Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
CLINICAL COURSE MANUAL
Course Code
Course Name
RHPT481
Physical Therapy For Respiratory Diseases
Course Outcome*
1.1
*
1.2
1.3
2.1
2.2
2.3
3.1
3.2
4.1
4.2
5.1
Mention the Course outcome not program outcome.
Page 1 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
LIST OF CLINICAL/PRACTICAL/LAB-WORK
Revision No.
Date
Approved by
Lab Work No.
PR - 01
PR - 02
PR - 03
PR - 04
PR - 05
PR - 06
PR -07
PR - 08
PR - 09
PR - 10
PR - 11
TITLE OF LAB WORK
Page No.
Outcomes Covered
Assessment of tracheal shift
Assessment of chest excursion
Assessment of tactile vocal ferimutis
Assessment of Chest Wall Pain
Assessment of respiratory muscle activity
PULMONARY FUNCTION TESTS
ASSESSMENT OF COMMON SYMPTOMS
Breathing Exercise
Thoracic Mobilization Techniques
Inspiratory Muscle Training
Airway Clearance Techniques
*
Kindly put 10-12 practical’s only, as you need tome to conduct 2-3 exams for the course.
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-01: Title
Objective Assessment of The Patient
1. Description:
Student can determine the position of the trachea.
The trachea is palpated to assess its position in relation to the sternal notch.
Trachea can shifted due to disproportionate intra thoracic pressure or lung volumes between two sides of
thorax.
Tracheal deviation indicates underlying mediastinal shift.
2. Requirements:
*Anatomical background about chest and lung
*cuted nails of examiner
3. Indication:
Cardiopulmonary disorder patient
4. Contraindication/Precaution:
Comatose patient
Unreliable patient
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
5. Detailed Procedure:
The techniques for palpation of tracheal position are as follows:
1-The patient is seated upright with the neck slightly flexed (to relax the sternocleidomastoid muscles) and the
chin in midline.
2-The examiner inserts the tip of a fully extended index finger into the suprasternal notch, just medial to one
sternoclavicular joint, and presses inward toward the cervical spine.
3- The same technique is then repeated on the other side.
• The direction of tracheal deviation depends on the underlying pathology. Comfortable positioning
Translation of words
6.
6. Observation/Finding Report:
1-Deviation occurs toward the side of the abnormality when there is loss of lung volume on one side (e.g., atelectasis, fibrosis, or
surgical excision of lung tissue).
2- Deviation is away from the side of the abnormality when there is an increase in volume on one side of the thorax (e.g.,
tension pneumothorax and pleural effusion).
3- The mediastinum may be shifted to the right in older patients when no lung pathology exists as a result of elongation of an
atherosclerotic aortic arch.
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-02: Title
Assessment of Chest Wall Excursion
1. Description:
Student should practice to administer
Movement of the chest wall, chest wall excursion (CWE), can be affected by a number of conditions.
Unilateral restriction may occur when there is underlying lobar pneumonia, atelectasis, or fibrosis or with
trauma or a surgical incision.
Bilateral restriction occurs in patients with extensive pulmonary fibrosis, as well as in those with COPD and
hyperinflated lungs.
2. Requirements:
During palpation of CWE,
*the extent of movement,
*timing,
*and symmetry are assessed.
3. Indication:
Cardiopulmonary disorder patient
4. Contraindication/Precaution:
5. Detailed Procedure:
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Palpation of CWE is performed segmentally, comparing one side with the other during quiet and deep breathing,
as illustrated in Figure
1- Upper lobes
*With the patient sitting or lying facing the examiner, the therapist places his/her palms
anteriorly over the first four ribs with the fingertips extended over the trapezius muscles.
*The skin is stretched downward until the palms are in the infraclavicular areas and then
drawn medially until the tips of the extended thumbs meet in the midline.
*With the elbows and shoulders maintained in a relaxed position, the therapist asks the patient
to take a deep inspiration and allows his/her hands to reflect the movement of the underlying
lung.
2- Right middle lobe and lingular segment
*The therapist places his widely outstretched fingers of both hands over the posterior axillary
folds and his/her palms over the anterior chest wall.
*The skin is then drawn medially until the tips of the extended thumbs meet in the midline.
*Again, with the elbows and shoulders maintained in a relaxed position, the therapist asks the
patient to take a deep inspiration and allows his hands to reflect the movement of the
underlying lung.
