What is Chest Physical Therapy?
Chest Physical Therapy consists of physical techniques (percussion, vibration) performed to the chest wall to loosen and remove bronchial mucus secretions and to open bronchial airways.
Postural Drainage is a technique that places the patient in various positions to allow gravity to assist in mucus drainage. The lungs are divided into lobes and the lobes are further divided into lung segments. Each segment has a main bronchial airway leading to the small airways in that segment. Each postural drainage position corresponds to a segmental bronchial airway, and places that airway pointed downward toward the floor. This allows gravity to pull mucus downward and out of that segmental bronchial airway. The weight of the lung also pulls on the upper-most bronchial airways, pulling them more opened, which helps to increase the ventilation of air and mucus movement with in that lung segment.
Percussion is a technique used while the patient is in each postural drainage position. We can further assist mucus drainage outward by percussing on the chest wall with cupped hands, in a rhythmical manner.
Some people call this chest clapping. It is important to keep the hand cupped so that a cushion of air forms between the hand and the chest. This keeps the hand from slapping on the chest and causing pain. Although proper percussion takes some practice, it allows us to apply a very vigorous force concentrated on one area of the chest wall to loosen mucus and open bronchial airways. It is best for the patient to wear a good quality cotton T-shirt for percussion. If more padding is needed (especially initially) a sweatshirt can be worn. In time the patient is usually able to tolerate more vigorous percussion than during the first few weeks. We usually perform percussion for at least two minutes in each of the postural drainage positions.
Vibration of the chest is performed just after percussion. This is done after the patient takes in a deep breath and holds it for one or two seconds. The therapist places hands on the chest where the percussion was performed. Then as the patient breathes out through pursed lips making an “fffffffffffff” sound the therapist tightens all the muscles of the arms and shoulders so that they vibrate and this force is thus imparted through the hands to the chest. It is actually difficult to vibrate effectively, takes a fair amount of effort and the therapist may feel that not much is occurring. But the patient will feel the vibration and can provide feedback to an inexperienced therapist to obtain optimal performance of this technique. Generally about five deep breaths are taken and vibration is performed on each of the five exhalations.
Then the patient is asked to sit up and Cough out any loosened mucus. This may be initiated with a huff cough. If there seems to be a great deal of mucus from any one postural drainage position we advise that percussion be performed in that position again, until the cough sounds clear, if possible. After clearing a segmental bronchial airway, we go on to the next postural drainage position until all eleven are completed.