Neurophysiological Facilitation of Respiration (NPF): Difference between revisions
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# '''Anterior stretch-lifting of the posterior basal area (Basal Lift)''' | # '''Anterior stretch-lifting of the posterior basal area (Basal Lift)''' | ||
=== '''Perioral pressure''' === | |||
[[File:Perioral pressure.jpg|thumb|262x262px|perioral pressure]] | [[File:Perioral pressure.jpg|thumb|262x262px|perioral pressure]] | ||
'''Method''' | '''Method''' | ||
Perioral pressure is provided by applying pressure with the therapist finger on the top lip between nose and lip. The pressure is maintained for the length of time that the therapist wishes the patient to breathe in the activated pattern. (wearing of surgical gloves is advised to avoid picking up a contaminant and/or carrying contaminants from one patient to another). | Perioral pressure is provided by applying pressure with the therapist finger on the top lip between nose and lip. The pressure is maintained for the length of time that the therapist wishes the patient to breathe in the activated pattern. (wearing of surgical gloves is advised to avoid picking up a contaminant and/or carrying contaminants from one patient to another). | ||
'''Observation''' | '''Observation''' | ||
* | * Expanded epigastric movement | ||
* 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<ref name=":0" /> | * 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<ref name=":0">Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998</ref> | ||
'''Mechanism''' | '''Mechanism''' | ||
Initiates the primitive reflex of sucking and swallowing | |||
=== '''Intercoastal stretch''' === | |||
[[File:Intercostal stretchiing (2).jpg|thumb|239x239px|Intercostal stretching]] | [[File:Intercostal stretchiing (2).jpg|thumb|239x239px|Intercostal stretching]] | ||
'''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. | 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. | ||
'''Observation''' | '''Observation''' | ||
Stretched area results increased movement | |||
'''Mechanism''' | '''Mechanism''' | ||
Intercostal stretch reflex | Intercostal stretch reflex<ref name=":0" /> | ||
=== '''Thoracic vertebral pressure''' === | |||
[[File:Vertebral pressure.jpg|thumb|Vertebral pressure]] | [[File:Vertebral pressure.jpg|thumb|Vertebral pressure]] | ||
'''Method''' | '''Method''' | ||
| Line 56: | Line 54: | ||
vertebral pressure high | vertebral pressure high | ||
* | * Expanded epigastric movements | ||
* Deep-breathing | * Deep-breathing | ||
vertebral pressure low | vertebral pressure low | ||
* Increased respiratory movements of the apical thorax | * Increased respiratory movements of the apical thorax<ref name=":0" /> | ||
'''Mechanism''' | '''Mechanism''' | ||
Dorsal-root-mediated intersegmental reflex | Dorsal-root-mediated intersegmental reflex<ref name=":0" /> | ||
=== '''Co-contraction of the abdomen''' === | |||
[[File:Co-contraction of the abdominal pressure.jpg|thumb|228x228px|Co-contraction of the abdominal pressure]] | [[File:Co-contraction of the abdominal pressure.jpg|thumb|228x228px|Co-contraction of the abdominal pressure]] | ||
'''Method''' | '''Method''' | ||
Provided by the therapist by pressing adequate pressure on the lower ribs and pelvis on the same side, so that pressure is applied at right angles to the patient. | Provided by the therapist by pressing adequate pressure on the lower ribs and pelvis on the same side, so that pressure is applied at right angles to the patient. | ||
'''Observation''' | '''Observation''' | ||
* | * Expanded epigastric movement | ||
* | * Muscle contraction increased | ||
'''Mechanism''' | '''Mechanism''' | ||
Abdominal muscles activated by stretch receptors | |||
=== '''Moderate manual pressure''' === | |||
[[File:Moderate manual pressure.jpg|thumb|Moderate manual pressure]] | [[File:Moderate manual pressure.jpg|thumb|Moderate manual pressure]] | ||
'''Method''' | '''Method''' | ||
| Line 87: | Line 83: | ||
'''Observation''' | '''Observation''' | ||
Gradually increased | Gradually increased movement of the rib under the area of pressure | ||
