Glossopharyngeal and Strelnikova Breathing Exercises

Glossopharyngeal Breathing

• Glossopharyngeal breathing (GPB), or "frog breathing," aids patients with reduced vital capacity due to respiratory muscle paralysis.
• Paralysis may be due to conditions like:
  • Poliomyelitis
  • High spinal cord injuries, such as tetraplegia
• It helps maintain or improve lung and chest wall compliance.
• Patients voluntarily force boluses of air into the lungs, creating positive pressure ventilation.
• The patient closes their mouth and traps air in pharynx
• The air goes to lungs as glottis opens
• Breathing technique enhances inspiration depth and vital capacity.
• Several gulps of air are taken (6–10), mouth is closed, and tongue traps air in pharynx forcing air into the lungs when the glottis opens.

Strelnikova Breathing Exercises

• Designed to exert a strong nasal breath while compressing the lungs using different muscles.
• Prevents hyperventilation by stressing the lungs during inhalation.
• It increases air resistance by using only nasal fast breath.
• Utilized in treating bronchospasm.

Airway Clearance Techniques

• Chest physiotherapy employs these techniques to remove sticky mucus from the lungs.
• Secretions can increase problems of inflammation and can block the airways.
• Antibiotics and inhaled medicines help open the airways and thin the mucus.
• Impaired airway clearance is a common pathway to lung damage.
• A lung defense is activated by bacteria or irritants.
• There may be augmented mucus production triggered by inflammatory and immune responses.
• The amount of mucus corresponds to mucociliary clearance failure.
• This contributes airway obstruction and mucus plugging.
• Inflammation can cause damage to the lung tissue.
• Recurring respiratory episodes accelerates lung damage.
• Airway clearance therapy goals:
  • Interrupt lung tissue cycle destruction
  • Decrease illnesses/infections
  • Improve the quality of life

Basic Airway Clearance Techniques

• Moving secretions from distal to proximal:
  • Gravity, postural drainage
  • Air movement (active cycle of breathing, autogenic drainage)
• Moving secretions from proximal to outside:
  • Suction
  • Forced expiratory (coughing) methods

Coughing

• Coughing is a sudden, forced air expulsion and keeps clear lungs.

• Coughing occurs voluntarily or reflexively to defend the body against retained secretions.

• The cough pump in healthy people works to the seventh generation of bronchi but the bronchi has 23 generations.

• Mechanical components of the cough mechanism:

  • Irritated respiratory airways activate the cough centers in the medulla, which reflex occurs.
  • Deep inspiration.
  • Pause of inspiration.
  • Glottis and vocal cords contract.
  • Intra-abdominal and intrathoracic pressure increases.
  • Glottis opens, and air is forced out with sudden action.

• Cough effectiveness is reduced by:

  • Inability to take a deep breath, due to pain from recent chest surgery, rib fracture, or acute lung disease.
  • Weak diaphragm/accessory muscles from spinal cord injuries or cell disease.
  • Inability to expel air because of spinal cord trauma, myopathy, tracheostomy, fatigue or critical illness.
  • Smoking and COPD decrease ciliary.
  • Amount and thickness increase from Cystic fibrosis, dehydration, pneumonia or bronchitis.

• Cough vs. Huff:

  • Voluntary or reflexive/Voluntary.
  • Doesn`t stimulate huffing/Stimulates cough.
  • Productive/Nonproductive.
  • Secretions removed from/toward proximal airways.
  • Inspiration with closed/opened glottis.
  • High intrathoracic/Low pressures.

Cough Suppression

• Smaller/Larger airways sensitivity to chemical/ mechanical stimuli.
• Both adapt to repeated stimulation as observed in the ICU.
• Involuntary cough suppression results in patients with:
  • Quadriplegia (decreased inspiratory effect)
  • Recurrent laryngeal palsy (inability to open/close glottis)
  • Exp effect greater than insp effect (quadriplegia + paraplegia)
• Conditions impacting coughing:
  • Myasthenia Gravis
  • Poliomyelitis
  • Head injury and unconsciousness block with medication.
  • Neuromuscular blocking drugs
  • Narcotics
  • Central nervous system depression
• Voluntary cough suppression is common following surgery through instructions before surgery.

