chest physiotherapy details

1. TECHNIQUES OF CHEST
PHYSIOTHERAPY

2. WHAT IS CHEST PHYSIOTHERAPY…??

3. TYPES OF TECHNIQUES
 Airway clearance techniques
 Facilitating airway clearance technique with
effective coughing techniques
 Technique to facilitate ventilation pattern
 Mobilization and Exercises

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. POSTURAL DRAINAGE

7. PERCUSSION

8. VIBRATION/SHAKING

9. MANUAL HYPERINFLATION

10. ACTIVE CYCLE OF BREATHING TECHNIQUE
Breathing control
Thoracic expansionFET

11. AUTOGENIC DRAINAGE

12. POSITIVE EXPIRATORY PRESSURE

13. HIGH FREQUENCY CHEST COMPRESSION

14. EXERCISES FOR AIRWAY CLEARANCE
Borg’s scale

15. INDICATIONS AND CAUTIONS
 Cystic fibrosis
 Atelectasis
 Asthama
 Respiratpry muscle weakness
 Bronchiectasis
 Mechanical ventilation
 Neonatal respiratory distress syndrome

16. 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

17.  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

18.  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

19. 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

20. FACILITATING AIRWAY CLEARANCE WITH
EFFECTIVE COUGHING TECHNIQUE
 What is cough….???
 Stages of cough
 Techniques of teaching effective coughing
self assisted coughing
manual coughing

21. SELF ASSISTED COUGHING TECHNIQUE

23. MANUAL COUGHING TECHNIQUE

26. TECHNIQUE TO FACILIATE VENTILATION
PATTERN
 Body positioning
 Breathing technique
 Mobilizing the thorax
 Facilitating the accessory muscles of respiration

27. 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

28. BREATHING TECHNIQUES
 Diaphragmatic breathing pattern
 Segmental expansion
 Glossopharyngeal breathing technique
 Pursed lip breathing

29. DIAPHRAGMATIC BREATHING

31. SEGMENTAL BREATHING

33. PURSED LIP BREATHING

34. FACILITATING THE ACCESSORY MUSCLES
OF RESPIRATION
Pectoralis Major
Sternocleido mastoid
Trapezius
Serratus anterior

35. INDICATIONS
 To increase ventilation
 Respiratory muscle weakness

36. 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.

37.  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

38. 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.

39. 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

41.  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:

42.  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.

43. 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

44. 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

45.  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)

46.  ..Desktop748.full.pdf
 ..Desktoppep on cystic fibrosis.pdf
 ..DesktopS231.full.pdf
 ..DesktopThe active cycle of breathing
techniques.docx

47. 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

48. Thank you