Postural Dranage Physiotherapy

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1. Postural drainage Rahul AP. BPT,MPT , MIAP (CRD&ICU Management ) Assi Proff : LIAHS – Kannur,Kerala

2. Definitions PD or bronchial drainage is a means of mobilizing secretions in one or more lung segments to the central airways by placing the patients in various positions so that the gravity assist in the drainage process It include the manual techniques such as percussion, shaking, vibration and voluntary coughing

3. When secretions are moved to the larger airways, they are then cleared by coughing or Endotracheal suctioning. 

4. Positions Positions are based on the anatomy of the lungs and the tracheobronchial tree. The patient may be positioned on a Postural drainage table that can be elevated at one end eg;Tilt table A small child can be positioned on the physio’s lap.

5. Bronchopulmonary segments

6. Goals To Prevent accumulation of secretions in patients who are at risk for pulmonary complications This may include: Patients with pulmonary diseases that are associated with increased production or viscosity of mucus, such as chronic bronchitis and cystic fibrosis. Patients who are on prolonged bed rest.

7. Post surgical patients who have received general anesthesia and who may have painful incisions that restrict deep breathing and coughing postoperatively. Any patient who is on a ventilator if they are stable enough to tolerate the treatment.

8. To Remove secretions already accumulated in the lungs of Patients with acute or chronic lung disease, such as pneumonia, Atelectasis , acute lung infections, and COPD. Patients who are generally very weak or are elderly.

9. INDICATIONS Cystic fibrosis Bronchiectasis Atelectasis Lung abscess Pneumonias Acute lung disease COPD –emphysema, chronic bronchitis For patients with a high spinal cord lesion/ spinal cord injury, myopathies etc. After surgeries (thoracic or abdominal surgery)

10. On prolonged bed rest Patient received general anesthesia and have painful incision that restrict deep breathing and coughing postoperatively Who is on ventilator (if stable enough to tolerate PD) Patient who is generally weak or old

11. CONTRAINDICATIONS Increased ICP Unstable head or neck injury Active hemorrhage Hemoptysis Recent spinal injury Empyema Bronchoplueral fistula Flail chest Uncontrolled hypertension Rib or vertebral fractures Tuberculosis

12. Pulmonary embolism. aged, confused, or anxious patients who don't tolerate position changes

13. PREPARATIONS Loosen the dress Sputum cup Pillows Explain the Rx and teach the patient deep breathing and cough

14. PROCEDURE Determine segments Vital signs Position the patient Stand in front of pt Maintain position Apply manual techniques Do coughing or suctioning

15. MANUAL TECHNIQUES

16. Percussion This is used to mobilize secretions by mechanically dislodging viscous or adherent mucus from the lungs It is done by the cupped hand over the lung segments being drained Here the PTs cupped hand alternatively strikes the patients chest wall in a rhythmic fashion to help loosen thick secretions The PT should try to keep his shoulder elbow and wrist loose and mobile during the maneuver The procedure should not be painful

17. Chest Percussion

18. To prevent irritation patient wear a light gown or shirt Contraindication to percussion Over # Osteoporotic bone Spinal fusion Over tumor area Pulmonary embolus Condition in which hemorrhage could easily occur (low platelet count ,anticoagulation therapy) Patient with unstable angina Case of chest wall pain (after any surgery CABG or trauma

19. Vibration This is done in conjunction with percussion It is applied only during expiration It is applied by placing both hands directly over the chest wall or one hand on top of other and gently compressing The therapist stiffen his arm and shoulder and apply light pressure and rapidly vibrating the chest wall as the patient breaths out

20. The vibrating action is achieved by the PT isometrically contracting the muscles of the upper extremity from shoulder to hand Ask the patient to breathe in deeply and exhale slowly and completely. Taking a deep breath and then exhaling slowly and forcefully without straining will hopefully stimulate a productive cough

21. Shaking It is a more vigorous form of vibration which is applied during exhalation using an intermittent bouncing maneuver coupled with wide movements of the PTs hand The PTs thumb are locked together the open hands are placed directly over the patients chest the fingers are wrapped around the chest wall The PT simultaneously compress and shake the chest wall

22. SEGMENTS

23. UPPER LOBE - Apical Segments To drain mucus from the upper lobe apical segments, the patient sits in a comfortable position on a bed or flat surface and leans on a back rest. The PT percusses and vibrates over the muscular area between the collar bone and very top of the shoulder blades on both sides for 3 to 5 minutes. Encourage the patient to take a deep breath and cough during percussion in order to help the airways clearance

24. UPPER LOBE - Apical Segments

25. Posterior Segments (right) The patient lie on his left side and then turn 45º on to his face , resting against a pillow with an another pillow supporting his head The left arm should kept comfortably behind his back with right arm resting on a pillow, the right knee should be flexed

26. Posterior Segments (right)

27. Posterior Segments (left) The patient lie on his right side and then turn 45º on to his face with 3 pillows to raise the shoulder 30cm (12 in) from the bed. The right arm should kept comfortably behind his back with left arm resting on a pillow, both knee should be slightly flexed

28. Posterior Segments (left)

29. Upper lobe-anterior Segments The patient lies flat on the bed or table with a pillow under his head and legs and arms relaxed by his side. The chest PT is given to right and left sides of the front of the chest, between the collar bone and nipple.

30. Upper lobe-anterior Segments

31. Middle lobe (lateral and medial segment) Patient lie on his back with his body quarter turned to the left maintain by a pillow under right side from shoulder to hip Arm should relaxed by his side Foot of the bed should be raised 35cm (14in) from the ground Chest is tilted to an angle of 15º

32. Middle lobe (lateral and medial segment)

33. Lingula (superior and inferior segment) Patient lie on his back with his body quarter turned to the right maintain by a pillow under left side from shoulder to hip Arm should relaxed by his side Foot of the bed should be raised 35cm (14in) from the ground Chest is tilted to an angle of 15º

34. Lingula (superior and inferior segment)

35. Lower lobes(apical segment) Patient lie prone with the head turned to one side Arm relaxed in a comfortable position by the side A pillow under his hips

36. Lower lobes(apical segment)

37. Lower lobes(anterior basal segment) Patient lie flat on his back with the buttocks resting on a pillow and knees are flexed The foot of the bed is elevated 46cm (18 in) from the ground The chest is tilted to an angle of 20º

38. Lower lobes(anterior basal segment)

39. Lower lobes(posterior basal segments) Patient lie prone with his head turned to one side Arms in a comfortable position by the side A pillow under his hip The foot of the bed is elevated 46cm (18 in) from the ground The chest is tilted to an angle of 20º

40. Lower lobes(posterior basal segments)

41. Lower lobes(medial basal or cardiac segment) Patient lie on his right side with a pillow under his hips The foot end is raised 46cm (18in) from the ground The chest is tilted to an angle of 20º

42. Lower lobes(medial basal or cardiac segment)

43. Lower lobes(lateral basal segment) Patient lie on his left side with a pillow under his hips The foot end is raised 46cm (18in) from the ground The chest is tilted to an angle of 20º

44. Lower lobes(lateral basal segment)

45. Thank you…