Techniques Improving Cough

• Manual assisted cough for abdominal weakness after injury (mid-thoracic or cervical spine) by a therapist or patient which assists abdominal pressure.
• Therapist uses two hands to interlock fingers at Epigastric area.
• Therapist applies inward and upward pressure on the abdomen during patient inhalation, pushing diaphragm to achieve effective cough but (excessive pressure at Epigastric area should be avoided).
• Patients push in, up and lean forward when self-assisted after deep breathing.
• Splinting alleviates chest pain.
• Support painful area from surgery or trauma using firmness hand on pillow during the coughing
• Pressure restricts movements and decreases pain.
• Humidification needed for thick secretions through the administration of Ultrasonic or humidification therapy, fluid and Supplemental of O2 which enhance mucociliary and produces productiveness.
• A saline solution is use to irrigate the airways in the airways with intubation.
• Tracheal tickle (external): circular motion over suprasternal notch to mechanically cough.
• Neuromuscular facilitation (by ice): apply ice for 3-5 seconds around thoracic to stimulate cough afferent nerve for 30 mins total.
• Positioning: Effective coughing is promoted when one plants feet on floor as they lean forward.
• Huffing: forceful expiration with open glottis to stimulates cough with huffing which is encouraged through deep breaths.
• Pressure applied to: trachea, after Inspiration to Mid-rectus abdominis, and along lower costal borders.
• Manual hyperventilation produces high speeds from ventilator may create reflex cough.
• Vibration over the chest can increase cough effectiveness and stimulate it and is similar to vibrations as huffing.
• The use of catheter for stimulation of oropharynx successful

Precautions and Complications for Cough

• Avoid uncontrolled/paroxysmal coughing.
• Do not apply forced coughing with history of CVA/aneurysm and clear the airway by several huffs.complication- -Airways/larynx trauma -Pneumothorax with emphysema -BronchoconstrictionBarotrauma
• Reduce HypertensionArrhythmia
• Reduce decreased venous return/transient systemic hypertension
• Syncope.
• Muscle Rupture.
• Rib Fracture.
• Urinary Incontinence.
• Pulmonary Embolism.

Teaching Effective Cough and Treatment Monitoring

• Have the patient place in relaxed sitting.
• Make inhale through diaphragm.
• Feel abdominal and use 3 huffs.
• Tighten vocal chords when making noise like "k” as glottis closes.
• Tip tongue put behind upper jaw while huffing 2 times before coughing.
• Treatment is improve through testing field, decreasing pain, resolving culture and normalizing resp pattern/rate.

Suctioning

• Clearing airways for patients with artificial airways because trach and main stem are only things cleared.
• Application may results as lining damage through possible infection.

Postural Drainage

• Positioning patient uses gravity with bronchial segment while coughing and is done by endotra or coughing helps on avoiding.
• Patient on position between 5-10 mins while coughing.
• 2 sessions/day is requires 45/50min per timing.

Goals and Indications

• Pulmonary : High rates
• Bed : High resters
• Post -Surgery patients
• Remove with Acute as COPD Atelectasis Lung infection, elderly, airway patients or coordination problems. Sever Hemoptysis, Increase in Pressure, Untreated problems or Instability as angina could all result in Relative Contraindications or head

Techniques

• Maximize gravity with: A: Breathing (local with diaphragm) B: Coughing C: Percussion D: Vibration E: Shaking Percussion with hand while relaxed through therapist

  Percussion is perform with hand while relaxed through lung part and continue for minutes until reposition when difficult. Percussion indications: Osteoprotic patient is not allowed as with tumor which mobilizes Indications. Pneum/hem-o and em-bolisum/gia is also

Vibration: remove with hand to lung for patient with percusions to remove during breathing. Shaking: index patient can

Use hot while making thin before loosening clothes

• Light for 3/7cases
• Morning and after with mucus/IPPB
• Relax and connect
• Expain/teach and check if few pathology
• Tilt table and cups

Lung position and huffing is

• Right lung: Apic Segment = Up and Lat- leaning forward while percussion
• An and Lower the segment
• Lower: back. Seg the same

Positions Lingula as

A: Med as forward with side B: Upper is kidney and left down on spine. Lung patient require position while post.

Head if have pressure which will cause with surgery. Radiograph and fever as treat or check if normal as you treat patient.

In ACBT

1. Relax to start ACBT patient and preform BC/DB as BC is gentler and helps airways.
2. Try that in nose and out with DB -A is controlled rest -B for air is held -C help clear when needs breathing

Drainage

3phases of stages. airway as air to expand

Devices

PEPtakes air above while breathing and pressure on sides is used to clear the secreation Flutter/oscillat and vibrate. Vest/HFC to air and help by oscillation.

PEPT: for youth. Flutter uses metal or sides and is portable. Acapella uses PEp and vibration. Quake is oscillation with rotation muscle strength/resist is increased

RT Technique

• Inspiralation from device by slow and deep methods as patient uses mouth pieces.
• Maneuver is used which should be prevented in order to ensure and volume/pressures.
• Is used to strength and lung as fatigue is result of obstruction to ventilation. To not tire in short sessions. Volume with pressure or prevent alveoli while coughing
• Spirometer is prevent collapse
• Slow/Easy and repeat
• Tension is for patients
• Light helps meditation
• How to Test relaxation
• Insection-Atitude
• Palpation
• Muscle passivs
• Movements:sleeping/lifting
• Relaxation -Positioning-Exercise.

Airways

Breathing while resting against: beutekyo, pursed lip, or the device.