Chest Physical Therapy

Subarna Debbarma (BPT, DNHE)

Chest Physical Therapy or Chest Physiotherapy (CPT)  is tranding topic now a Days read some Highlights 

What is Chest Physiotherapy?

Chest physiotherapy (CPT) is a Airways Clearance  technique  used by a Physical Therapist for  clearing airways of the lungs, to improve secretions.

Chest physical Therapy  done by various ways/methods like - postural drainage, percussion ,vibration/shaking ,etc.


Postural drainage (PD) is accomplished by position- ing the patient so that the position of the lung seg- ment to be drained allows gravity to have its greatest effect. Modified positions are used when a precaution or relative contraindication to the ideal position exists. For example, if an increase in intracranial pressure is a concern, the head of the bed should remain flat instead of being tipped into Trendelenburg (head down) position.

Chest Physical Therapy or Chest Physiotherapy (CPT)

Chest Physical Therapy or Chest Physiotherapy (CPT)

Chest Physical Therapy or Chest Physiotherapy (CPT)

Equipment Required For Postural Drainage

1. For the hospitalized patient, there exists a vari- ety of beds that employ manual or electric de- vices to position the patient. Air therapy beds, most often used in the intensive care unit (ICU), are valuable aids allowing ease of positioning, especially in large or unresponsive patients. 

2. Make use of pillows or bedrolls to support body parts or relieve pressure areas. 

3. For home treatment, aids in positioning might include pillows, a slant board (or ironing board if the patient is small), a foam wedge, sofa cushions, or a bean bag chair.

Preparation for Postural Drainage

1. Nebulized bronchodilators before PD may facilitate the mobilization of sputum.

 2. An adequate intake of fluids (if allowed) decrease the viscosity of the secretions, allowing easier mobilization. 

3. Become familiar with the workings of the

model of bed the patient is occupying, especially the movement of the bed into the Trendelenberg position.

4. In the ICU, it is imperative to be familiar with the multiple lines, leads, and tubes attached to the patient. Allow enough slack from each de- vice to position a patient for postural drainage.

5. Make sure there are enough personnel to posi- tion the patient with as little stress to both patient and staff as possible (Frownfelter, 1987).

6. Have suctioning equipment ready to remove secretions from an artificial airway or the pa- tient's oral or nasal cavity after the treatment.

Treatment with PD

1. After determining the lobe of the lung to be treated, position the patient in the appropriate po- sition, using pillows or bed rolls as needed to sup- port the patient comfortably in the position indicated.

2. If postural drainage is used exclusively, each position should be maintained for 5 to 10 min- utes, if tolerated, or longer when focusing on a


Percussion is performed with the aim of loosening retained secretions from the airways so they may be removed by suctioning or expectoration. A rhythmical force is provided by clapping the caregiver's cupped hands against the thorax over the affected lung seg- ment, trapping air between the patient's thorax and the caregiver's hands . It is performed during both the inspiratory and expiratory phases.

Equipment Required for Percussion

1. The only equipment required for manual percussion is the caregiver's cupped hands to deliver the force to mobilize secretions.

2. For the adult and older pediatric population, electric or pneumatic percussors that mechanically simulate percussion are available. This enables a patient to apply self-percussion more effectively. Several models have variable frequencies of percussion, as well as different levels of intensity.

3. Several devices may be used to provide percus- sion to infants: padded rubber nipples, pediatric anaesthesia masks, padded medicine cups, or the bell end of a stethoscope.

Preparation for Percussion

1. Placing the patient in appropriate PD positions (as the patient's condition allows) enhances the effect of percussion.

2. Place a thin towel or hospital gown over the patient's skin where the percussion is to be ap- plied. The force of percussion over bare skin may be uncomfortable; on the other hand, padding that is too thick absorbs the percussion without benefit to the patient.

3. Adjust the level of the bed so that proper body mechanics may be used during the treatment. Fatigue or injury of the caregiver may be the result of lengthy or numerous treatments if proper body mechanics are ignored.

Treatment With Percussion

1. Position the hand in a cup with the fingers and thumb adducted. It is important to maintain this cupped position with the hands throughout the treatment, while letting the wrists, arms, and shoulders stay relaxed.

