Types of techniques: Airway clearance techniques Facilitating airway clearance technique with effective coughing techniques Technique to facilitate ventilation pattern Mobilization and Exercises Airway clearance technique: Postural drainage Percussion Vibration/shaking Manual hyperinflation Active cycle of breathing technique Autogenic drainage Positive expiratory pressure High frequency chest compression Exercises for airway clearance Indications and cautions: Cystic fibrosis Atelectasis Asthama Respiratpry muscle weakness Bronchiectasis Mechanical ventilation Neonatal respiratory distress syndrome Contraindications: Intracranial pressure (ICP) > 20 mm Hg Head and neck injury until stabilized Active hemorrhage with hemodynamic instability Recent spinal surgery (e.g .• laminectomy) or acute spinal injury Active hemoptysis Empyema Bronchopleural fistula Large pleural effusions Pulmonary embolism Aged, confused, or anxious patients Rib fracture. with or without flail chest Surgical wound or healing tissue

1. By-
Dr. Suman Mandal
BPT (DU)

2. 1. Airway clearance techniques
2. Facilitating airway clearance
technique with effective coughing
techniques
3. Technique to facilitate ventilation
pattern
4. Mobilization and Exercises

3. 1. Postural drainage
2. Percussion
3. Vibration/shaking
4. Manual hyperinflation
5. Active cycle of breathing technique
6. Autogenic drainage
7. Positive expiratory pressure
8. High frequency chest compression
9. Exercises for airway clearance

11. Breathing control
Thoracic expansion
FET
(Forced Expiratory
Technique)

15. 1. Cystic fibrosis
2. Atelectasis
3. Asthama
4. Respiratpry muscle weakness
5. Bronchiectasis
6. Mechanical ventilation
7. Neonatal respiratory distress syndrome

16. 1. Intracranial pressure (ICP) > 20 mm Hg
2. Head and neck injury until stabilized
3. Active hemorrhage with hemodynamic instability
4. Recent spinal surgery (e.g .• laminectomy) or acute spinal
injury
5. Active hemoptysis Empyema
6. Bronchopleural fistula
7. Large pleural effusions
8. Pulmonary embolism
9. Aged, confused, or anxious patients
10. Rib fracture. with or without flail chest
11. Surgical wound or healing tissue

17. Trendelenburg Position is Contraindicated for the
Following: .
1. Patients in whom increased ICP is to be
avoided
2. Uncontrolled hypertension
3. Distended abdomen
4. Esophageal surgery
5. Recent gross hemoptysis related to recent
lung carcinoma
6. Uncontrolled airway at risk for aspiration

18. 1. Subcutaneous cmphysema
2. Recent epidural spinal infusion or spinal
anesthesia
3. Recent skin grafts, or flaps, on the thorax
4. Burns.
5. open wounds. and skin infections of the thorax
Recently placed pacemaker
6. Suspected pulmonary tuberculosis
7. Lung contusion
8. Bronchospasm
9. Osteomyelitis of the ribs
10. Osteoporosis
11. Coagulopathy Complaint of chest-wall pain

19. 1. Motivation
2. Patient’s goals
3. Physician/caregiver’s goals
4. Effectiveness ( of considered technique
5. Patient’s age
6. Ease (of learning and of teaching)
7. Skill of therapist/teachers
8. Fatigue or work required
9. Need for assistants or equipment
10. Limitations of technique based on
disease type and severity
11. Costs (direct and indirect)
12. Desirability of combing methods

25. 1. Body positioning
2. Breathing technique
3. Mobilizing the thorax
4. Facilitating the accessory
muscles of respiration

26. 1. Standing upright position
2. Erect sitting (self supported or with assist) with feet
moving (e.g., active, active assisted or passive cycling
motion)
3. Erect silting (self-supported or with assist) with feet
dependent
4. Lean forward sitting with arms supported and feet
dependent
5. 24S degree sitting with legs dependent
6. Erect long sitting (legs non dependent)
7. < 4S degrees sitting (legs non dependenl)
8. Prone and semi prone/side lying
9. Supine

27. 1. Diaphragmatic breathing pattern
2. Segmental expansion
3. Glossopharyngeal breathing technique
4. Pursed lip breathing

33. 1. Pectoralis Major
2. Sternocleido mastoid
3. Trapezius
4. Serratus anterior

34. 1. To increase ventilation
2. Respiratory muscle weakness

35. What is mobilization.?
Mobilization is defined as the therapeutic and
prescriptive application of low-intensity exercise in
the management of cardiopulmonary dysfunction
usually in acutely ill patients.
Primarily, the goal of mobilization is to exploit the
acute effects of exercise to optimize oxygen transport.
Even a relatively low intensity mobilization stimulus
can impose considerable metabolic demand on the
patient with cardiopulmonary compromise.

36. In addition, mobilization is performed in the
upright position, that is the physiologic position,
whenever possible,
to optimize the effects of being upright on central
and peripheral hemodynamics and fluid shifts.
Thus mobilization is prescribed to elicit both a
gravitational stimulus and an exercise stimulus.

37. What are the exercises given?
Exercise is the term used to describe the therapeutic and
prescriptive application of exercise in the management of
subacute and chronic cardiopulmonary and
cardiovascular dysfunction. Primarily, the goal of exercise
is to exploit the cumulative effects of and adaptation to
long-term exercise and thereby optimize the function of
all steps in the oxy gen transport pathway.

38. It depends on the patient’s condition
Whether the patient is in patient or in out patient department
Also it depends on the functionality of the patient at the present
stage
It is decided on the basis of the exercise testing protocol
Also on the basis of METs

39. Step 1
Identify all the factors underlying the pathology causing deficits
in oxygen supply.
Step 2
Determine whether mobilization and exercise are indicated and
if so, which form of either will specifically address the oxygen
transport deficits identified in Step I.
Step 3
Match the appropriate mobilization or exercise stimulus to
patient's oxygen transport capacity.
Step 4
Set the intensity within therapeutic and safe limits of the
patient's oxygen transport capacity.
Step 5
Combine the various body positions especially in the erect
position with the following maneuvers:

40. Step 6
Set the duration of the mobilization sessions based on the
patient's responses (i.e., changes in measures and indices of
oxygen transport) rather than time.
Step 7
Repeat the mobilization session as often as possible based on its
beneficial effects and on is being safely tolerated by the patient.
Step 8
Increase the intensity of the mobilization stimulus. duration of
the session, or both comml!l1surate with the patient's capacity
to maintain optimal oxygen transport when confronted with an
increased mobilization stressor, and in the absence of distress;
monitored variables to remain within predetermined threshold
range.

41. PREMISE: Position of optimal physiological function is being
upright and moving. Mobilization and Exercise:
1. Body Positioning
2. Breathing Control Maneuvers
3. Coughing Maneuvers
4. To minimize the work of breathing. of the heart. and oxygen
demand overall
5. ROM Exercises (Cardiopulmonary indications)
6. Postural Drainage Positioning
7. Manual Technique
8. Suctioning

42. Thank you