3- Lower lobes
*With the patient sitting with his back to the therapist, the therapist places both hands high up
in the axilla with outstretched fingers over the axillary folds.
*The skin is then drawn medially until the extended thumbs meet in the midline.
*Again, with the elbows and shoulders maintained in a relaxed position, the therapist asks the
patient to take a deep inspiration and allows his hands to reflect the movement of the
underlying lung.
6. Observation/Finding Report:
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
*Normally, both lungs should expand equally, and thus the therapist’s thumbs and hands
will move with equal timing the same distance from each other during both quiet and deep
breathing. Diminished or delayed movement of one side often provide the earliest evidence
of a localized pathology that is reducing lung compliance.
*CWE can also be measured with a tape measure to quantify motion in different areas of
the thorax. The tape measure is wrapped around the thorax in a level position and pulled
just taut (but not restricting chest expansion) at three anatomic sites:
1)The angle of Louis on the sternum, located at the second rib, for upper chest motion,
which is produced by bucket handle motion
2)The xiphoid process for mid-chest expansion, which is due predominantly to bucket
handle motion
3)The midpoint between the xiphoid process and the umbilicus for lower chest
expansion, where most of the bucket handle motion occurs
7. Pictorial demonstration of examination/treatment techniques:
*The individual is instructed to inspire normally to obtain a measure of chest motion
during tidal breathing.
*The tape measure is allowed to move with chest expansion and the distance from end
expiration to end inspiration is recorded; adding an inexpensive spring-loaded metal
flange to the end of the tape can increase the accuracy of measurement.
*Chest wall motion is then obtained, as described previously, during maximal inspiration.
*If it is difficult to obtain measurements at all three anatomic sites, data from the upper and
lower sites will provide information regarding pump handle and bucket handle
motion.
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-03: Title assessment of tactile vocal Fremitus (TVF)
1. Description:
Student should practice to administer
Palpable vibrations resulting from the transmission of voice sounds to the chest wall are known as vocal or
tactile fremitus.
2. Requirements:
To identify fremitus, the examiner places either the palms or the hypothenar eminences of his/her hands
lightly on symmetric areas of the chest wall. The patient is then instructed to say “99,” and the intensity of the
vibrations detected in each hand are compared as the examiner moves his or her hands over several areas of
the chest (apical, anterior, lateral, and posterior).
3. Indication:
Cardiopulmonary disorder patient
4. Contraindication/Precaution:
Comatose patient
Unreliable patient
5. Detailed Procedur
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Under normal conditions, equal vibrations of moderate intensity are perceived during speech, but not during quiet
breathing.
• Various pathologies will cause a change in intensity or quality of fremitus:
6. Pictorial demonstration of examination/treatment techniques:
Various pathologies will cause a change in intensity or quality of fremitus:
*Increased fremitus is noted when there is increased density of the underlying lung tissue (e.g., consolidation)
caused by exudate or mass.
*Fremitus is decreased or absent when there is fluid or air in the pleural space or when there is atelectasis due to
bronchial obstruction.
*When vibrations are detected during quiet breathing, it is termed rhonchal fremitus.
7. Observation/Finding Report:
Tactile vocal Fremitus is INCREASED with the presence of secretions and over areas of consolidation (E.g.
Pulmonary fibrosis, Pulmonary edema, Atelectasis and Lung tumors)
Tactile vocal Fremitus is DECREASED or ABSENT with more air in that area and over areas of effusion or
collapse(E.g. Pleural effusion, Pneumothorax, COPD).
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-04: Title
assessment of Chest Wall Pain
1. Description:
Patients sometimes report chest pain during the initial interview or as therapy gets underway. Chest pain can
result from numerous cardiac, pulmonary, and other causes. And sometimes patients experience more than
one of these conditions at the same time. It is important for PTs to be able to differentiate between
neuromusculoskeletal and systemic causes of chest pain, the latter of which may require referral to a
physician.
2. Requirements:
Information that may assist in differentiating neuromusculoskeletal and systemic problems include the
individual’s past medical history and presence of any cardiovascular or pulmonary risk factors, the clinical
presentation, vital signs, chest pain pattern, and any associated signs and symptoms (e.g., fever, chills, upper
respiratory or gastrointestinal complaints, dyspnea, and lightheadedness).
3. Indication:
For assessment cardiopulmonary patient
4. Contraindication/Precaution:
o
o
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
o
5. DetailedProcedure:
*Obtain a description of the patient’s pain (e.g., type, extent, location, precipitating factors, and mechanisms
of relief)
*Ask the patient to outline the borders of the painful area(s).
