Chest physiotherapy, also known as respiratory physio, is done specificly to improve breathing by

• direct removal using suctioning
• indirect removal of fluids such as phlegm and muscus by targeted percussions, positioning

Chest physiotherapy are often done in hospitals, nursing homes as well as home physiotherapy, as these patients tends to be more sedentary, bed/home bound, with less energy to travel to clinics for their physiotherapy sessions.

Some chest / respiratory methods:

Clapping (percussion) therapy

After listening to the chest using a stethoscope, the physiotherapy may do percussion therapy. They cup their hands, and lightly but firmly percuss the patient’s

• chest (upper, middle and lower)
• back
• under arms

This is done with them facing down, facing up and even side lying.

Chest flutter (vibrations/vibratory) therapy

The physio will place their hands, palm down onto the patients chest and lungs, and apply an oscillating pressure over the back and front to loosen any mucus or phlegm.

Specific controlled breathing exercises

• Deep breathing exercises (DBE)
• Regulated exhalation exhalation (REE)

often with use of an incentive spirometer to gauge and measure lung volume. This lung volume exerciser that patients can consider as well.

Suctioning using a machine and tube

These are done for patients who cannot swallow effectively, causing them to have retained or excessive lower respiratory tract secretions. Can be done to patients with or without tracheostomy (even on babies if necessary). The ones that are used in clinics and hospitals are the machine ones, but there are hand-powered suctioning for mild / light cases. Sometimes we use a nebulizer first to loosen thick secretions to make it easier for suctioning.

Postural drainage

This is one of the key “passive” techniques that we teach and advise patient, because it can make a significant baseline help just by resting (be it sitting or lying down), in the most optimal way for your lungs to clear secretions…using the power of gravity, which works 24/7. Patients can do this with

• electric beds (more affordable alternative to electric hospital beds are the manual height adjustable beds with add on side railings)
• firm pillows with normal beds
• adjustable bed wedges

that are strategically positioned to improve lung recovery and function

Prescribe and supervise general cardiovascular exercises

Nothing is better than getting up and moving about, for those who are well and strong enough to do so. For these patients, we will assess first to determine strength, stamina, safety and stability before prescribing general exercises which will help to improve the patient’s well being, strength, stamina…which will overall improve their lung strength and function too. Some home exercise tools:

• hand cycle which are placed on tables and needs to be secured with weights so they dont move around when you do the exercise
• leg cycle which can be placed under beds or chairs when not in use, and when needed, just slide out to use
• treadmill or elliptical
• rowing machine
• seated stationary bicycle
• leg and hip strengthening press