Chest Physiotherapy Techniques

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Questions and Answers

Which of the following is not a benefit of practicing relaxation techniques?

Slowing heart rate

Increasing anxiety levels (correct)

Lowering blood pressure

Improving sleep quality

What is the primary focus of Progressive Muscle Relaxation?

Tensing all muscles simultaneously

Deep breathing exercises

Tensing and releasing muscles methodically (correct)

Visualizing calming environments

Which technique is characterized by visualizing a calming environment?

Pursed lip breathing

Guided Imagery (correct)

Incentive spirometer

Rib cage mobilization

Which of the following best differentiates relaxation from meditation?

Relaxation focuses on calming, while meditation requires intentional awareness. Signup and view all the answers

Which physiological response is typically associated with stress?

Increased heart rate Signup and view all the answers

What is the primary purpose of percussion in chest physiotherapy?

To mobilize secretions to the central airways Signup and view all the answers

Which technique uses an inflatable vest to apply oscillations to the chest?

High-Frequency Chest Wall Oscillation (HFCWO) Signup and view all the answers

In the technique of manual percussion, which of the following is a requirement?

The force applied must be equal Signup and view all the answers

Which of the following is NOT a precaution when performing percussion?

Can be performed over the abdomen Signup and view all the answers

What type of movements are involved in the technique of vibration?

Fine oscillatory movements combined with compression Signup and view all the answers

During what phase of respiration should vibration be applied?

Only during exhalation Signup and view all the answers

What is one of the aims of chest physiotherapy?

To decrease work of breathing Signup and view all the answers

What distinguishes Intrapulmonary Percussive Ventilation (IPV) from manual percussion?

IPV uses an external device to deliver percussion Signup and view all the answers

Which method for cough stimulation involves applying circular motion to the trachea?

Tracheal tickle Signup and view all the answers

What is a characteristic that differentiates a cough from a huff?

Cough involves a closed glottis while huff involves an open glottis Signup and view all the answers

What is the primary goal of pleural stretching techniques?

To improve lung expansion Signup and view all the answers

Which of the following stretching types involves an external force?

Passive stretching Signup and view all the answers

Which breathing technique specifically helps with reducing respiratory distress in patients like those with asthma?

Pursed lip breathing Signup and view all the answers

What is the primary action taken during the cough mechanism?

Glottis closes and vocal cords tighten Signup and view all the answers

Which of the following or combination aims to improve joint mobility and respiratory functions through stretching?

Both active and passive stretching Signup and view all the answers

What is the purpose of humidification as a method to support coughing?

To mobilize thick secretions in the respiratory tract Signup and view all the answers

What is defined as a reduction in muscle contractility during breathing?

Weakness of the respiratory muscles Signup and view all the answers

Which of the following is NOT an etiology of respiratory muscle weakness?

Obesity Signup and view all the answers

Which training aim focuses on improving performance during physical activities?

Improve exercise performance Signup and view all the answers

What does resistance-training devices do to respiratory muscles?

Simulate weight lifting Signup and view all the answers

Which type of device requires individuals to produce sufficient pressure to initiate breathing?

Pressure threshold valves Signup and view all the answers

What is an example of an endurance-training device?

Flow-resistance trainer Signup and view all the answers

What method is used to overload muscle fibers for improved endurance?

Increasing training duration Signup and view all the answers

In respiratory muscle training, a device that measures air volume inhaled is called a?

Incentive spirometer Signup and view all the answers

What is the primary purpose of an incentive spirometer?

To assess inhalation volume and inspiratory effort Signup and view all the answers

Which type of incentive spirometer primarily focuses on improving diaphragm activity?

Volume-oriented incentive spirometer (VIS) Signup and view all the answers

In which situation is the use of an incentive spirometer indicated?

For patients with ribcage injuries Signup and view all the answers

What is the primary function of positive expiratory pressure (PEP) therapy?

To prevent premature airway closure Signup and view all the answers

Which of the following statements is true regarding Acapella?

It combines PEP therapy and airway vibrations. Signup and view all the answers

How does a peak flow meter assist in asthma management?

