BASIC TECHNIQUE IN PHYSIOTHERAPY

Chest Physiotherapy
Walking Aids
BREATHING TECHNIQUES

Breathing Control
Breathing Exercise
BREATHING CONTROL
Normal Tidal Breathing using the lower
chest with relaxation of the upper chest
and shoulders
Method
 Patient should be in comfortable, well
supported position eg.sitting or high side lying
 The patient is encouraged to relax his upper
chest,shoulders and arms while using the
lower chest
BREATHING CONTROL
 Ask the patient to breathe in and out normally
 Place your hand on the upper abdomen
 As the patient breathes in hand should be felt
to rise up and out
 As the patient breathes out the hand sinks
down and in
 This is performed for a few minutes or till they
are no longer breathless.
POSITIONS ADAPTED FOR
BREATHLESS PATIENT

 Any breathless patients eg. patient with bronchial

asthma will benefit from using breathing control in
positions which encourage relaxation.
Useful Positions are
• Relaxed sitting
• High side lying
Other positions
• Forward lean standing
• Relaxed standing
• Forward lean sitting
BREATHING EXERCISE
Thoracic Expansion or Deep Breathing Exercise
Inspiration is emphasized in this exercise
Method:
 Take a slow but deeper than normal breath into the
lungs, through the nose and out through the mouth.
 It may be combined with a 3 sec hold before passive
relaxed expiration
 Upper chest ,shoulders and arms should be relaxed
 This exercise is done 3-4 times followed by a period
of breathing control
COUGHING AND HUFFING
 Coughing – Here the patient is tought to take deep
breath(high lung volume),tighten abdominal muscles
and cough.Here the force of the expired air is
sufficient to clear secretions from the trachea and
main bronchi
 Huffing – Here the patient is tought to take medium
sized breath(mid-lung volume),tighten abdominal
muscles and huff out through the mouth.Here the
force of the expired air is effective in moving
secretions up from the lobar and segmental bronchi
FORCED EXPIRATION TECHNIQUE

 Here the patient is tought to perform

one or two huffs
 This is followed by relaxed controlled
breathing
 Then secretions are cleared with one or
two coughs
METHOD OF CLEARING AIRWAY

 A cycle of breathing control

 Thoracic expansion or deep breathing
exercises
 Forced Expiration Technique
CHEST PERCUSSION

Chest percussion or clapping is used to

mobilize secretions by mechanically
dislodging viscous or adherent mucous from
the lungs

Method:
 Is performed using cupped hands
CHEST PERCUSSION
WRIST ACTION DURING PERCUSSION
CHEST PERCUSSION
 Done with rhythmical flexion and extension
action of the wrist
 Usually done with 2 hands,but it may be more
appropriate to use with one hand depending
upon the area of the chest
 The procedure should not be painful or
uncomfortable
CHEST PERCUSSION

Contraindications
 Over fractures or osteoporotic bone
 Frank Haemoptysis
 Patients with presence of low platelet count
 Pleuritic pain
Gravity Assisted Drainage Positions

 This consists of positioning the patient

to allow gravity to assist the drainage of
secretions from specific areas of lungs
 Treatment time is usually 10-15 minutes
in each position
 Patient should perform airway clearance
technique during this treatment
The postural drainage positions which are illustrated
here are modified drainage positions.
INITIAL MANAGEMENT OF A SPRAIN

RICE regimen :-

 R - rest
 I - ice
 C - compression
 E - elevation
INITIAL MANAGEMENT OF A SPRAIN

 Rest - no weight bearing for the first 24

hours after the injury (Possibly longer,
depending upon severity)
 Ice - apply ice packs using a towel over
a plastic bag to the area that is painful.
Be careful to avoid frostbite. Ice should
be intermittently applied for the first 24
hours
INITIAL MANAGEMENT OF A SPRAIN

 Compression - an ACE bandage or

other soft elastic material should be
applied to the ankle to help prevent the
accumulaton of edema.
 Elevation - elevating the ankle helps in
removing edema. By having the foot
higher than the hip (or heart), gravity is
used to pull edema out of the ankle.
WALKING AIDS

Types
 Axillary Crutch
 Elbow Crutch
 WALKING AID
 Axillary Crutch-Made
of wood or aluminium
with axillary pad,a hand
piece and rubber ferrule
 Elbow Crutch-Made
of metal with a plastic
forearm band,a hand
piece and rubber ferrule
AXILLARY CRUTCH
 SIZING THE CRUTCHES

Two main adjustments to make

1. height of the crutches
2. position of the hand grips
 AXILLARY CRUTCH
• Height
Standing Straight, place crutches 3-4 inches in front of you
and 6 inches out to the side.
Keep shoulders relaxed. there should be room for two
fingers to fit comfortably between the tops of the crutches

• Hand Grips
Remain standing in the same position and let your arms fall
to your sides. Look at where your wrists fall with respect
to the crutches. Position the hand grips at this height.
Ideally, there should be a 15-20 degree bend in the elbow
when adjusted correctly
ELBOW CRUTCH

 In standing position , elbow flexed to15-

30°. The crutch should contact the floor
2-4 in outside and 6 in in front of your
foot. The cuff on the crutch should sit 1-
1.5 in below the back of the elbow.
Non Weight Bearing Gait
 Patient should stand with a triangular base
 To walk, the affected limb in a slightly bent
position
 Move both the crutches a little forward taking
weight through the crutches
 Then lift or hop the unaffected limb in line with
the crutch
Partial Weight Bearing Gait

 With two Crutches

 Here both the crutches and the affected limb
is taken forward.
 Weight is taken through the crutches and the
affected leg
 Then the unaffected leg is brought forward
Partial Weight Bearing Gait

 With single crutch

 The crutch is placed on the unaffected side.
 Bring the crutch and the affected limb
forwards.
 Weight is taken by the crutch and the affected
limb
 Then bring the unaffected limb forward