•*Palpation is valuable in identifying chest wall pain. Starting well away from the affected area and moving
toward it, the therapist palpates the ribs and intercostal spaces by pressing firmly downward. In addition, the
effects of deep breathing, coughing, breath holding, and ipsilateral arm motion on the pain are noted.
6. Pictorial demonstration of examination/treatment techniques:
*Chest wall pain due to musculoskeletal dysfunction is usually nonsegmental, localized to the anterior
chest, and aggravated by deep inspiration but unrelated to exercise.
*A localized area of intense pain accompanied by a grating sensation with expiration is usually indicative
of a rib fracture.
*Localized intercostal tenderness may represent fibrositis of an intercostal muscle.
*Pain due to subluxation of a costal cartilage can be reproduced by squeezing the ribs on either side of the
dislocation.
*Chest pain due to nerve root irritation is more superficial and often radiates segmentally according to
dermatomal distribution; it is aggravated by upper body exertion only, and sensory loss or hyperesthesia
may occur over the affected dermatome.
*Other abnormalities are sometimes detected during palpation of CWE, vocal fremitus, or chest wall pain.
**Subcutaneous air, or emphysema, is perceived as a crackling sensation that can be heard, as well as felt,
and results from intrapulmonary rupture of air spaces (e.g., chest trauma, acute asthma, and surgical
incision). It is usually found above the sternum and clavicles or in the neck.
**Unstable rib fractures can be detected by “popping” ofthe segment during inspiration and coughing.
7. Observation/Finding Repor
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Students Name
Academic No
Faculty Name
Section No
Signature
Date
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
PR-05: Respiratory Muscle Activity ASSESSMENT
1. Description:
Palpation of respiratory muscle activity is used to assess diaphragmatic function and the presence of accessory
muscle recruitment.
2. Requirements:
3. Indication:
1. Routine assessment
4. Contraindication/Precaution:
5. Detailed Procedure:
Diaphragm
*With the patient lying supine and flat, the examiner places both hands lightly over the anterior chest with
thumbs over costal margins so that their tips almost meet at the xiphoid.
The patient is instructed to take a deep inspiration while the examiner’s hands are allowed to move with
chest expansion.
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
6. Pictorial demonstration of examination/treatment techniques:
*Because of its dome shape, contraction of the diaphragm causes descent of the central tendon and elevation
and outward rotation of the lower ribs. Therefore, normal diaphragmatic function results in equal upward
motion of each costal margin, which produces an increase in the thoracic circumference of 2 to 3 in.
*Inward motion of the costal margins during inspiration occurs when the diaphragm is no longer domeshaped, as in hyperinflation (e.g., COPD), or when there is fluid or air in the pleural space (i.e., pleural
effusion or pneumothorax).
8. Observation/Finding Report:
Scalene muscles
*With the patient sitting and facing away, the examiner places his or her hands on the upper trapezius muscles
so that the fingers rest on the clavicles and the thumbs meet near the midline posteriorly. Activity of the
scalene muscles is assessed as the patient takes at least two quiet breaths.
*Normally, the scalene muscles are only minimally active during quiet breathing, mostly acting (in
conjunction with the parasternal intercostals) to counteract the inward motion of the upper chest that would
result from an unopposed drop in intrapleural pressure produced by diaphragmatic descent (as seen in
individuals with high spinal cord lesions).
More pronounced scalene contraction signals the recruitment of the accessory muscles of inspiration, and
therefore an increase in the work of breathing.
Page 13 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Page 14 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-06: Title:
PULMONARY FUNCTION TESTS (PFTs)
1. Description:
Pulmonary function tests (PFTs) consist of a series of inspiratory and expiratory maneuvers designed to
assess the integrity and function of the respiratory system. The information provided by PFTs is helpful to
the therapist in establishing realistic treatment goals and an appropriate treatment plan according to the
patient’s current pulmonary problems and degree of impairment.
*Normal values vary depending on age, gender, height, and ethnicity
2. Requirements:
Spirometric and pulmonary mechanics
Disposable mouth pice
Nose clip
3. Indication:
*To evaluate respiratory symptoms
*To determine severity of impairment in patients with known respiratory disease
*To follow the course of disease in a patient, including the response to therapy
*To assess preoperative risk for predicting postoperative respiratory complications
*To screen for subclinical disease
*PFTs include measurements of lung volume and capacity, ventilation, pulmonary
mechanics, and diffusion.
