Neurophysiological Facilitation of Respiration (NPF): Difference between revisions
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==== '''Intercoastal stretch''' ==== | ==== '''Intercoastal stretch''' ==== | ||
'''Method''' | ===== '''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. | 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. | ||
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==== '''Thoracic vertebral pressure''' ==== | ==== '''Thoracic vertebral pressure''' ==== | ||
===== '''Method''' ===== | |||
vertebral pressure high - manual pressure applied to thoracic vertebrae in the region T2 - T5 | vertebral pressure high - manual pressure applied to thoracic vertebrae in the region T2 - T5 | ||
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* Deep-breathing | * Deep-breathing | ||
vertebral pressure low | vertebral pressure low | ||
* Increased respiratory movements of apical thorax | * Increased respiratory movements of the apical thorax | ||
===== '''Mechanism''' ===== | ===== '''Mechanism''' ===== | ||
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==== '''Co-contraction of the abdominal muscles''' ==== | ==== '''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. | 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''' ===== | ===== '''Observation''' ===== | ||
* Increased epigastric movements | * Increased epigastric movements | ||
* Increased muscle contraction (rectus | * Increased muscle contraction (rectus abdominous) | ||
* Decreased girth in obese | * Decreased girth in obese | ||
* Increased firmness to palpation | * Increased firmness to palpation | ||
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==== '''Applied manual pressure''' ==== | ==== '''Applied manual pressure''' ==== | ||
===== '''Method''' ===== | |||
Mild pressure of the open hand(s) is maintained over the area in which expansion is desired | Mild pressure of the open hand(s) is maintained over the area in which expansion is desired | ||
===== '''Observation''' ===== | ===== '''Observation''' ===== | ||
Gradually increased excursion of area under contact | Gradually increased excursion of the area under contact | ||
===== '''Mechanism''' ===== | ===== '''Mechanism''' ===== | ||
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==== '''Anterior stretch-lifting of the posterior basal area (Basal Lift)''' ==== | ==== '''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 | 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 | ||
Revision as of 16:22, 8 May 2020
Neurophysiological Facilitation of Respiration (NPF)[edit | edit source]
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.[edit | edit source]
- 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[edit | edit source]
- 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[edit | edit source]
There are six techniques used in the NPF
- Perioral pressure
- Intercoastal stretch
- Thoracic vertebral pressure
- Co-contraction of the abdominal muscles
- Applied manual pressure
- Anterior stretch-lifting of the posterior basal area (Basal Lift)
Perioral pressure[edit | edit source]
Method[edit | edit source]
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[edit | edit source]
- 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[edit | edit source]
The primitive reflex response related to sucking
Intercoastal stretch[edit | edit source]
Method[edit | edit source]
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[edit | edit source]
- Increased epigastric movements
- Increased muscle contraction (rectus abdominous)
- Decreased girth in obese
- Increased firmness to palpation
- Depression of umbilicus
Mechanism[edit | edit source]
Intercostal stretch reflex
Thoracic vertebral pressure[edit | edit source]
Method[edit | edit source]
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[edit | edit source]
vertebral pressure high
- Increased epigastric excursions
- Deep-breathing
vertebral pressure low
- Increased respiratory movements of the apical thorax
Mechanism[edit | edit source]
Dorsal-root-mediated intersegmental reflex
Co-contraction of the abdominal muscles[edit | edit source]
Method[edit | edit source]
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[edit | edit source]
- Increased epigastric movements
- Increased muscle contraction (rectus abdominous)
- Decreased girth in obese
- Increased firmness to palpation
- Depression of umbilicus
Mechanism[edit | edit source]
Stretch receptors in abdominal muscles
Applied manual pressure[edit | edit source]
Method[edit | edit source]
Mild pressure of the open hand(s) is maintained over the area in which expansion is desired
Observation[edit | edit source]
Gradually increased excursion of the area under contact
Mechanism[edit | edit source]
Cutaneous afferents
Anterior stretch-lifting of the posterior basal area (Basal Lift)[edit | edit source]
Method[edit | edit source]
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[edit | edit source]
- Expansion posterior basal area
- Increased epigastric movements
Mechanism
Stretch receptors in intercostals. back muscles