It provides data on airway patency Signup and view all the answers

What is a function of the Flutter device in respiratory therapy?

To produce high frequency oscillations during exhalation Signup and view all the answers

Which condition would most likely benefit from the use of an incentive spirometer?

Pneumonia recovery Signup and view all the answers

Study Notes

Chest Physiotherapy (Pulmonary Rehabilitation)

Chest physiotherapy employs physical methods to reduce breathing effort, re-educate breathing patterns, enhance gas exchange, assist coughing, and clear excess secretions.

Aims of Chest Physiotherapy

Decrease work of breathing
Re-educate breathing techniques
Improve gas exchange
Assist coughing
Remove excess secretions

Airway Clearance Techniques (Manual Techniques with Postural Drainage)

Percussion: A manual technique used by respiratory therapists to improve airway clearance by mobilizing secretions in one or more lung segments to the central airways. It involves cupping hands alternately on the chest wall, producing an energy wave transmitted to the lungs & airways.

Types of Percussion

Manual Percussion: Using cupped hands
Mechanical Percussion: Electric or pneumatic percussors (available in various intensities & frequencies for adults & children)
Intrapulmonary Percussive Ventilation (IPV): Provides intrathoracic percussion & vibration, an alternative method for positive pressure delivery to the lungs.

Percussion Technique

Hands move in alternating rhythmic patterns during both phases of respiration.
Percussion rate is 100-480 times per minute.
The sound should be hollow, not a slap.
Consistent force application is crucial.
Percussion should be performed for several minutes.

Precautions for Percussion

Avoid bony prominences
Avoid floating ribs
Avoid performing over breast tissue

Vibration

A fine oscillatory movement combined with chest compression, used to remove secretions.
Gentle & high-frequency hand movements
Apply hand on chest wall, either side-by-side or overlapping.
Apply during exhalation, in the same direction of movement.
Achieved by isometric contraction of the therapist's upper limb.

High-Frequency Chest Wall Oscillation (HFCWO)

External chest wall oscillations using an inflatable vest, applied to the chest.
These machines vary frequencies & intensities, helping loosen & thin mucus, separating it from airway walls.

Shaking (Manual Technique)

Vigorous vibration using intermittent bouncing maneuvers, paired with wide hand movements during exhalation.

Cough & Huff

Cough Definition: A sudden expulsion of air against a closed glottis, voluntarily or reflexively. Effective for clearing secretions in the first 7 generations of bronchi.
Mechanism: Deep inhalation → glottis closes & vocal cords tighten → abdominal muscles contract → diaphragm elevates → increasing thoracic & abdominal pressure → glottis opens.

Cough Stimulation Methods

Splinting: Decreasing incisional pain by applying hands or pillows.
Tracheal Tickle: Used in children & unconscious patients using circular motion on the trachea.
Neuromuscular Facilitation: Intermittent 3-5 second ice application on paraspinal muscles to stimulate afferent nerves.
Suction: For patients unable to cough or who are on artificial airways, though it only clears the trachea & main bronchi.
Humidification: Increasing hot fluid intake to mobilize thick secretions.

Cough & Huff Types

Cough: Voluntary or reflexive, productive or non-productive, does not stimulate huffing, closed glottis, increases intra-abdominal & intrathoracic pressure, forced expiration.
Huff: Voluntary, non-productive, stimulates coughing, open glottis, deeper than cough with less pressure, less expiratory force.

Stretching

Elongates pathologically shortened soft tissue while increasing range of motion & mobility.
Types:
- 1-Active: where agonist stretch antagonist.
- 2-Passive: external force.
Aims:
- Lengthen soft tissues
- Increase joint mobility
- Break adhesions
- Improve respiratory functions

Pleural Stretching Techniques

The pleura are thin membranes lining the lungs; muscles & surrounding tissues can be stretched to enhance lung expansion & reduce pleural restriction.
Benefits: Improves lung expansion, reduces stiffness, improves breathing in conditions like asthma, COPD, or post-surgery.
Techniques: Includes deep diaphragmatic breathing, thoracic expansion exercises, intercostal stretching, side-lying thoracic expansion, segmental breathing, cat-cow stretch (thoracic mobility), rib cage mobilization, trunk rotation stretch, pursed lip breathing, and incentive spirometry.

