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What is the primary purpose of percussion in pulmonary rehabilitation?
What is the primary purpose of percussion in pulmonary rehabilitation?
Which frequency range is appropriate for percussion application?
Which frequency range is appropriate for percussion application?
Which condition is an indication for percussion therapy?
Which condition is an indication for percussion therapy?
What is a contraindication for percussion therapy?
What is a contraindication for percussion therapy?
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In which patient scenario should percussion be approached with caution?
In which patient scenario should percussion be approached with caution?
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What duration should percussion be applied to non-cooperative patients?
What duration should percussion be applied to non-cooperative patients?
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Which of the following is NOT a condition that requires caution during percussion?
Which of the following is NOT a condition that requires caution during percussion?
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What is the purpose of paraspinal ice application to thoracic vertebrae?
What is the purpose of paraspinal ice application to thoracic vertebrae?
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Which technique involves contracting abdominal muscles to produce a cough?
Which technique involves contracting abdominal muscles to produce a cough?
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What is a key characteristic of huffing compared to coughing?
What is a key characteristic of huffing compared to coughing?
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What is one major benefit of the Active Respiratory Techniques Cycle?
What is one major benefit of the Active Respiratory Techniques Cycle?
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In which conditions is Autogenic Drainage primarily utilized?
In which conditions is Autogenic Drainage primarily utilized?
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What is the goal of Autogenic Drainage?
What is the goal of Autogenic Drainage?
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What does the Belgium technique of Autogenic Drainage involve?
What does the Belgium technique of Autogenic Drainage involve?
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Which of the following is NOT part of the Active Respiratory Techniques Cycle?
Which of the following is NOT part of the Active Respiratory Techniques Cycle?
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What is a potential risk of ice application to the thoracic vertebrae?
What is a potential risk of ice application to the thoracic vertebrae?
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What position should a patient ideally assume to enhance coughing effectiveness?
What position should a patient ideally assume to enhance coughing effectiveness?
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What technique is primarily used during the expiratory phase to facilitate mobilization of secretions?
What technique is primarily used during the expiratory phase to facilitate mobilization of secretions?
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Which of the following contraindications should be considered before applying vibration techniques?
Which of the following contraindications should be considered before applying vibration techniques?
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Which muscle groups are primarily contracted during the coughing process?
Which muscle groups are primarily contracted during the coughing process?
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What is the main purpose of applying pressure to the extrathoracic trachea during coughing enhancement?
What is the main purpose of applying pressure to the extrathoracic trachea during coughing enhancement?
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Which technique involves maximum inspiration, closure of the glottis, and a limited number of coughs?
Which technique involves maximum inspiration, closure of the glottis, and a limited number of coughs?
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During the application of vibration, how should the physiotherapist position their hands?
During the application of vibration, how should the physiotherapist position their hands?
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What enhances the effectiveness of a cough after applying pressure to the lower costal margins?
What enhances the effectiveness of a cough after applying pressure to the lower costal margins?
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Which of the following is a technique distinct from coughing but also used to enhance respiratory function?
Which of the following is a technique distinct from coughing but also used to enhance respiratory function?
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Study Notes
Pulmonary Rehabilitation
- Focuses on manual techniques for pulmonary rehabilitation.
Manual Techniques
- Percussion: Aids in mobilizing secretions through mechanical oscillations on the chest wall.
- Frequency: 100-480 Hz.
- Intensity: Varies per individual.
- Timing: During inspiration and/or expiration, after 3-4 thoracic expansion exercise cycles.
- Duration: Maximum 30 seconds for non-cooperative patients.
- Should not be uncomfortable.
- Hand application: Commonly applied using both hands.
- Single-handed use: For neonates, pediatric age groups, small chest areas; self-percussion is also noted.
Indications of Percussion
- Lung abscess
- Cystic fibrosis
- Bronchiectasis
- Difficulty clearing secretions
- Excessive sputum production (25-30 ml/day in adults)
- Atelectasis due to mucus plugs
- Foreign body in the airways
Contraindications of Percussion
- Massive hemoptysis
- Severe osteoporosis
- Rib fractures
- Pulmonary thromboembolism
- Patients with clotting problems or fat embolism
- Patients undergoing dialysis
- Over tumor tissues
- Over painful areas
Cardiovascular Conditions Requiring Caution
- Chest pain
- Unstable angina
- Hemodynamic instability
- Low platelet count (thrombocytopenia)
- Anticoagulant therapy
- Unstable and potentially fatal dysrhythmias
Orthopedic Conditions Requiring Caution
- Osteoporosis
- Long-term steroid therapy
- Osteomyelitis
- Osteogenesis imperfecta (impaired bone development)
- Spinal fusion
- Rib fracture, flail chest
Pulmonary Conditions Requiring Caution
- Bronchospasm
- Hemoptysis
- Severe dyspnea
- Untreated lung abscess
- Pneumothorax
- Pneumonia or other infection conditions
- Immediately after chest tube removal
- Pulmonary embolism
Oncological Conditions Requiring Caution
- Cancer metastases to ribs and vertebrae
- Carcinoma in the bronchus
- Removable tumor
Other Conditions Requiring Caution
- New skin grafts
- Burns
- Open chest wounds
- Thoracic skin infections
- Subcutaneous emphysema
- Immediately after cataract surgery
Vibration
- Applied to affected lung segments.
