Physical therapist and respiratory therapist are the only people who can generally perform chest physiotherapy (CPT) treatment. Therefore indirect removal of mucus from the breathing passages of a patient improves breathing. However we have many respiratory conditions that affect the breathing pattern.
Respiratory Conditions Affecting Breathing Pattern
- Asthma: Occasional spasm may occur due to persistently inflame of airways. Hence causing wheezing and shortness of breath. However allergies, infections, or pollution can trigger asthma symptoms.
- Chronic obstructive pulmonary diseases (COPD): Lung conditions defined by an inability to exhale normally, therefore causes difficulty in breathing.
- Chronic bronchitis: This is a form of COPD characterized by a chronic productive cough.
- Emphysema: This causes damage of lung allowing air to be trapped in the form of COPD thereafter causes difficulty in blowing air out is its hallmark.
- Acute bronchitis: This is a sudden infection of the airways, usually caused by a virus.
- Cystic fibrosis: This a genetic condition causing poor clearance of mucus from the bronchi. However the accumulated mucus results in repeated lung infections.etc
- When a physiotherapist gets to know the diagnosis and treatment. It is done in terms of giving the patient bronchodilators, decongestants, corticosteroids and pulmonary surfactant. Usually done by respiratory specialist, then the physiotherapist now can start there management. Also remember the role of a physiotherapist is to work on the musculoskeletal system. For example muscles,bones,soft tissue and nerves, done either by strengthening through exercises ,activation of muscles that are weak. However the goal of a physiotherapist in chest is the same. They work on strengthening respiratory muscles and chest expansion is to help in easing breathing without straining. Therefore helping the patients to breathe with more ease and to get more oxygen into the body.
- Chest Physical therapy Techniques include
- Postural drainage. The technique involves placing the patient in a position which allows gravity to assist in draining mucus from the periphery of the lungs to the central upper airway. Shown in Fig 1&2
Postural Drainage
Is an airway clearance technique that helps people with COPD clear mucus from their lungs. However the goal of postural drainage is to help drain mucus from each of these lobes into the larger airways, so as it can be coughed up more readily.
Chest Percussion (Chest Physiotherapy)
Chest percussion (chest physiotherapy) uses clapping of the chest with a cupped hand to vibrate the airways in the lungs. This vibration moves the mucus from smaller airways into larger ones. Therefore the lungs cough it up.
Vibration
This is a technique that gently shakes the mucus. Therefore can move into the larger airways from smaller airways and lungs cough it up.
Huffing
This is also known as huff coughing. It is a technique that helps move mucus from the lungs. Huffing should be done in combination with another ACT. Exhale forcefully, but slowly, in a continuous exhalation to move mucus from the smaller to the larger airways.
Note: In all this techniques you have to consider who is able to do this and who is not that from children, middle age to geriatrics (old people)
What are the contraindications of these techniques?
– A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person.
Examples of Contraindications
-Recent spinal surgery (i.e., laminectomy)
-Acute spinal injury
-Empyema
-Bronchopleural fistula
-Cardiogenic pulmonary swelling
-Large pleural effusion
-Pulmonary embolism
-Confused, anxious, or otherwise impaired patients who actively resist or do not tolerate position changes.
-Rib fracture with or without flail chest or other significant
chest injury, neurosurgery, aneurysms, and eye surgery)
-Uncontrolled hypertension
-Esophageal or other upper body surgery adversely affected by this position
-Lung carcinoma recently treated by surgery or radiation with actual or significant potential of hemoptysis
-Uncontrolled airway with significant risk of aspiration
(tube feeding or recent meal)
-Recent epidural anesthesia or recent epidural or intrathecal drug administration
-Recent skin grafts or flaps on the thorax.
-Burns, open wounds, and skin infections of the thorax
-Recently placed transvenous or subcutaneous pacemaker
(mechanical vibration and percussion are relatively more contraindicated)
-Suspected or known active pulmonary tuberculosis
-Lung contusion
– Osteomyelitis of the thorax
-Osteoporosis of the thoracolumbar region
-Coagulopathy or thrombocytopenia (manual vibration may be well tolerated)
-Complaints of chest wall pain
-Absolute: Osteogenesis imperfecta or other bone disease.
-Elevated intracranial pressure or known intracranial aneurysm
-Acute unstable head, neck or spine injury
Reference https:www.bronchiectasis.scot.nhs.uk/chest -physiotherapy
