Neurophysiological Falicitation of Respiration.pptx

Respiratory Neurophysiological facilitation

1. NEUROPHYSIOLOGICAL FALCILITATION OF RESPIRATION -Dr. Sheetal Bankar (Cardiovascular & Respiratory PT)

2. Contents Introduction Techniques Indications & Contraindications Summary References

3. Introduction Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition. NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing.

4. Visible deeper respirations - larger expansion of the ribs and increased epigastric excursion; Increased visible and often palpable tone in abdominal muscles; Change in respiratory rate (usually slower); Involuntary coughing; more normal respiratory pattern; rapid return of mechanical stability; Changes in bream sounds on auscultation; Retention of improved respiratory pattern after the treatment period Apparent increase in the level of consciousness (Bethune 1976). Application of these procedures results in:

5. Techniques There are six techniques used in the NPF Perioral pressure Intercostal stretch Anterior stretch basal lift Thoracic vertebral pressure Moderate manual pressure Co-contraction of abdomen.

6. 1. Perioral Pressure: Method : Pressure is applied to the patient's top lip by the therapist's finger and maintained. Observation : • Increased epigastric excursion • Deep breathing • Sighing • Mouth closure • Swallowing • Snout phenomena Mechanism : Primitive reflex response related to sucking

7. 2. Intercostal Stretch: Method : A pply pressure to the upper border of a rib in order to stretch the intercostal muscle in a downward(not inward) direction on expiratory phase maintained. Observation : Increased movement of area being stretched. Mechanism : Intercostal stretch receptors.

8. 3. Anterior Stretch Basal Lift: Method : A pplied by placing the hands under the posterior ribs of the supine patient and lifting gently upwards. Observation : • Expansion posterior basal area. • Increased epigastric movements. Mechanism : • Dorsal-root-mediated intersegmental reflex. • Stretch receptors in intercostals in back muscles Fig: Basal Lift

9. 4. Thoracic Vertebral Pressure Vertebral pressure – High : Manual pressure to thoracic vertebrae in region of T2 –T6 . Observation : • Increased epigastric excursions. • 'Deep breathing’. Vertebral pressure – Low : Manual pressure to thoracic vertebrae in region of T9-T1. Observation : Increased respiratory movements of apical thorax. Mechanism : Dorsal-root-mediated intersegmental reflex.

10. 5. Moderate Manual Pressure Method : Mild pressure of the open hand(s) is maintained over the area in which expansion is desired. Observation : Gradually increased movement of the rib under the area of pressure. Mechanism : Cutaneous afferents. Fig: Moderate Manual Pressure

11. 6. Co-Contraction of Abdomen Method : • Pressure laterally over lower ribs and pelvis. • Alternate right and left sides. Observation : • Increased epigastric movements. • Increased muscle contraction (rectus abdominus). • Decreased girth in obese. • Increased firmness to palpation. • Depression of umbilicus. Mechanism : Stretch receptors in abdominal muscles? intercostal to phrenic reflex.

12. Indications: Neurologically impaired adult patients who are hypoventilating or have retained secretions (impaired tracheobronchial clearance, reduced lung volumes). Used to alter the respiratory patterns and relieve the symptoms of hyperventilation syndrome (control of breathing) . Unconscious and non-alert patients. NPF is a useful technique to improve short term ventilation with lower consciousness.

13. Contraindications: Children under the age of 7 years because of differences in the anatomy, physiology and neurology of respiration. Patients with hyperinflated lungs . Rib and sternum fractures. Respiratory failure. Floating ribs. Sensitive mammary tissue in female patients .

14. Reference: Physiotherapy for cardiac and respiratory problems, jennifer A. Pryor, S. Ammani prasad, third edition.

15. Thank You.