Thursday, January 24, 2008

Postural Drainage and Chest Physiotherapy

From mist tents to vibrating air-filled vests, the world of airway clearance therapy for cystic fibrosis patients has undergone many changes over the last few decades. Their underlying goal is the same: stimulate the lungs to move as much sticky mucus out of the airways as possible. Patients with cystic fibrosis who are old enough to remember the “olden days” of chest physiotherapy (CPT) are excited about the latest advancements, but wish they had come so much sooner. Some respiratory therapists and CF patients themselves, still insist on utilizing the more archaic therapies, mostly because of familiarity and routine. Newer medical technology is of course, expensive, and the high cost of obtaining certain airway clearance devices poses a distinct barrier to patients in need. This next few articles outline the various types of mainstream CPT methods over the years.

Postural Drainage and CPT

Also called bronchial drainage, this refers to the positions that use of gravity to aid in the mucus clearance. In order to be effective, the head must be lower than the chest. This allows the mucus to flow toward the trachea, where it can be more easily coughed out. Different postures are useful for targeting different regions in the lungs. These 6 positions are to be used in a systematic manner, working from the upper to the lower lobes. There are a total of 9 regions that can be drained in this manner. Achieving the correct positions can be done using a tilt table, a positional hospital bed, or pillows.

Postural drainage is most effective when combined with chest percussions and vibrations. This is called CPT. It has also been called “clapping” or “thumping.” In years past, the caregiver administering CPT did so by cupping his or her hand, and beating on patient’s back in each of the regions of the lungs. Its effectiveness was almost solely determined by technique. Improper cupping of the hand produced only a slapping sensation, painful to both patient and caregiver. Also, as fatigue set in, the steady, rhythmic pounding would slow down and lose intensity.

To ensure a more uniform cupping, a small rubber device was developed that could be easily gripped by the caregiver. The device looked like the paddles used for air hockey, but had a hollowed out bottom which functioned in the same manner as cupping the hands.

The “clapping method” of CPT, is no longer in widespread use for adults having CF. Certain aspects of postural drainage, however, are still useful for infants. Instead of clapping, however, the caregiver instead taps with two fingers on the different lung regions, while holding the child in the different postural drainage positions.

In place of clapping, which as mentioned before was sometimes fatiguing, a motorized massage/percussion tool is used. Respiratory therapists in hospitals use a professional model, such as the GK3 Postural Drainage and Percussion Massagers (see image below).

The product, which looks quite similar to a car buffer, is available for home use, but costs anywhere from $1,300 to $1700.

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