Neurophysiological Facilitation of Respiration (NPF)

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed and Kim Jackson

Introduction[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

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

Perioral Pressure[edit | edit source]

perioral pressure


Perioral pressure is provided by applying pressure with the therapist's finger on the top lip between the 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).


  • 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]


Initiates the primitive reflex of sucking and swallowing

Intercostal Stretch[edit | edit source]

Intercostal stretching


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.


Stretched area results increased movement


Intercostal stretch reflex[1]

Thoracic Vertebral Pressure[edit | edit source]

Vertebral pressure


  • 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]


vertebral pressure high

  • Expanded epigastric movements
  • Deep-breathing

vertebral pressure low

  • Increased respiratory movements of the apical thorax[1]


Dorsal-root-mediated intersegmental reflex[1]

Co-contraction of the Abdomen[edit | edit source]

Co-contraction of the abdominal pressure


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.


  • Expanded epigastric movement
  • Muscle contraction increased


Abdominal muscles activated by stretch receptors

Moderate Manual Pressure[edit | edit source]

Moderate manual pressure


Mild pressure of the open hand(s) is maintained over the area in which expansion is desired[1]


Gradually increased movement of the rib under the area of pressure


Stretch reflex

Anterior Stretch-Lifting of the Posterior Basal Area (Basal Lift)[edit | edit source]

Basal lift


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.


  • Expansion posterior basal area
  • Expanded epigastric movements


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 the respiratory patterns and relieve the symptoms of hyperventilation syndrome (control of breathing).[2]
  • Unconscious and non-alert patients
  • NPF is a useful technique to improve short term ventilation with lower consciousness.[3][4]

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.

Evidence[edit | edit source]

  • Perioral pressure followed by Intercoastal stretch has increased minute ventilation (Ve) and oxygen saturation (Spo2) in short term ventilated patients with lower consciousness.[4]
  • Anterior stretch-lifting of the posterior basal area (Basal Lift), Abdominal co-contraction and Intercoastal stretch has improved spontaneous tidal volume(Vt), minute volume(Ve) and middle chest expansion in short term mechanical ventilated patients[3]
  • Also, Anterior stretch-lifting of the posterior basal area (Basal Lift) has improved spontaneous respiratory rate (RR) significantly in short term mechanically ventilated patients [3]

References[edit | edit source]

  1. Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998
  2. M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002
  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Jennifer A. Prayor & Barbara A. Webber. Physiotherapy for Respiratory and cardiac problems. 2nd edition. Churchill Livingstone. 1998
  2. 2.0 2.1 2.2 2.3 M. Jones & F. Moffatt. Cardiopulmonary physiotherapy. Bios Scientific Publisher Ltd. 2002
  3. 3.0 3.1 3.2 Dr. Hardini Prajapati, "Effect of Neurophysiological Facilitation [NPF] of Respiration on Ventilation of Mechanically Ventilated Patients: An Experimental Study", International Journal of Science and Research (IJSR),, Volume 7 Issue 9, September 2018, 629 - 631
  4. 4.0 4.1 Ventilatory effects of neurophysiological facilitation and passive movement in patients with neurological injury A Chang, J Paratz, J Rollston - Australian journal of physiotherapy, 2002