Chest Physical Therapy

What is Chest Physical Therapy?

Chest Physical Therapy (CPT) is a therapeutic approach aimed at improving respiratory function and clearing mucus from the airways in individuals with respiratory conditions such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), or bronchiectasis.

It typically involves a combination of techniques including percussion, vibration, postural drainage, and breathing exercises, administered by trained healthcare professionals.

CPT helps to loosen and mobilize mucus, making it easier for patients to cough up and clear from their lungs, thereby improving lung function and reducing the risk of respiratory complications.

Completing CPT is simple. Anyone can perform CPT for a kid with cystic fibrosis, including parents, siblings, and friends. During hospital stays or care center visits, it can also be performed by respiratory therapists, physical therapists, or nurses.

How to Perform Chest Physical Therapy?

When using postural drainage, the patient rests or sits in different positions to empty as much air as possible from the targeted lung segment. Then percussion, vibration, and gravity are used to empty that portion of the lung. These positions may be modified by your care team to meet your or your child’s needs.

The caregiver can clap on the CF patient’s chest wall when they are in one of the positions. Usually lasting three to five minutes, this is occasionally followed by 15 seconds of vibration over the same region (or five exhalations). After that, it is advised that they cough or puff vigorously to clear their lungs of mucus.

The mucus is moved into the larger airways by the caregiver clapping (percussion) on the chest wall over the area of the lung that has to be drained. The palm of the hand is pointing downward as it is cupped as though to hold water (as illustrated in the illustration below). To lessen the force of the clapping, the cupped hand curls to the chest wall and traps an air cushion.

A consistent beat and force are used in percussion. There should be a hollow sound to every beat. Percussion is less demanding because the majority of the action is done with the wrist and the arm relaxed. Proper cupping of the hand ensures that percussion is neither uncomfortable nor stinging.

It’s very important to remember not to applaud the:

• Spine
• Breastbone
• Stomach
• Lower ribs or back

Instead of using the conventional cupped palm method for percussion, other devices can be employed. Find out which respiratory therapist or CF physician might be the most suitable for you.

A method called vibration helps the mucus to enter the larger airways by gently shaking it. The caregiver tenses the shoulder and arm muscles to produce a gentle shaking action while placing a firm touch on the chest wall over the area of the lung that is being drained. The caregiver then lightly presses on the part that is vibrating. (Alternatively, the caregiver might put one hand over the other and press the top and bottom hands together to make them vibrate.)

The flattened hand, not the cupped hand, is used for vibration (see the illustration below). The goal is to exhale as slowly and completely as you can.

Coughing may occur when deep breathing transfers the mucus that has become loosened. To help someone breathe more deeply and get air into their lower lungs, they can employ diaphragmatic breathing, also known as belly breathing or lower chest breathing.

When someone breathes in, their tummy expands, and when they exhale, it settles in. You can get more information about this kind of breathing from your CF respiratory or physical therapist.

Diaphragmatic breathing

Breathing may be readily controlled and muscular oxygen consumption is minimal when the diaphragm is in good working order. The effort required to breathe increases if the muscles are required to initiate inspiration. Breathing control can be taught to patients by using the diaphragm as best as possible. The goals of controlled breathing techniques are to enhance gas exchange, lessen respiratory effort, raise diaphragm excursion, and boost ventilation efficiency.

Incentive spirometry

The active motion toward maximal inspiration is a component of this strategy. When the patient inhales as deeply as possible, a spirometer that can provide visual or audio feedback is used to measure their breathing.

Glossopharyngeal breathing

This is typically done by raising the patient’s inspiratory capacity in cases where there is a significant weakening of the muscles that permit inspiration. It aids patients who have trouble inhaling deeply before coughing, for example. Given their increased risk of respiratory difficulties, it is important that patients with spinal cord injuries receive this instruction.

Pursed lip breathing

When combined with controlled expiration and gentle lip breathing, this is a helpful technique. By generating back pressure in the airways, it maintains airway openings. Patients with chronic obstructive pulmonary disease (COPD) are observed to use it. In doing so, it raises the tidal volume and lowers the respiratory rate, hence increasing tolerance to increasingly difficult exercises.

Postural drainage

In order to support the natural airway cleaning mechanism, the patient is positioned with the aid of gravity. It is the process by which secretions from one or more lung segments flow into the central airways, from where they can be aspirated out mechanically or coughed out. Manual methods like vibration, percussion, and voluntary coughing are used.

Percussion

Percussion, sometimes referred to as tapotement, clapping, and cupping, is a technique used to transmit kinetic energy to the lungs and chest walls on an intermittent basis. This is accomplished by rhythmically pounding the thorax over the lung segment(s) that are being drained with a cupped hand or mechanical device.

How Long Does CPT Take?

Each treatment session typically lasts 20 to 40 minutes. To reduce the risk of vomiting, CPT is best performed 1.5–2 hours after eating or before meals. Bedtimes and early mornings are often advised. If the patient is becoming sicker or is more congested, the duration and frequency of CPT may need to be extended. Your respiratory therapist or CF physician can advise you on the best postures, CPT frequency, and duration.