4. Contraindication/Precaution:
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Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Poor orientation
Uncooperative patient
Disabled patient
Comatosed patient
5. Detailed Procedure:
*Forced vital capacity (FVC) (the maximal volume that can be expired as forcefully and
rapidly as possible after a maximal inspiration)
*Forced expiratory volume in 1 sec (FEV1) (the volume of gas expired over the first
second of an FVC)
*FEV1/FVC (the forced expiratory volume in 1 sec expressed as a percentage of forced
vital capacity)
6. Pictorial demonstration of examination/treatment techniques:
*In obstructive lung disease, the TLC and RV points are displaced to the left (indicating
increased volumes), peak expiratory flow rate is significantly reduced (e.g., the volume
expired in the first second [FEV1] is decreased), the FEV1/FVC is reduced to less than
65%, and the curve is flattened or concave.
*In restrictive lung disease, the TLC and RV points are shifted to the right (indicating
decreased volumes), the FVC and peak expiratory flow are reduced, but the FEV1/FVC is
usually normal and the shape of the curve is preserved.
*Some patients have both obstructive and restrictive defects and therefore will exhibit a
combination of low volumes and reduced expiratory flow rates.
*Typical patterns for flow–volume loops, showing both forced inspiration and expiration
curves, for obstructive and restrictive dysfunction compared with normal .
Page 16 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Forced vital capacity (FVC) (the maximal
volume that can be expired as forcefully and
rapidly as possible after a maximal
inspiration)
Forced expiratory volume in 1 sec (FEV1)
(the volume of gas
expired over the first second of an FVC)
FEV1/FVC (the forced expiratory volume in
1 sec expressed as a
percentage of forced vital capacity)
*Normally FVC and vital capacity (VC)
should be within 200 mL of each other.
*FVC may be <VC in chronic OLD if forced
expiration causes bronchiolar collapse or is
reduced by mucous plugging and bronchiolar
narrowing
*Both FVC and VC are similarly decrease in
RLD
*As a measure of flow, FEV1 is valuable in
assessing the severity of airway obstruction
(see FEV1/FVC)
*FEV1 is decrease in both RLD and OLD; in
RLD the reduce is proportional to that of the
FVC, whereas it is more marked in OLD
*Younger subjects can normally expire 50%60% of FVC in 0.5 sec, 75%-85% in 1 sec,
94% in 2 sec, and 97% in 3 sec.
The FEV1/FVC is typically 70%-75% in
healthy older adults
*FEV1/FVC <65% is diagnostic of OLD, the
severity of which can be gauged by the
extent of the decrease, as are the degrees of
functional limitation and morbidity
*In RLD, FVC is often decrease and FEV1
may be similarly decrease, normal, or
increase so FEV1/FVC is normal or increase
Page 17 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-07: Title : ASSESSMENT OF COMMON SYMPTOMS
1. Description:
Student should be able select the appropriate activity for training the patients with hand
impairments. Breathlessness (Dyspnea) Rate of perceived exertion (RPE) or Borg scale
(Dyspnea scale)
2. Requirements:
Select the appropriate tools
3. Indication:
Contraindication/Precaution:
4. Detailed Procedure:
0
Nothing at all
0.5
Very, very weak (just noticeable)
1
Very weak
2
Weak (light)
Page 18 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
3
Moderate
4
Somewhat strong
5
Strong (heavy)
67
Very Strong
8910
Maximal
5. Pictorial demonstration of examination/treatment techniques:
6. Observation/Finding Report:
Page 19 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-08: Title: breathing EXERCISE
GOALS:
1.
2.
3.
4.
Improve or redistribute ventilation.
Prevent postoperative pulmonary complications.
Improve the strength, endurance, and coordination of the muscles of ventilation.
Correct inefficient or abnormal breathing patterns and decrease the work of
breathing.
5. Promote relaxation and relieve stress.
6. Teach the patient how to deal with episodes of Dyspnea.
a. Diaphragmatic breathing exercise
These are designed to improve the efficiency of ventilation, decrease the work of
breathing, increase the excursion (descent or ascent) of the diaphragm, and
improve gas exchange and Oxygenation.
Position – Semi-Fowler’s position (in which gravity assists the diaphragm)
Procedure
Start instruction by teaching the patient how to relax the accessory muscles of
inspiration those muscles (shoulder rolls or shoulder shrugs coupled with relaxation).