Relaxation Techniques

Therapeutic exercises to decrease tension & anxiety, targeting stress-related physiological responses.
Stress responses: increased heart rate, palpitations, excess sweating, shortness of breath, and muscle tension.
Relaxation techniques can: slow heart rate, lower blood pressure, slow breathing rate, improve digestion, maintain blood sugar levels, reduce stress hormones, increase blood flow to major muscles, relieve muscle tension/chronic pain, improve mood, improve sleep quality, and lower fatigue.
Techniques: Deep breathing/diaphragmatic breathing, guided imagery, progressive muscle relaxation.

Devices Used for Respiratory Muscle Training

Weakness of respiratory muscles occurs due to a reduction in muscle contractility, impacting normal pressure & airflow during breathing. Caused by respiratory diseases (COPD, emphysema), neurological lesions, electrolyte imbalances, blood gas abnormalities, intense weight loss, or cardiac decompensation.
Respiratory Muscle Training: Repetitive breathing exercises against an external load (controlled by time, intensity, & frequency).
- Aims: Increase strength of respiratory muscles, improve exercise performance/capacity.
- Overloading: Increased training duration, increasing intensities, increasing frequency.
Muscle Response: Strength improves with high-intensity/short duration stimuli. Endurance improves with low-intensity/long duration stimuli.
Types of Respiratory Training Devices:
- Endurance-training devices (prolonged periods, e.g., 30 minutes).
- Resistance-training devices (e.g., flow resistance).
Mechanisms:
- Passive flow-resistance uses a variable diameter orifice, resisting load. Dynamic flow-resistance continuously adjusts flow rate dependent on breath.
- Example: Power-breath, pressure threshold valves require a pressure load exerted by the patient for respiration initiation.

Incentive Spirometer

A device that measures inhaled air volume.
Operation: Breathing in triggers a piston rising within the device, illustrating inhaled volume.
Patient's inspiratory effort is assessed by visual feedback of increasing volume.
Types: Flow-oriented (FIS) for increasing upper chest muscle work and Volume-oriented (VIS) improving diaphragm activity.

Indications of Use

Ribcage injuries
Bedridden patients
Asthma
Pneumonia
Chronic obstructive pulmonary disease
Cystic fibrosis
Sickle cell anemia
Atelectasis

Positive Expiratory Pressure (PEP)

Breathing against resistance (device or pursed lips).
The increase in pressure transmits to airways, creating back pressure, stenting them during exhalation.
Role of PEP: Prevent premature airway closure, reduce gas trapping, promote collateral ventilation to areas distal to obstructions, facilitate airway clearance by promoting mucus movement proximally.
PEP Therapy: The patient exhales against a fixed-orifice resistor, usually generating 10-20 cm H2O pressure. Devices like Acapella combine PEP & airway vibrations.

Acapella

Combines PEP therapy & airway vibrations for pulmonary secretion mobilization.
Allows use in any position. Facilitates airway opening.
Facilitates opening of airways for conditions like COPD, asthma, & cystic fibrosis.
Color-coded units for adjusting flow (15 L/min high, <15 low), based on clinical need.
Allows inhalation & exhalation without removing the device.
Prolongs expiratory airflows for increased secretion removal.

Flutter

Small, pipe-shaped device with PEP & high-frequency oscillation.
Generates vibrations during exhalation to help mobilize airway secretions.
Facilitates clearance and improves airflow.

Peak Flow Meter

Used for asthma management, providing information about airway openness.
Measures small changes in airways prior to wheezing.
Daily use helps track when peak flows drop, facilitating timely medication adjustments.

Peak Flow Zones

Green zone (80-100% of personal best): normal peak flow
Yellow zone (50-80% of personal best): caution, narrowing airways
Red zone (<50% of personal best): severe airway narrowing, stop activity & seek help

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Description

Explore the essential techniques and aims of chest physiotherapy used in pulmonary rehabilitation. This quiz covers manual and mechanical percussion methods, as well as their benefits in enhancing airway clearance and improving respiratory functions.