- Applied during expiration.
- Uses both hands stacked, fingers open, lower hand on thorax.
- Elbows straight
- Palmar surfaces of hands on chest wall.
- Body weight utilized.
- Performed after 3-4 thoracic expansion exercise cycles
Shaking
- Effects: Accelerates expiratory airflow, facilitates mobilization of secretions.
- Contraindications: Osteoporosis, metastatic conditions affecting ribs and vertebrae.
Other Techniques
- Coughing
- Huffing
- Forced expiration
- Active respiratory techniques cycle
Coughing
- Physiotherapists can improve weak coughs by teaching good technique to enhance volume and compression, or stimulate cough reflex.
- This is often needed after surgery and chest splinting may be required.
- The patient performs inspiration, closes the glottis, and contracts abdominal, perineal, gluteal, and shoulder depressor muscles, usually no more than 2 times per expiratory phase.
- Positions are important to support this process (sitting, leaning, laying).
Coughing Positions
- Various positions are depicted in the slides.
Cough Enhancement Techniques
- Positioning: Leaning forward, neck flexed, supported by arms, feet on the ground.
- Forced Expiration ("Huffing"): Stimulates pulmonary mechanoreceptors, initiating reflex coughing.
- Pressure Application: Applying pressure to the extrathoracic trachea, rectus abdominis after inspiration, or lower costal margins during exhalation can enhance cough efficacy.
- Hand Ventilation: Respiratory (inspiratory) flow rates from manual ventilator stimulate pulmonary mechanoreceptors, triggering reflex coughing.
- Mechanical Stimulation: Direct mechanical stimulation can also induce reflex coughing.
- Neuromuscular Facilitation: Paraspinal ice application to thoracic vertebrae for 3-5 seconds (intermittently) can initiate coughing. The use of ice should be carefully selected and closely monitored due to potential hypertension risks.
Controlled Coughing
- Deep breath, followed by quick, effective cough by contracting abdominal muscles.
- Useful for surgical patients.
- Glottis is closed.
Huffing
- Glottis is open.
- Command: "Take a breath, exhale rapidly."
- Inspiration depth varies based on the target region.
Active Respiratory Techniques Cycle
- Combination of techniques to clear secretions.
- Promotes proper breathing pattern, minimizes fatigue.
- Prevents bronchospasm and hypoxemia.
- Flexible and adaptable.
Active Respiratory Techniques Cycle (Continued)
- TEE (Thoracic Expansion Exercises): Listed as a component of the cycle.
- BC (Breath Control): Listed as a component.
- FET (Forced Expiratory Technique): Component, potentially involving huffing or other forced expiration.
- Repeating this cycle is recommended but tolerance is key.
Autogenic Drainage
- Controlled breathing technique regulating respiration, speed, depth, and localization.
- Used for patients with muscle disorders (especially those with AD pathology) to clear mucus, improve ventilation, and maintain chest wall mobility.
- Used in various conditions affecting lung function. (cystic fibrosis, chronic bronchitis, asthma, bronchiectasis, atelectasis, kyphoscoliosis, muscular dystrophy, postoperative conditions).
- Aims to provide highest airflow without causing airway collapse.
- Applied in Belgium and Germany with different approaches.
-
Belgium Technique: Inhalation via nose, glottis opening, holding breath for 2-3 seconds, exhaling with an open mouth.
- Three Phases: dissolving mucus, accumulation, and transfer to mouth.
- German Technique (two-phase): Breathing from middle tidal volume, holding breath for 2-3 seconds at end of inspiration, passive expiration followed by active expiration.
Manual Assisted Cough
- Various types depicted including: anterior thorax assisted, cost-a-frenic assisted, Heimlich type, self-coughing, and mechanical support. Methods for supporting coughing are presented.
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Description
This quiz covers manual techniques used in pulmonary rehabilitation, focusing primarily on percussion methods. It discusses the frequency, intensity, timing, and indications for use, as well as contraindications that should be considered when administering these techniques. Ideal for healthcare professionals and students learning about respiratory health.