Doing CPT Comfortably and Carefully

During CPT, the CF patient and the caregiver should feel at ease. The individual should take off any jewelry, buttons, zippers, or tight clothes from around their neck, chest, and waist before beginning. Wearing light, airy apparel, such as a T-shirt, is OK.

Avoid performing CPT while naked. Watches, bracelets, and other large jewelry should be taken off by the caregiver. Have tissues on hand or a location where you can cough up mucus close by.

When doing drumming, the caregiver should stay upright to safeguard their back, rather than bending forward. The CF patient should lie on a surface that is comfortable for the caregiver to be on.

While using CPT, many families find that using pillows, sofa cushions, or bundles of newspapers under pillows for support is beneficial. Other options include cribs with adjustable mattress heights and tilts, foam wedges, or bean bag chairs. Pillows are not necessary when placing infants in a caregiver’s lap.

Which Equipment is required for CPT?

It may be beneficial to have tools like vibrators, drainage tables, and electrical and nonelectric palm percussion. Stores that sell medical equipment may sell these. When performing their own CPT, older kids and adults might find percussion instruments helpful. Consult your physician or the respiratory therapist at your CF clinic regarding CPT equipment.

Although insurance companies frequently do not cover this type of equipment, find out the benefits of your particular plan by contacting your insurance company. The firms that manufacture these devices occasionally provide support initiatives. For more information, get in touch with the business or go to its website.

Instructions for CPT

The locations for CPT are shown in the following diagrams. The diagrams indicate the appropriate places to vibrate or clap the chest using shaded areas. To refresh your memory:

You can utilize pillows to enhance your comfort. The positions can be changed in sequence if the person gets tired easily, but clapping or percussion should be applied to every part of the chest.

Remind yourself to simply vibrate and clap over the ribcage.

To avoid injuring the left spleen, right liver, and lower back kidneys, refrain from clapping and vibrating across the spine, breastbone, stomach, lower ribs, or back. Never vibrate or clap on exposed skin.

Self-Percussion (Upper Lobes)

Your youngster should clap on the front of the chest, over the muscle that is between the collarbone and the top of the shoulder blade, while sitting up straight. Repeat at the other location. If your youngster can reach it, he or she can also clap their own upper back.

Upper Front Chest (Upper Lobes)

Make sure your kid is sitting up straight. Clap over the muscle region between the collarbone and the upper part of the shoulder blade on both sides of the upper front chest.

Upper Back Chest — Upper Lobes

Sit your child upright and have them lean forward at a thirty-degree angle on a pillow draped over the back of a sofa or soft chair. Clap your child’s upper back on both sides while you stand or sit behind them. Be careful not to stomp on your child’s spinal column.

Upper Front Chest — Upper Lobes

Place your youngster on their back with their arms at their sides. Place yourself behind your kid’s head. Clap the area between your child’s nipple and collarbone on both sides of their chest.

Left Side Front Chest

Your child should raise his or her left arm aloft while lying with their left side up. On the front side of the left chest, place a clap over the lower ribs, slightly below the nipple region. Avoid patting your child’s stomach.

Right Side Front Chest

Assume your child is lying on his or her right side, raising the right arm above the head. Clap your hands over your lower chest on the front side of your right chest, just below your nipple area. Refrain from clapping your child’s lower ribs.

Lower Back Chest (Lower Lobes)

Place your child on their stomach to lie down. Give each other a firm handshake at the base of their chest, a little above the level of their ribs. Refrain from clapping over the backbone or the lower rib cage.

Left Lower Back of Chest (Lower Lobe)

To reach your child’s back, have them roll toward you, quarter turn, while they are lying with their left side up. Give a gentle pat on the lower left side of his or her chest, a little over the ribcage’s bottom line.

Right Lower Side Back (Lower Lobe)

In order for you to reach your child’s back, have them lie with their right side up and roll toward you, quarter turn. Give a gentle tap to the lower right side of his or her chest, somewhat over the lower border of the ribs.

Conditions that Chest Physiotherapy Treats

Patients who are unable to cough up thick localized secretions are usually advised to do so, as demonstrated in the following cases:

• Asthma
• Bronchitis
• Chronic obstructive pulmonary disease
• Bronchiectasis
• Lung abscess
• Atelectasis
• Pneumonia
• Cystic fibrosis
• Emphysema

Contraindications

Generally speaking, the following are taken into account:

• Cardiac arrhythmias, often known as unstable angina, are irregular heartbeats. Heart arrhythmias, or irregular heartbeats, are caused by malfunctioning electrical signals in the heart.
• High blood pressure, pulse, SPO2
• Lung tumors
• Myocardial infarction (heart attack), is a matter of major concern before physiotherapy.
• Bleeding
• Suspected or known active pulmonary tuberculosis
• Head and neck injuries
• Elevated intracranial pressure
• Pulmonary embolism
• Surgical wounds
• Rib fractures
• Uncontrolled hypertension
• Subcutaneous emphysema

Author: Nitesh Dhameliya

Blogger, Content Writer, Physical Therapist