Chest physiotherapy (CPT) is a means of clearing the lungs of accumulated mucus. It uses gravity and physical therapy to help move the secretions out of the lungs and stimulate coughing. It is used for persons with increased amounts of mucus or thick secretions, those with weak breathing muscles, or individuals with ineffective coughs. CPT consists of clapping, vibration, deep breathing, and coughing.
Clapping With the Cupped Hand Clapping with the cupped hand on the chest wall over the section of the lungs to be drained starts vibrations which are transmitted to the air passages (bronchi), stimulating the movement of secretions. These vibrations may help to remove secretions sticking to the walls of the air passages.
The hand is cupped by holding the fingers together so that the shape of the cupped hand conforms with the chest wall. The cupped hand tends to trap a cushion of air which softens the blow of the clapping. Clapping should be vigorous but not painful. Clapping should not be done on bare skin, but over soft comfortable clothing or towels. Rings should be removed before clapping. Ribs are strong and flexible but can be broken by a blow with the hand. The cupping technique cushions the blow of the hand during clapping by trapping air between the hand and chest wall.
Vibration Vibration is more difficult than clapping, but is valuable because it helps stimulate the flow of secretions. The assistant presses flattened hand firmly over the proper section of the child's chest wall, then tenses his upper arm and shoulder muscles (isometric contractions). At the same time, the child should make an "fff" or "sss" sound as he exhales as slowly and completely as possible.
Deep Breathing Deep breathing assists in the movement of secretions and may stimulate coughing. With inhalation (breathing in), the airways widen and lengthen; with exhalation (breathing out), the airways narrow and shorten. A forced but not strained exhalation following a deep inhalation may move secretions and may stimulate a productive cough. An effective cough is an essential part of clearing the airways.
Cough An adequate cough is an essential part of the chest physiotherapy program. The ability to cough effectively is the major defense against retaining mucus in the lungs. An effective cough is accomplished by taking two or three deep breaths, exhaling slowly, followed by a deep intake of breath and a deep cough. This should be done at least two times, or more as necessary, following chest physiotherapy. To minimize the chance of vomiting, chest physiotherapy is best done before meals or no sooner than one hour after eating. Early morning and bedtime are usually recommended. CPT exercises before bedtime help clear airways of accumulated secretions and may reduce nighttime coughing.
Mechanical Percussors/Vibrators Various mechanical percussors and vibrators are available commercially, but your physician should be consulted before any purchase is made.
CPT Do's and Dont's The chest should be protected by one layer of clothing or by a towel. This prevents irritation caused by clapping the bare chest with the hand. Clap over each area shown in the illustrations for one minute with a cupped hand.
Vibrate over each area following CPT five times while child is exhaling.
CPT is to be done prior to meals or no sooner than one hour following meals, to prevent vomiting. Do not clap over any bony portions of the chest, for example, the breastbone or the spine. Never clap below the bottom of the rib cage. Encourage the child to cough following CPT.
Upper Lobes Child is in sitting position. Clap over upper shoulder and blade on each side of the back.
Child lies flat on back. Clap just below collar bone on each side of chest.
Middle Lobes Child lies head down, on his side and rotates 1/4 turn backward. A pillow may be placed behind child for support. Clap over the nipple on each side.
Lower Lobes Child lies head-down, on his side. Clap on lower part of chest toward the front, and upper part of chest on the back. Since these two positions are done at the same time, allow longer time for clapping (2-3 minutes).
Child lies on abdomen in a head-down position. Clap on lower back on each side of spine.