!"#$%&#'()* ,-#$*).

# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
ULMCnSIC1nLkA ] CnLS1 nSIC1nLkA
CvL8ALL CCAL: 1o lmprove Lhe cardloresplraLory funcLlon of Lhe paLlenLs

Speclflc goals of ulmophysloLherapy are as follows:
1. revenL alrway obsLrucLlon and accumulaLlon of secreLlons
2. lmprove alrway clearance and venLllaLlon.
3. lmprove endurance & general exerclse Lolerance.
4. 8educe energy cosLs durlng resplraLlon.
3. revenL or correcL posLural deformlLles and oLher compllcaLlons assoclaLed wlLh
resplraLory dlsorders
6. romoLe relaxaLlon
7. MalnLaln or lmprove chesL moblllLy
8. lmprove cough effecLlveness

CCMCNLN1S CI ULMCnSIC1nLkA kCGkAM
1. oslLlonlng
2. Manual 1echnlques
A. ercusslon
8. vlbraLlon
C. Shaklng
3. Cough
4. SucLlonlng
3. 8reaLhlng Lxerclses
6. ChesL MoblllzaLlon Lxerclse
7. uyspnea 8ellevlng oslLlons
8. Work slmpllflcaLlon & Lnergy conservaLlon Lechnlques

I. 8kLA1nING LkLkCISLS
! deslgned Lo reLraln Lhe muscles of resplraLlon and lmprove or redlsLrlbuLe venLllaLlon,
lessen Lhe work of breaLhlng, and lmprove gas exchange and oxygenaLlon.

A. INDICA1ICNS
1. AcuLe or chronlc lung dlsease (8esLrlcLlve or CbsLrucLlve)
2. 1horaclc & abdomlnal paln due Lo Lrauma or surgery
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2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

3. Alrway obsLrucLlon due Lo bronchospasm or secreLlons
4. SCl and oLher neuropaLhlc condlLlons causlng weakness of Lhe chesL muscles
3. Severe orLhopedlc abnormallLles especlally deformlLles of Lhe splne
6. SLress managemenL

8. GCALS CI 8kLA1nING LkLkCISL
1. lmprove venLllaLlon
2. lmprove effecLlveness of cough mechanlsm
3. revenL aLelecLasls
4. lmprove sLrengLh, endurance & coordlnaLlon of resplraLory muscles, lmprove
efflclency and lessen work of resplraLlon
3. MalnLaln or lmprove chesL and Lhoraclc splne moblllLy
6. CorrecL lnefflclenL or abnormal breaLhlng paLLern
7. romoLe relaxaLlon
8. 1each Lhe paLlenL how Lo deal wlLh shorLness of breaLh aLLacks
9. 8eLraln muscles of resplraLlon

C. GUIDLLINLS AND kLCAU1ICNS
Culdellnes for 1eachlng 8reaLhlng Lxerclses
1. Choose a quleL place.
2. Lxplaln Lhe raLlonale and goals of Lhe exerclse/Lralnlng.
3. Pave Lhe pL. assume a comforLable and relaxed poslLlon and loosen resLrlcLlve cloLhlng.
lnlLlally sLarL ln a seml-lowler's poslLlon (head and Lrunk supporLed aL 43 degrees wlLh hlp
and knee flexed and plllow under Lhe legs).
4. Cbserve and assess Lhe pL's sponLaneous breaLhlng paLLern whlle aL resL and afLer Lhe
acLlvlLy.
3. ueLermlne lf venLllaLory Lralnlng ls lndlcaLed.
6. LsLabllsh a basellne for assesslng changes, progress, and ouLcomes of lnLervenLlon.
7. lf necessary, Leach Lhe paLlenL relaxaLlon Lechnlques. ay parLlcular aLLenLlon Lo Lhe
relaxaLlon of Lhe SCM, upper Lrapezlus and levaLor scapulae.
8. ueLermlne wheLher Lo emphaslze lnsplraLory or explraLory phase of venLllaLlon.
9. uemonsLraLe Lhe deslred breaLhlng paLLern Lo Lhe pL.
10. Pave Lhe pL pracLlce Lhe correcL breaLhlng paLLern ln a varleLy of poslLlons.
11. All breaLhlng paLLerns should be deep, volunLarlly, conLrolled and relaxed
!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
recauLlons!!!
1. never allow pL Lo force exp|rat|on. lL should be relaxed or llghLly conLrolled. 8ecause
forced explraLlon lncreases Lurbulence ln Lhe alrways leadlng Lo bronchospasm and
lncreased alrway resLrlcLlon.
2. uo noL allow pL Lo Lake a h|gh|y pro|onged exp|rat|on. 1hls causes pL Lo gasp wlLh Lhe
nexL lnsplraLlon and Lhe breaLhlng becomes lrregular and lnefflclenL.
3. uo noL allow pL Lo lnlLlaLe lnsplraLlon wlLh Lhe accessory muscles and upper chesL. Advlse
Lhe pL Lhe upper chesL should be relaLlvely quleL durlng breaLhlng.
4. Allow Lhe pL Lo perform deep breaLhlng for only 3 Lo 4 reps Lo avold hypervenLllaLlon.
1LS CI 8kLA1nING LkLkCISL
1A. DIAnkAGMA1IC 8kLA1nING
8aLlonale: Lo lmprove Lhe efflclency of venLllaLlon, decrease work of breaLhlng, lncrease Lhe
excurslon of Lhe dlaphragm and lmprove gas exchange and oxygenaLlon
lndlcaLlons:
- lnefflclenL venLllaLlon
- lncrease work of breaLhlng
- decrease dlaphragmaLlc excurslon
- poor gas exchange and oxygenaLlon
- posLural dralnage Lo moblllze lung secreLlons