Place your hand(s) on the rectus abdominis just below the anterior costal margin.
Ask the patient to breathe in slowly and deeply through the nose.
Page 20 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Have the patient keep the shoulders relaxed and upper chest quiet, allowing the
abdomen to rise slightly.
Then tell the patient to relax and exhale slowly through the mouth.
Page 21 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Students Name
Academic No
Faculty Name
Section No
Signature
Date
PR-09: Title : Thoracic Mobilization Techniques
Chest mobilization exercises are any exercises that combine active movements of the trunk or extremities
with deep breathing.
They are designed to maintain or improve mobility of the chest wall, trunk, and shoulder girdles when
it affects ventilation or postural alignment.
Exercises that combine stretching of these muscles with deep breathing improve ventilation on that side
of the chest.
a) To Mobilize One Side of the Chest
1. While sitting, have the patient bend away from the tight side to lengthen hypo mobile structures and
expand that side of the chest during inspiration
2. Then, have the patient push the fisted hand into the lateral aspect of the chest, bend toward the tight
side, and breathe out
3. Progress by having the patient raise the arm overhead on the tight side of the chest and side-bend
away from the tight side. This places an additional stretch on hypo mobile tissues.
b.) To Mobilize the Upper Chest and Stretch the pectoralis muscle
While the patient is sitting in a chair with hands elongating the clasped behind the head, horizontally
abduct the arms have him or her Pectoralis major) during a deep inspiration.
Then instruct the patient to bring the elbows together and bend forward during expiration.
c. To Mobilize the Upper Chest and Shoulder
Page 22 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
While sitting in a chair, have the patient reach with both arms overhead (180 bilateral shoulder flexion
and slight abduction) during inspiration.
Then bend forward at the hips and reach for the floor during expiration
Students Name
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PR-10: Title : Respiratory muscle Training (RRT)
Procedure
The patient inhales through a resistive training device placed in the mouth.
These devices are narrow tubes of varying diameters or a mouthpiece and adapter with
an adjustable aperture that provide resistance to airflow during inspiration and therefore
place resistance on inspiratory muscles.
The smaller the diameter of the tube and, the greater is the resistance.
The patient inhales through the device for a specified period of time several times each
day.
Incentive spirometer is a form of ventilatory training that emphasizes sustained maximum
Page 23 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
inspirations.
The purpose of incentive spirometer is to increase the volume of air inspired.
It is used primarily to prevent alveolar collapse and atelectasis in post operative patients.
Procedure.
Have the patient assume a comfortable position (semi reclining, if possible) and inhale
and exhale three to four times and then exhale maximally with the fourth breath
Then have the patient place the spirometer in the mouth, inhale maximally through the
mouthpiece to a target setting and hold the inspiration for several seconds.
This sequence is repeated five to ten times several times per day.
Students Name
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Faculty Name
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Date
PR-11: Title : Airway Clearance Techniques
*An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear.
A cough may be reflexive or voluntary.
*The Cough Mechanism
1. Deep inspiration occurs.
2. Glottis closes, and vocal cords tighten.
3. Abdominal muscles contract and the diaphragm elevates, causing an increase in intra thoracic and intraabdominal pressures.
4. Glottis opens.
5. Explosive expiration of air occurs.
Page 24 of 25
Kingdom of Saudi Arabia
Ministry of Higher Education
Majmaah University
College of Applied Medical Sciences
Department of Physical Therapy
Teaching an Effective Cough
Assess the patient’s voluntary or reflexive cough.
2. Have the patient assume a relaxed, comfortable position - Sitting or leaning forward
3. Teach the patient controlled diaphragmatic breathing, emphasizing deep inspirations.
4. Demonstrate a sharp, deep, double cough.
5. Demonstrate the proper muscle action of coughing (contraction of the abdominals).
6. Take a deep but relaxed inspiration, followed by a sharp double cough. The second cough during a single
expiration is usually more productive.
b) Additional Techniques to Facilitate a Cough
1.Manual-Assisted Cough
If a patient has abdominal weakness manual pressure on the abdominal area assists in developing greater intraabdominal pressure for a more forceful cough.
a. Therapist-Assisted Techniques
b. Self-Assisted Technique
2. Splinting
If chest wall pain from recent surgery or trauma is restricting the cough, teach the patient to splint over the
painful area during coughing.
3. Tracheal Stimulation The therapist places two fingers at the sternal notch and applies a circular motion with
pressure downward into the trachea to facilitate a reflexive cough
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