It is the term used to describe externally applied proprioceptive and tactile stimulus that produces reflex respiratory movt. Responses and that appears to alter rate and depth of breathing




1-For a unconscious patients-As it is not possible to place them in optimum position for postural drainage.

-Inadequate ventilation due to shallower monotonus resp. is a major factor in development of atelectasis

-Inadequate ventilations- retension of secretion

Deranged mech. ventilation or resp. function is another complication of lack of muscle tone and instability of chest wall.

-Stiff chest as a result of lack of costal muscle.


2-As a relaxation procedure to conscious patient like CVA and GBS.


Application of PNF result:


1-Visible deeper inspiration

2-larger expansion of ribs

3-Increased epigastric excursion

4-Change in R.R.

5-Involuntary coughing

6-Changes in breath sounds

7-Return of mech.chest wall stability

8-Less necesscity for suctioning

9-More normal resp.pattern

10-Increase in level of consciousness

11-Retension of new pattern by sucessive repetition.


Responses most pronounced in deeply unconscious.



1-Perioral pressure

2-Intercostal stretch

3-Vertebral pressure

4-Co contraction of abdomen

5-Anterior –stretch basal lift

6-Sustained manual pressure


Perioral pressure:

Procedure-Stimulation is provided by applying firm pressure to patient’s upper lip

-Pressure is maintained for the length of time that the therapist wishes the breath in activated pattern.

PRECAUTIONS-Keep the side of finger on lip to prevent occlusion of nasal passage and use of surgical gloves



  • The response to this stimulus is a brief period of apnea followed by increased epigastric excursions (approx-5 sec)
  • As the stimulus is maintained the epigastric excursion may increase so that movt is transmitted to upper chest and the pt. appears to be in deep breathing.
  • R.R. may become slower.

      When this is applied to unconscious patient-if the mouth is open it will close, swallowing noted and sucking movt. are evident even in the presence of oral airways


  • Movt in chewing ,sucking ,swallowing have been reported in stroking the lips in comatose pt. due to infantile rooting reflexes.
  • Studies reveal that perioral pressure to reduce spastic m/s tone .it said that perioral pressure would inhibit hypertonus and that if the pt.mouth was open the pressure will close it.
  • Some uses the stimulus as a method of relaxation.


Intercostal stretch:

  • Mech-Reflexive activation of diaphragm by intercostal afferents and its margins.
  • Procedure:This is provided by applying pressure to upper border of a rib in order to stretch the intercostal m/s in a downward direction(not inward)
  • Application of stretch should be timed with exhalation
  • Maintain till pt. achives normal breathing pattern

Can be performed unilaterally or bilaterally on any rib with exception of floating ribs or fractured

  • Observation-The response to this stimulus is a gradual increased in resp. movt. In the area under  and around the stretch.
  • PRECAUTION-Care must be exercised around the female mammary tissues.

-when performed over area of instability as in the presence of paradoxical movt. in upper rib cage over areas of decrease mobility this is an effective procedure

Vertebral pressure:

  • Pressure is applied to uppermost thoracic vertebrae results in increase epigastric excursion in the presence of a relaxed abdominal wall.

Pressure over lower thoracic vertebrae results in inspiratory movt. of apical thorax

  • Mech-Firm pressure is applied directly over the vertebrae of the upper and lower thoracic cage activities the dorsal intercostal muscles

-Pressure should be applied with an upper hand for comfort and must be firm enough to provideintrafusal stretch.

-so patient shoud be in supine  position to eliminate stabilization of patient and to observe patients relaxation.

In every intercostal space the dorsal part of external (insp) & dorsal part of inter (exp) intercostal m/s are antagonistic during quiet breathing.


Co contraction of abdomen:

  • Observation-Increase epigastric movts.

-increase tone in abdominal m/s activation of diaphragm

-decrease girth in obese

-depression of umblicus

  • Pressure is directed across the abdomen produces intrafusal stretch ,thus activating the m/s spindle side contralateral to pressure reached first.AS
  • As those m/s stretched and shortened they stretch the intrafusal fibre of opposive m/s and vice versa and cycle goes on…..

This should be done bilatrally with pressure applied alternately and maintained for some seconds on either side

Anterior stretch basal lift:

  • Procedure-Placing the hands under the ribs of the supine patients and lifting gently upwards.
  • Done uni or bilaterly
  • Observation-As the lift is sustained stretch is maintained and increasing movt. Of the ribs in a lateral and post direction can be seen and felt.
  • Increased epigastric movt. Also often becomes obvious
  • The lift to back places stretch to the spaces between some of the mid thoracic ribs.

The epigastric movt.suggest that the diaphragm is being activated by intercostals.

Dr.vikas dwivedi

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