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    Orthopedic Manual Therapy Chadcook3rdPTMASUD

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    Hisham Al Shami
    Postural drainage is a technique used to clear secretions from the lungs by placing a patient in different positions to allow gravity and manual techniques to drain secretions. It involves positioning patients in various positions optimized for drainage of specific lung segments. Manual techniques like percussion, vibration, and shaking are used to loosen secretions and improve drainage. Postural drainage is effective for conditions with increased mucus production but requires careful patient positioning and timing of treatments.

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    Orthopedic Manual Therapy Chadcook3rdPTMASUD

    Uploaded by

    Hisham Al Shami
    35 views30 pages
    Postural drainage is a technique used to clear secretions from the lungs by placing a patient in different positions to allow gravity and manual techniques to drain secretions. It involves positioning patients in various positions optimized for drainage of specific lung segments. Manual techniques like percussion, vibration, and shaking are used to loosen secretions and improve drainage. Postural drainage is effective for conditions with increased mucus production but requires careful patient positioning and timing of treatments.

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    Postural drainage is a technique used to clear secretions from the lungs by placing a patient in different positions to allow gravity and manual techniques to drain secretions. It involves positioning patients in various positions optimized for drainage of specific lung segments. Manual techniques like percussion, vibration, and shaking are used to loosen secretions and improve drainage. Postural drainage is effective for conditions with increased mucus production but requires careful patient positioning and timing of treatments.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views30 pages

    Orthopedic Manual Therapy Chadcook3rdPTMASUD

    Uploaded by

    Hisham Al Shami
    Postural drainage is a technique used to clear secretions from the lungs by placing a patient in different positions to allow gravity and manual techniques to drain secretions. It involves positioning patients in various positions optimized for drainage of specific lung segments. Manual techniques like percussion, vibration, and shaking are used to loosen secretions and improve drainage. Postural drainage is effective for conditions with increased mucus production but requires careful patient positioning and timing of treatments.

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    © All Rights Reserved
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    POSTURAL DRAINAGE

    Definition
     Postural drainage (bronchial drainage), is an
    intervention for airway clearance by mobilizing
    secretions in one or more lung segments to
    the central airway by placing the patient in
    various positions so gravity assists in the
    drainage process.
     It is effective in cystic fibrosis, bronchiectasis,
    & other pulmonary diseases.
    Goals & indications
     Prevent accumulation of secretions in patients at risk of
    pulmonary complications :-
     Diseases with increased production or viscosity of
    mucus
     Prolonged bed rest
     Who has received general anaesthesia
     Painful incision causing restricted deep breathing &
    coughing
     Patients on ventilator

     Remove accumulated secretions from the lung :-


     Acute or chronic lung disease
     Generally weak or elderly people
     Patients with artificial airways
    Contraindications
     Severe hemoptysis
     Untreated acute conditions
     Severe pulmonary edema
     Congestive heart failure
     Large pleural effusion
     Pulmonary embolism
     pneumothorax
     Cardiovascular instability
     Cardiac arrhythmias
     Severe hypertension or hypotension
     Recent MI
     Unstable angina
     Recent neurosurgery
     Head down position may cause increased ICP – use modified
    positions
    Preparation
     All the patients do not require postural drainage
    for all the lung segments. So the procedure must
    be based on the clinical findings.
     In postural drainage, the person is tilted or
    propped at an angle to help drain secretions from
    the lungs.
     The lower lobes require drainage most frequently
    because the upper lobes drain by gravity.
     Before postural drainage, the client may be given
    a bronchodilator medication or nebulization
    therapy to loosen secretions.
     Postural drainage treatments are scheduled
    two or three times daily, depending on the
    degree of lung congestion.
     The best times include before breakfast,
    before lunch, in the late afternoon, and before
    bedtime.
     It is best to avoid hours shortly after meals
    because postural drainage at these times can
    be tiring and can induce vomiting.
    Lung lobes & segments
    Position for chest
    physiotherapy
    Manual techniques
    Percussion
     Chest clapping
     Rhythmical force is applied with the cupped hands
    against the thorax, over the involved lung
    segment, trapping air between patient’s thorax &
    caregiver’s hands.
     Aim – dislodging or loosening bronchial secretions
    from airways.
     Performed during both inspiratory & expiratory
    phase of breathing.
     Used during PD & also during ACBT to increase
    its effectiveness.
     Mechanism – transmission of wave of energy
    through chest wall to lungs – wave loosens
    secretions from bronchial wall – moves them
    proximally – removal of secretions.

     Handheld percussor can also be used.

     Pediatrics – use padded rubber nipple, pediatric


    face mask, padded medicine cups, bell of
    stethoscope.

     Use towel or patient’s gown to cover skin.


     Sound of percussion should be hollow.

     Even & steady rhythm – 100 – 480 times/min.

     Force should be equal B/L & to the patient’s comfort.

     Infants – use 4 fingers cupped, 3 fingers with middle


    finger tented or thenar & hypothenar surface of hand.

     Should not be done on bony prominences, breast


    tissue – discomfort & reduce effectiveness of treatment.
     Not tolerated by many post-operatively without
    adequate pain control.

     Associated with fall in oxygen saturation.

     Relative C/I –
     Osteoporosis
     Coagulopathy
    Vibration & Shaking
     Opposite ends of spectrum.

     Vibration –
     Gentle high frequency force
     Delivered through sustained co-contraction of
    caregiver’s UE to apply vibratory force.

     Shaking –
     Vigorous
     Similar to vibration but is a bouncing maneuver, also
    referred as rib springing – supplying concurrent
    compressive force to chest wall.

     Performed only during expiration.


     Enhances mucociliary transport from periphery to
    central airways.

     Produces increased chest wall displacement & stretch


    of respiratory muscles may produce increased
    inspiratory effort & lung volumes.

     Mechanical vibrators can also be used.

     Infants – padded electric tooth brush.

     Advantages –
     Better tolerated than percussion
     Allows to assess pattern & depth of respiration

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