Physiotherapy for airway clearance in adults.
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Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults. Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet, Flutter, positive expiratory pressure mask, high-frequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders. The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient. (+info)
Percussion--a new way to diagnose a pneumothorax.
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We describe a new clinical sign in a case series of three patients who developed pneumothoraces during mechanical ventilation in the intensive care unit. All three patients were in the supine position. Two patients had x-rays that were inconclusive before insertion of chest drains and the third had a pneumothorax diagnosed on clinical findings alone. On each occasion we were able to diagnose pneumothorax using sternal percussion and simultaneous auscultation. The method relies on percussion of the sternum while simultaneously ausculating the anterior (superior) chest on the side of the suspected pneumothorax. The stethoscope is then placed on the other side of the chest. The percussion sound on the affected side has an exaggerated, resonant and booming quality. The percussion note is exaggerated partly because a stethoscope is used and partly because, in the supine patient, air localizes upwards to the anterior thorax. (+info)
Influence on myoelectric discharges of anteroposterior displacement of the mandibular position near the tapping point.
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The purpose of this study was to examine the influence that the anteroposterior mandibular displacement near the tapping point exerts on the myoelectric activity of masseter and temporal muscles at a specific occluding force and to clarify the possibility of judging the mandibular position by measuring the amount of myoelectric discharge. Eight dentulous subjects were selected for the study. Surface electrodes were placed over the anterior, middle and posterior regions of the masseter muscle and over the anterior, middle and posterior bundles of the temporal muscle. Independently of the measurement region, the changes in the masseter and temporal muscle myoelectric activity which accompanied the anteroposterior mandibular displacement, were low. Moreover, when the mandible was displaced anteroposteriorly, the total amount of the myoelectrical discharge from all the recorded places, as well as the amounts of myoelectrical discharge over the middle part of the masseter muscle and the anterior bundle of the temporal muscle reached their lowest values in those mandibular positions which included the tapping point in less than half of the subjects. Therefore, this study indicates that the possibility of judging anteroposterior mandibular displacement by masseter and temporal muscle electromyography is quite low. (+info)
A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients.
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INTRODUCTION: Cystic fibrosis (CF) patients have abnormally viscid bronchial secretions that cause airway obstruction, inflammation, and infection that leads to lung damage. To enhance airway clearance and reduce airway obstruction, daily bronchopulmonary hygiene therapy is considered essential. OBJECTIVE: Compare the effectiveness of and patient preferences regarding 3 airway clearance methods: postural drainage and percussion (PD&P), intrapulmonary percussive ventilation (IPV), and high-frequency chest wall compression (HFCWC). METHODS: The participants were hospitalized CF patients >or= 12 years old. Effectiveness was evaluated by measuring the wet and dry weights of sputum obtained with each method. In random order, each patient received 2 consecutive days of each therapy, delivered 3 times daily for 30 minutes. Sputum was collected during and for 15 minutes after each treatment, weighed wet, then dried and weighed again. Participants rated their preferences using a Likert-type scale. Mean weights and preferences were compared using analysis of variance with repeated measures. Patient preferences were compared using Freidman's test. RESULTS: Twenty-four patients were studied. The mean +/- SD wet sputum weights were 5.53 +/- 5.69 g with PD&P, 6.84 +/- 5.41 g with IPV, and 4.77 +/- 3.29 g with HFCWC. The mean wet sputum weights differed significantly (p = 0.035). Wet sputum weights from IPV were significantly greater than those from HFCWC (p < 0.05). The mean dry sputum weights were not significantly different. With regard to overall preference and to the subcomponents of preference, none of the 3 methods was preferred over the others. CONCLUSIONS: HFCWC and IPV are at least as effective as vigorous, professionally administered PD&P for hospitalized CF patients, and the 3 modalities were equally acceptable to them. A hospitalized CF patient should try each therapy and choose his or her preferred modality. (+info)
Chest physiotherapy in pediatric practice.
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Chest physiotherapy (CPT) in children is generally considered as a separate and specialized treatment modality that should be rendered only by a physiotherapist. Actually this is not difficult if one has a proper understanding of the basic concept and principle behind the maneuver. This article aims at making CPT simple, so that it could be incorporated in routine pediatric practice for managing respiratory ailments. (+info)
Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: a randomized controlled trial [ISRCTN17802078].
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INTRODUCTION: We hypothesized that the use of intrapulmonary percussive ventilation (IPV), a technique designed to improve mucus clearance, could prove effective in avoiding further deterioration in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) with mild respiratory acidosis. METHODS: The study was performed in a medical intensive care unit of a university hospital. Thirty-three patients with exacerbations of COPD with a respiratory frequency >or= 25/min, a PaCO2 > 45 Torr and 7.35 +info)
Ankylosis of traumatized permanent incisors: pathogenesis and current approaches to diagnosis and management.
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Ankylosis is a known complication of replanted or severely intruded permanent incisors and can be diagnosed by the characteristic sound emitted when the tooth is tapped. The ankylosed incisor demonstrates a lack of physiologic mobility and, later, radiographic evidence of replacement resorption. If the patient is pre-adolescent or adolescent at the time of trauma, infraocclusion relative to adjacent teeth will become apparent during jaw growth. Despite considerable knowledge about the pathogenesis of ankylosis garnered from animal studies and observation of human replanted teeth, there is no known treatment to arrest this condition. Management techniques and rehabilitation options for addressing ankylosis and its consequences are supported by little evidence, do not appear to be widely adopted and do not offer any proven long-term benefit. Avulsion and severe intrusion of permanent incisors are rare injuries. Should the decision be made to intervene by replantation or reduction of the intrusion, the clinician must be prepared to diagnose ankylosis, identify its negative consequences and develop treatment plans accordingly. (+info)
Physiological effects of vibration in subjects with cystic fibrosis.
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The physiological mechanisms by which vibration and other physiotherapy interventions may clear secretions in subjects with cystic fibrosis are unknown. The main aim of this study was to compare the expiratory flow rates and frequencies of airflow oscillation of vibration to those of Acapella(R), Flutter(R), positive expiratory pressure and percussion. Respiratory flow rates were measured during interventions, the order of which was randomised. The oscillation of the airflow of the interventions was determined by frequency spectral analysis. In 18 young adult subjects with cystic fibrosis, the mean peak expiratory flow rate of vibration was greater than Flutter(R), percussion, Acapella(R) and positive expiratory pressure. The mean+/-sd of the oscillation of the airflow of vibration (8.4+/-0.4 Hz) was lower than Acapella(R) (13.5+/-1.7 Hz) and Flutter(R) (11.3+/-1.5 Hz) but similar to percussion (7.3+/-0.3 Hz). Theoretically, the higher peak expiratory flow rate of vibration compared to the other physiotherapy interventions may promote secretion clearance. In addition, the frequency of oscillation of vibration was within the range demonstrated to increase mucus transport. This study has provided some evidence for the physiological rationale for the use of vibration to aid secretion clearance. (+info)