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.
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.
4-Co contraction of abdomen
5-Anterior –stretch basal lift
6-Sustained manual 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 pt.to 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.
- 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
- 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.