'''Mechanism''' | '''Mechanism''' | ||
Stretch reflex | |||
=== '''Anterior stretch-lifting of the posterior basal area (Basal Lift)''' === | |||
[[File:Basal lift.jpg|thumb|Basal lift]] | [[File:Basal lift.jpg|thumb|Basal lift]] | ||
'''Method''' | '''Method''' | ||
Basal lift is applied 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 | Basal lift is applied 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''' | '''Observation''' | ||
* Expansion posterior basal area | * Expansion posterior basal area | ||
* | * Expanded epigastric movements | ||
'''Mechanism''' | '''Mechanism''' | ||
Stretch receptors in intercostals. back muscles | Stretch receptors in intercostals. back muscles<ref name=":0" /> | ||
=== '''Indication''' === | === '''Indication''' === | ||
Revision as of 12:41, 13 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
Techniques[edit | edit source]
There are six techniques used in the NPF
- Perioral pressure
- Intercoastal stretch
- Thoracic vertebral pressure
- Co-contraction of the abdomen
- Applied manual pressure
- Anterior stretch-lifting of the posterior basal area (Basal Lift)
Perioral pressure[edit | edit source]
Method
Perioral pressure is provided by applying pressure with the therapist finger on the top lip between nose and lip. The pressure is maintained for the length of time that the therapist wishes the patient to breathe in the activated pattern. (wearing of surgical gloves is advised to avoid picking up a contaminant and/or carrying contaminants from one patient to another).
Observation
- Expanded epigastric movement
- 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[1]
Mechanism
Initiates the primitive reflex of sucking and swallowing
Intercoastal stretch[edit | edit source]
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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.
Observation
Stretched area results increased movement
Mechanism
Intercostal stretch reflex[1]
Thoracic vertebral pressure[edit | edit source]
Method
- vertebral pressure high - manual pressure applied to thoracic vertebrae in the region T2 - T5[1]
- vertebral pressure low - manual pressure applied to thoracic vertebrae in the region T9 - T1[1]
Observation
vertebral pressure high
- Expanded epigastric movements
- Deep-breathing
vertebral pressure low
- Increased respiratory movements of the apical thorax[1]
Mechanism
Dorsal-root-mediated intersegmental reflex[1]
Co-contraction of the abdomen[edit | edit source]
Method
Provided by the therapist by pressing adequate pressure on the lower ribs and pelvis on the same side, so that pressure is applied at right angles to the patient.
Observation
- Expanded epigastric movement
- Muscle contraction increased
Mechanism
Abdominal muscles activated by stretch receptors
Moderate manual pressure[edit | edit source]
Method
Mild pressure of the open hand(s) is maintained over the area in which expansion is desired[1]
Observation
Gradually increased movement of the rib under the area of pressure
Mechanism
Stretch reflex
Anterior stretch-lifting of the posterior basal area (Basal Lift)[edit | edit source]
Method
Basal lift is applied 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
- Expanded epigastric movements
Mechanism
Stretch receptors in intercostals. back muscles[1]
Indication[edit | edit source]
- Neurologically impaired adult patients who are hypoventilating or have retained secretions (impaired tracheobronchial clearance, reduced lung volumes)[2]
- Used to alter respiratory pattern and relieve the symptoms of hyperventilation syndrome (control of breathing).[2]
- Unconscious and non-alert patients
Contraindication[edit | edit source]
- Children under the age of 7 years because of differences in the anatomy, physiology and neurology of respiration[2]
- Patients with hyperinflated lungs[2]
- Rib and sternum fractures
- Respiratory failure
- Floating ribs
- Sensitive mammary tissue in female patients.
References[edit | edit source]
- Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998
- M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002