2. The sound of percussion should be a hollow sound as opposed to a slapping sound. If erythema occurs with percussion, it is usually a re- sult of slapping or not trapping enough air be- tween the hand and the chest wall (Imle, 1989).

3. An even, steady rhythm will best be tolerated by the patient, and the rate of manual percussion is normally between 100 and 480 times per minute (Imle, 1989).

4. The force applied to the chest wall from each hand should be equal. If the nondominant hand is not able to keep up with the dominant hand, the rate should be slowed to match that of the slower hand. It might also be helpful to start with the nondominant hand and let the domi- nant hand match the nondominant (Frownfelter, 1987). The force does not have to be excessive to be effective; the amount of force should be adapted to the patient's comfort.

5. If the size of an infant does not allow use of a full hand, percussion may be done manually with four fingers cupped, three fingers with the middle finger "tented," or the thenar and hypothenar surfaces of the hand (Crane, 1990).

6. Hand position should be such that percussion does not occur over bony prominences. The spinous processes of the vertebrae, the spine of the scapula, and the clavicle should all be avoided. Percussion over the floating ribs should also be avoided, since these ribs have only a single attachment.

7. Percussion should not be performed over breast tissue. This would produce discomfort and di- minish the effectiveness of the treatment. In the case of very large breasts, it may be necessary to move the breast out of the way with one hand and percuss with the other hand.

8. A patient may be taught to perform one-handed self-percussion to those areas that can be reached comfortably, either manually or with a mechanical percussor. This does however, virtually preclude the treatment of the posterior lung segments.


The techniques of vibration and shaking are on opposite ends of a spectrum. Vibration involves a gentle, high frequency force, whereas shaking is more vigorous in nature. Vibration and shaking are performed with the aim of moving secretions from the lung periphery to the larger airways where they may be suc- tioned or expectorated. Vibration is performed by co- contracting all the muscles in the caregiver's upper extremities to cause a vibration while applying pressure to the chest wall with the hands. Shaking is a stronger bouncing maneuver, which also supplies a concurrent, compressive force to the chest wall.

Like percussion, vibration and shaking are used in conjunction with PD positioning. Unlike percussion, they are performed only during the expiratory phase of breathing, starting with peak inspiration and con- tinuing until the end of expiration. The compressive forces follow the movement of the chest wall.

Equipment Required for Vibration/Shaking

1. For manual techniques, the only equipment re- quired is the caregiver's hands.

2. Mechanical vibrators are available to administer the treatment and are useful for self-treatment by a patient or to reduce fatigue in the caregiver.

3. For infants, a padded electric toothbrush is an alternative (Crane, 1990).

Treatment with Vibration/Shaking

1. Conventional chest physical therapy is often referred to as a combination of postural drainage and percussion, vibration, or shaking.

2. For shaking, with the patient in the appropriate PD position, place your hands over the lobe of the lung to be treated and instruct the patient to take in a deep breath. At the peak of inspiration, apply a slow (approximately 2 times per second), rhythmic bouncing pressure to the chest wall until the end of expiration. The hands follow the movement of the chest as the air is ex-haled.

3. For vibration, the hands may be placed side by side or on top of one another . As with shaking, the pa- tient is instructed to take in a deep breath while in a proper PD position. A gentle but steady co- contraction of the upper extremities is performed to vibrate the chest wall, beginning at the peak of inspiration and following the movement of chest deflation.

4. If the patient is mechanically ventilated, the previously described techniques must be timed with ventilator controlled exhalation.

5. If the patient has a rapid respiratory rate, either voluntary or ventilator controlled, it may be necessary to apply vibration or shaking only during every other exhalation.

 6. The frequency of manual vibration is between 12 and 20 Hz, shaking is 2 Hz (Gormezano, 1972; Bateman, 1981).

7. A mobile chest wall is necessary to apply a compressive force without causing discomfort. If a patient has limited chest wall movement, vibration will probably be tolerated better than shaking.

8. Mechanical vibrators may be used by patients themselves, realizing that limited attention can be paid to the posterior portions of the lungs.

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