Manual techniques apply external forces against the chest wall to facilitate airway clearance when a patient is in a modified or traditional gravity assisted drainage position.

These techniques include:

  • Chest Percussion
  • Vibrations

Percussion and Vibrations are techniques to help patient’s clear mucus build up. It applies forces within the chest to aid the patient’s own secretion clearance mechanisms. It can be provided short term by your therapist. If there is a long term need it will be taught to a carer.

Items required to perform this technique include a towel and possibly bed and pillows.

Physiotherapy aims to allow patients to self-manage their condition. However sometimes very thick secretions, weakness, or patient inability to cooperate means a manual technique can be used to assist. Percussion and Vibrations combined with other physiotherapy techniques helps to move secretions to where they can easily be coughed and cleared. Allowing air to reenter areas of lung tissue previously blocked by mucus further re-opening the lungs.

Percussion

Chest Percussion is one of the intervention for airway clearance which augments the mobilisation of secretions in one or more lung segments to the central airways by placing the patient in various positions so gravity assists in the drainage process. Chest percussion is usually used in combination with active cycle breathing techniques, or coupled with positioning in those who are unable to actively participate in active controlled breathing exercises.

Technique

  • Patient should be in a comfortable or painless position.
  • Chest percussion is performed with cupped hands which strike’s the patient chest wall in an alternating rhythmic manner over the lung segments being drained.
  • The technique is applied over a towel to ensure it does not feel uncomfortable.
  • Therapist should try to keep shoulders, elbows and wrist loose and mobile during the manoeuvre.

Duration: Several minutes, which may vary from 5 to 15 minutes depending on the condition of the patient, secretions are cleared using forced expiratory technique and a cough. Alternatively, therapist continues until the patient needs to alter the position to cough.

Benefits of Percussion

Percussion is used to help clear secretions which will significantly decrease the risk of developing a chest infection. Percussion also has a number of other benefits:

  • Can be used in combination with other respiratory physiotherapy techniques
  • Can be applied with the patient in a number of suitable positions
  • Effective in increasing lung volumes
  • Can provide relief to patients who are acutely breathless
  • In some cases, can be used with no active input from the patient

Vibrations

Vibrations are a manual technique used by respiratory physiotherapists to help clear secretions (phlegm) from the chest. The technique tends to be applied on expiration (breathing out), and involves the physiotherapist using both hands to vibrate the lower chest wall in order to loosen secretions and allow them to be coughed out. Vibrations can be applied to both lungs or just one lung.

Assessment will enable your respiratory physiotherapist to deliver the technique most effectively; auscultation (listening to your chest) will be particularly useful in deciding the location and duration for which to deliver the technique.

Technique

Assessment will enable your respiratory physiotherapist to deliver the technique most effectively; auscultation (listening to your chest) will be particularly useful in deciding the location and duration for which to deliver the technique.

  • Patient should be in a comfortable or painless position.
  • During vibration, physiotherapists will place a flat hand firmly against the patient’s chest wall, on top of the appropriate lung segment to be drained.
  • They then stiffen their arm and shoulder, apply light pressure and create a shaking movement, similar to that of a mechanical vibrating device.
  • The patient will be instructed to breathe in deeply during vibration therapy, and exhale slowly and completely. Taking a deep breath and then exhaling slowly and forcefully without straining will help stimulate a productive cough.

Benefits of Vibrations

  • Effective way of clearing secretions, which reduces the risk of developing a chest infection.
  • Can be used in a variety of positions – not limited to in sitting
  • Can require little active input from the patient if necessary
  • Modified technique can be taught and applied by the patient on their own chest at home
  • Can be used in combination with other secretion clearance techniques including autogenic drainage, postural drainage and positioning to gain more effect.
  • Vibrations should not be uncomfortable as any discomfort will inhibit expiration and air flow.

Percussion and vibrations are often beneficial manual techniques to help in the removal of secretions in a number of respiratory conditions, these include:

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