurological deficits, are partially breathing, or on a ventilator. Contraindications include fractures to the rib cage or spine, children, and respiratory failure. Techniques include perioral stimulation to initiate epigastric movement, thoracic vertebral pressure over T2-T4 to increase abdominal excursion and over T9-T11 to increase thoracic movement, anterior stretch lift of the basal area to increase rib movement, intercostal stretching to increase epigastric movement and general respiration, co-contraction of abdominal pressure to increase excursion and stimulate coughing

1. NEUROPHYSIOLOGICAL FACILITATION OF
RESPIRATION [NPF]
PRESENTER: REKHA MARBATE

2. DEFINATION
• NPF involves the use of selective external proprioceptive and tactile
stimuli that produce reflex responses in the rib cage and diaphragm to
assist respiration in unconscious patients

3. • INDICATIONS
• Unconscious/ non alert
• Neurological deficit
• Partially breathing
• On a ventilator

4. • CONTRAINDICATION
• Fractures to the ribs, sternum or face
• Children
• Respiratory Failure
• Floating ribs

5. • PRECAUTIONS
• Sensitive mammary tissue in Females
• Ceasing treatment due to undesirable treatment

6. • TECHNIQUES
1. Perioral stimulation
2. Thoracic vertebral pressure
3. Anterior stretch lift of the posterior basal area
4. Intercostal stretch
5. Moderate manual pressure
6. Co-contraction of the abdominal pressure

7. PERIORAL STIMULATION

8. MECHANISM AND BENEFITS
• Initiates increased epigastric movement
• Sustained pressure promote further excursion of the thoracic region,so
the patient appears to be deep breathing
Physiology
• Activates the primitive reflex of sucking and swallowing

9. VERTEBRAL PRESSURE

10. MECHANISM AND BEBEFITS
• When pressure is applied over T2-T4 = Increased epigastric
abdominal excursion
• T9-T11 = Increased respiratory movement of the apical thorax

11. ANYTERIOR STRETCH LIFT OF BASALAREA

12. MECHANISM AND BENEFITS
• Increased excursion of the ribs laterally and posteriorly both the sides
• Increased epigastric movements
Physiology
• Dorsal root mediated intersegmental reflex

13. INTERCOSTAL STRETCHING

14. MECHANISM AND BENEFITS
• Stretch applied over the lower ribs will increase epigastric movements
• Increases general movements assisting respiration
PHYSIOLOGY
• Induce stretch reflex

15. Co-contraction of the abdominal pressure

16. MECHANISM AND BENEFITS
• Increase epigastric excursion
• Observable increase in abdominal tone
• As tone excursion of rib will
Stimulate coughing if secretions present
PHYSIOLOGY
• Abdominals muscles are activated by Intrafusal stretch receptor

17. MODERATE MANUAL PRESSURE

18. MECHANISM AND BENEFITS
• Gradual increase in rib movement under the area of pressure
• Specific for localized lung pathology
PHYSIOLOGY
• Stretch reflex

19. References :
1. Jennifer A Pryor , S Ammani Prasad. Physiotherapy for respiratory
and cardiac problems 4th edition, pg no.199-203