Neurophysiological Facilitation of Respiration (NPF)

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Neurophysiological Facilitation of Respiration (NPF)

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

Indication.

• NPF techniques may be employed as a first-line treatment for neurologically impaired adults with retained secretions. Abdominal pressure performed by the physiotherapist may assist effective clearance of secretions during spontaneous coughing.
• Neurologically impaired adult patients who are hypoventilating or have retained secretions (impaired tracheobronchial clearance, reduced lung volumes)
• Used to alter respiratory pattern and relieve the symptoms of hyperventilation syndrome (control of breathing).

Contraindication

• 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

Techniques

There are six techniques used in the NPF

1. Perioral pressure
2. Intercoastal stretch
3. Thoracic vertebral pressure
4. Co-contraction of the abdominal muscles
5. Applied manual pressure
6. Anterior stretch-lifting of the posterior basal area (Basal Lift)

Perioral pressure

Method

The pressure is applied to the patient's top lip by the therapist's finger and maintained. The pressure is maintained for the length of time that the therapist wishes the patient to breathe in the activated pattern. (As a precautionary measure the use of surgical gloves is advised to avoid picking up a contaminant and/or carrying contaminants from one patient to another).

Observation

• Increased epigastric excursions
• As the stimulus is maintained the epigastric excursions may increase so that movement is transmitted to the upper thorax and the patient appears to be deep breathing
• Swallowing
• Mouth closure

Mechanism

The primitive reflex response related to sucking

Intercoastal stretch

Method

Intercostal stretch is provided by applying pressure to the upper border of a rib in order to stretch the intercostal muscle in a downward(not inward) direction. The stretch position is then maintained while the patient continues to breathe in his/her usual manner. This procedure can be performed unilaterally or bilaterally on any rib with the exception of the floating ribs. Care must be taken to avoid sensitive mammary tissue in female patients.

Observation

• Increased epigastric movements
• Increased muscle contraction (rectus abdominous)
• Decreased girth in obese
• Increased firmness to palpation
• Depression of umbilicus

Mechanism

Intercostal stretch reflex

Thoracic vertebral pressure

Method

vertebral pressure high - manual pressure applied to thoracic vertebrae in the region T2 - T5

vertebral pressure low - manual pressure applied to thoracic vertebrae in the region T9 - T1

Observation

vertebral pressure high

• Increased epigastric excursions
• Deep-breathing

vertebral pressure low

• Increased respiratory movements of apical thorax

Mechanism

Dorsal-root-mediated intersegmental reflex

Co-contraction of the abdominal muscles

Method

This procedure is performed by the therapist placing one hand on the patient's lower ribs and one on the pelvis on the same side and pushing with moderate pressure so that force is applied at right angles to the patient.

Observation

• Increased epigastric movements
• Increased muscle contraction (rectus abdorninus)
• Decreased girth in obese
• Increased firmness to palpation
• Depression of umbilicus

Mechanism

Stretch receptors in abdominal muscles

Applied manual pressure

Method

Mild pressure of the open hand(s) is maintained over the area in which expansion is desired

Observation

Gradually increased excursion of area under contact

Mechanism

Cutaneous afferents

Anterior stretch-lifting of the posterior basal area (Basal Lift)

Method

This procedure is performed by placing the hands under the posterior ribs of the supine patient and lifting gently upwards. The lift is maintained and provides a maintained stretch and pressure posteriorly and stretch anteriorly as well

Observation

• Expansion posterior basal area
• Increased epigastric movements

Mechanism

Stretch receptors in intercostals. back muscles