CHEST PHYSICAL

THERAPY
PRE-FINAL TOPIC
OVERVIEW
□ Chest Physical Therapy (CPT) is a single or
combination of procedures performed to
maintain bronchial hygiene and pulmonary
toilet.
□ A complete chest physical therapy regimen usually
consist of anatomical positional to maintain
maximum gravitational drainage of secretions.
□ A good chest physiotherapy requires a Respiratory
Therapist to be knowledgeable in pulmonary
anatomy and physiology.
CONTRAINDICATION OF CPT
□ Increase ICP
□ Active hemorrhage with hemodynamic instability
and hemoptysis
□ Recent spinal injury or injury
□ Empyema
□ Broncho-pleural fistula
□ Rib fracture
□ Flail chest
□ Uncontrolled hypertension
CAUTIONS WHEN PERFROMING
CPT
□ Osteoporosis
□ Surgical Incisions
□ Indwelling catheters
□ Chest Tubes
□ Subcutaneous empyema
□ Cardiac Instability
□ Traction
□ Ventilatory and monitoring circuitry
Hazards of
CPT
□ Dyspnea
□ Aspiration
□ Increase in intracranial
pressure
□ Hypotension
□ Broncho-pleural fistula
□ Extra-pleural hematomas
□ Heparin Infusion
□ Empyema
Postural
Drainage
□ A method of removing pooled secretions by
anatomically positioning the patient so as to
allow gravity to assist in movement and drainage
of secretions into the large airways where they
can mobilize and cough up or suction.
□ Indications include: Excessive accumulation of
secretions, Retained secretions, Prophylactic care
of pre-operative patient with history of pulmonary
problem.
Percussion
□ Percussion is a technique of rhythmically tapping the chest
wall with cupped hands.
□ It is design to loosen the secretions in the area underlying the
percussion by the air pressure that is generated by the
cupped hands on the chest wall.
□ Chest percussion period of 30-45 seconds can be repeated as
tolerated during 4-6 minutes of each individual postural
drainage positions.
□ Should be done over bare skin to minimize transmission.
□ Striking with maximum of the wrist flexion and a minimum
of arm movement is recommended to reduce the fatigue of
the Respiratory Therapist
Indications and
Precautions
□ Indications is the same of the Postural
Drainage.
□ Precautions include:
◦ Cancer with known metastatic changes
◦ Anticoagulant therapy
◦ Tuberculosis
◦ Petechiae
◦ Osteoporotic Changes
◦ Empyema
◦ Pulmonary Embolus
◦ Untreated Tension Pneumothorax
◦ Flail Chest
Vibrations
□ Are performed by placing one hand on top of the other over
the affected area and tensing the shoulders, keeping the
arms straight and applying vibrating action from the
shoulder to hand
□ The hands are oscillated or vibrated in an isometric fashion
for 5-10 seconds
□ Vibrations are intended to move secretions into the larger
airways.
□ Vibrations are applied only during exhalations.
□ A cough of each vibrations cycle will aid in mobilization of
secretions
□
Cough Assist
□ Ideal and Normal
◦ The alert, oriented patient is asked to take a deep breath
◦ Closure of glottis
◦ Contraction of abdominal muscles, building up
intrapulmonary pressure
◦ Opening of glottis and rapid forceful exhalation
◦ Is activated by the stimulation of secretions.
□ Cough Assistance
◦ Is indicated with patient who cannot develop a forceful cough
◦ The therapist hands should be place on the side of the rib cage and
pushes inward and downward during forceful exhalations.

□ Huff
◦ Is performed for patient with ineffective cough patient with
extremely large FRC, neurological impaired, and patient with
artificial airways.
◦ Patient is instructed to performed short step like cough of small
volumes.
Breathing Retraining
□ These technique are design to assist patient with
muscular weakness, post operative pain or
chronic pulmonary disease to assume efficient
ventilatory pattern.

□ Goals:
◦ Improve and increase ventilation
◦ To strengthen respiratory musculature
◦ To prevent development of atelectasis
◦ To decrease work of breathing.
Diaphragmatic Exercise

□ The patient is taught and trained to abandon the

inefficient method of breathing and use
diaphragm effectively.
□ The patient is encouraged to exhale slowly and
completely. The therapist may assist exhalation by a
slight inward and upward pressure below the
xiphiod process.
Pursed Lip Breathing
□ This technique is discovered spontaneously by
COPD patients
□ The patient is instructed to inhale slowly and
exhale slowly through pursed lips.
□ The benefit is from the resistance to flow.
□ The back pressure prevents premature collapse of
the airways.
□ And excellent technique to teach the patients
control the rate and depth of breathing.
Segmental Breathing
□ This is useful in directing airflow to the specific area
of the lungs.
□ The hand is placed with firm pressure over the
specific lung segment.
□ The patient is incourage to inhale forcefully against
the pressure of the hand.
□ The areas of the lungs is particularly susceptible to this
maneuver are apices, middle lobes, and the lateral
basal and posterior basal segements.
END OF DISCUSSION