Chest Physiotherapy services are offered at this practice.
Chest physiotherapy can be beneficial when the pulmonary function is compromised due to infection, damage to the lungs, or prolonged periods of being bedridden and the patient is unable to expectorate his/her phlegm effectively or if a patient is unable to take deep enough effective breaths. Chest physio comprises of many different techniques and is tailored to a patient’s needs. A patient with a history of smoking may have hyperinflation of the lungs and may benefit from expiratory breathing exercises. A baby with a chest infection may still be a predominant nose breather and may struggle to aerate the lungs effectively if its nose is blocked and may need gentle suctioning of the nasal passage or a cough may have to be ellicted by a physio and the secretions removed orally.
The need for chest physiotherapy is generally assessed by the physiotherapist using auscultation (listening) to the chest via a stethoscope, assessment of expansion of the chest and breathing pattern. Diagnostic (finger) percussion may also be used.
Based on the assessment the physiotherapist will decide which technique is best suited to you. Patients may be nebulised with plain saline or a prescription ampule from your medical doctor (such as duovent or pulmicort or a bisolven/saline or mistabron mixture). The physiotherapist will most likely ask you to bring in your own presciption as physiotherapists are not registered to stock medication or to prescribe bronchodilators yet. The physiotherapist may then perform postural drainage, where the patient is positioned in order for secretions to be assisted by gravity to drain from the chest. The position will depend on the particular lobe of the lung that is infiltrated by secretions.
Various manual chest drainage techniques may be performed. These may include percussions (often abbreviated as ‘perc’), where the practitioner cups her hands and gently taps the chest at an amplitude and frequency depending on her objective and on the patient history, chest vibrations (abbreviated as ‘vibs’), which can be done either manually or via an electrical device called a vibromat, chest shaking (most often used in combination with expiratory breathing exercises), or assisted breathing. The latter can take many shapes and forms. The ‘Active Cycle of Breathing Therapy’, (ACBT) is a technique/’therapy’ that is based on the principle that small breaths actually moves secretions from the periphery of the lung, and deeper breaths move phlegm closer to the main airways. Therefore ‘deep’ breaths are sometimes seen as ‘shallow’ breaths. During the ACBT breathing exercises is interspersed with resting periods in order to avoid bronchospasm (where the airways contract and become ‘tight’ and narrows the air flow) which may aggravate shortness of breath and result in ineffective coughing spasms.
You may discuss any questions you have relating to your nebulizer, or humidifiers, or even regarding nasal irrigation and different devices to assist with breathing such as a PEEP machine with your physiotherapist . Your physio should be able to provide you with a whole range of breathing exercises suited to your needs. An asthmatic patient or someone who suffers from emphysema may need to concentrate more on expiratory breathing exerecises for example, whereas someone with atelectasis of the lung would need more inspiratory breath holds.
It is important to continue with your pulmonary rehabilitation up to a point where you are as functional as possible. Respiratory rehab is very different from main stream physical rehab in that it involves knowing how to pace yourself so as to not over exert yourself, whilst still increasing your exercise capacity. If your physio has access to a lung function machine this may assist in monitoring your improvement, but other tests such as your peakflow or the six minute walking test may also be helpful.