The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

COMPARISON OF CHEST PHYSIOTHERAPY TECHNIQUES

Yoshihiro Uzawa RPT; The University of Toledo Respiratory Care Program, Toledo,Ohio. Yasunari Yamaguchi RPT, Norihiro Kaneko MD; Kameda General Hospital, Kamogawa, Chiba, Japan

(Background) Chest physiotherapy is performed to facilitate airway clearance. Although there are many techniques reported, only percussion and vibration are commonly used in the United States. The purpose of this study is to compare the characteristics of each technique.
(Method) The subjects were 10 healthy males (mean age 23.9 yrs, mean VC 4.72L) on which three chest physiotherapy techniques (Squeezing, Vibration, and Percussion) were performed in standard fashion and randomized order. Squeezing was performed by having a therapist place his hands over the area of the subject's chest wall, then during expiration, increased amounts of pressure were applied in a medial caudal direction. Just before they began inspiration, the therapist released his hands from the chest wall and allowed them to inhale. The therapist performed percussion by using the therapist's hands in a cupped position, and applied kinetic energy to the subject's chest wall. Vibration was performed by placing the therapist's hands on the subject's chest wall and applied a vibratory motion caused by the arms. Subjects were placed in the lateral position, and each technique was performed on the right lower lobes. The subjects were instructed to breathe normally until three techniques were completed. Tidal volume and flow rates were measured, and flow volume curve was observed by using a spirometer (Chesdac 55, CHEST Co.). Baseline was measured in the lateral position and then all three techniques were performed for five minutes each to the subjects in the same position. Between techniques, the subjects were allowed to return to baseline. ANOVA was used to analyze these data.

(Result) Table 1 Different value between during each technique and baseline
Squeezing Percussion Vibration
Tidal Volume (ml) 605.4±276.0 * 247.8±184.6 241.4±139.3
Peak Flow Rate(ml/sec) 379.2±227.1 ** 225.4±137.1 75.0±74.4
Flow Rate at 75% TV (ml/sec) 366.4±273.1*** 158.0±116.4 101.4±73.6
Flow Rate at 50% TV (ml/sec) 289.8±178.1**** 76.6±78.9 37.6±89.1
Flow Rate at 25% TV (ml/sec) 266.2±135.5* 76.2±79.0 30.2±74.6
*p<0.001 Squeezing vs. Percussion and Vibration, **p<0.001 Squeezing vs. Vibration
***p<0.05 Squeezing vs. Percussion, p<0.01 Squeezing vs. Vibration
****p<0.01 Squeezing vs. Percussion and Vibration

(Conclusion) Results indicate that Squeezing increased tidal volume and flow rate during the expiratory phase, augmenting airway clearance. It appears Squeezing increases the flow rate both at high and low volume. It shows that Squeezing maintains peripheral airway patency during expiration. Therefore, it appears that the use of Squeezing for patients who need to remove secretions is more effective than the use of Percussion and Vibration, especially for patients who have peripheral airway collapse and obstruction, such as asthma and bronchitis.

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