rocedure:
1. L poslLlon: seml-lowler. ln Lhls poslLlon, gravlLy wlll asslsL Lhe dlaphragm.
*!""#""$#%&: pL lnlLlaLes breaLhlng paLLern wlLh Lhe accessory muscles (shoulder and neck)
2. 1 lnsLrucLlon: 8elax Lhose muscles by shoulder rolls or shrugs
3. 1 places hls hand/s on Lhe recLus abdomlnls below anLerlor cosLal margln.
4. 1 asks Lhe pL Lo breaLhe ln slowly and deeply Lhrough Lhe nose whlle keeplng Lhe
shoulders and upper chesL quleL, allowlng Lhe abdomen Lo rlse sllghLly.
3. 1 asks Lhen Lhe pL Lo relax and exhale slowly Lhrough Lhe mouLh.
6. racLlce for 3-4x Lhen resL.
* lf pL ls havlng dlfflculLy lnhallng uslng Lhe dlaphram:
7. 1 asks Lhe pL Lo lnhale by snlfflng for several Llmes.
8. Self-monlLorlng: Ask Lh pL Lo place hls hand on Lh abdomen, Lhe hand should rlse sllghLly
durlng lnsplraLlon and fall durlng explraLlon.
9. racLlce uu8L ln varylng poslLlons (slLLlng, sLandlng, walklng or cllmblng sLalrs)
!"#$%&#'()* ,-#$*).# /
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2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved


!"#$ &'()'(*+,&-. /.,+*0, )1 &0, .11.(0, )' 02. /30. )1 -.'0&*30&)'4 5)/6 )1 7/.302&'8 3'9
):;8.' ()',+<=0&)'4 .:(+/,&)' )1 02. 9&3=2/38< 3'9 .:./(&,. (3=3(&0; &' ')/<3* ,+7>.(0,

18. SLGMLN1AL 8kLA1nING
8aLlonale: Lo emphaslze expanslon on problem areas of Lhe lungs or chesL wall
lndlcaLlons:
- hypovenLllaLlon 2 Lo flbrosls, paln, muscle guardlng p surgery, LelecasLs, pneumonla
- sLlff lower rlb 2 Lo chronlc bronchlLls, emphysema, asLhma
- posL surglcal pL conflned ln a semlrecllnlng poslLlon

l. LaLeral CosLal Lxpanslon/ LaLeral 8asal Lxpanslon
- can be carrled ouL '%()*&#+*)), .+ /()*&#+*)),
- lndlcaLed: sLlff lower rlb seen ln chronlc bronchlLls, emphysema or asLhma
rocedure:
1. L poslLlon: hook lylng (progresslon: slLLlng)
2. 1 places hls hands along Lhe laLeral aspecL of Lhe lower rlbs Lo dlrecL pL's aLLenLlon Lo Lhe
areas where movemenL ls Lo occur.
3. 1 asks Lhe pL Lo breaLhe ouL and feel Lhe rlb cage move downward and lnward whlle 1 ls
applylng pressure on Lhe rlbs aL Lhe same Llme.
4. 8efore lnhalaLlon, 1 applles a S downward and |nward Lo faclllLaLe Lhe exLernal
lnLercosLals.
3. 1 applles llghL manual reslsLance Lo Lhe lower rlbs as Lhe pL breaLhes ln Lo lncrease
sensory awareness.
6. 8epeaL Lhe same procedure.
7. 1each pL Lo perform lL lndependenLly or wlLh use of a belL/Lowel ln applylng reslsLance.

ll. osLerlor 8asal Lxpanslon
- lndlcaLed: posL surglcal pL conflned Lo a seml recllnlng poslLlon ln bed

rocedure:
1. L poslLlon: slLLlng whlle leanlng forward on a plllow, sllghLly bendlng Lhe hlps
2. 1 places hands over Lhe posLerlor aspecL of Lhe lower rlbs.
3. 8epeaL same procedure.
!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

1C. UkSLD LI 8kLA1nING
- lL lnvolves llghLly purslng Lhe llp durlng conLrolled exhalaLlon
- keep alrways open by creaLlng a back pressure

8aLlonale:
- decreases resplraLory raLe and work of breaLhlng
- lncreases Lhe Lldal volume
- lmproves exerclse Lolerance

lndlcaLlons:
- CCu (Lo deal wlLh dyspnea, lL can decrease Lhe percelved level of exerLlon durlng acLlvlLy)
rocedure:
1. L poslLlon: anyLhlng as long as pL ls comforLable and relax.
2. 1 asks Lhe pL Lo breaLhe ln slowly and deeply Lhrough Lhe nose and Lhen breaLhe ouL
genLly Lhrough llghLly pursed llps as lf blowlng on and bendlng Lhe flame of a candle buL noL
blowlng lL ouL.

recauLlon:
1. LxplraLlon musL be relaxed and Lhere should be no abdomlnal conLracLlon. 1 places hls
hand on Lhe abdomlnals Lo check.

SuMMA8?
1LS DLSCkI1ICN INDICA1ICN
ulAP8ACMA1lC
88LA1PlnC


- lnvolunLary
- ueslgned Lo lmprove venLllaLlon,
oxygenaLlon & excurslon of
dlaphragm
- used Lo moblllze secreLlon
- 0+#1*'&(.%"2 !3456
7809:39;<5=!<54;
- CCu
- neumonla
- re & osL posLural
dralnage
u8SL-Ll
88LA1PlnC
- promoLes longer explraLlon
- keeps alrway open by creaLlng
- CCu wlLh SC8
- AsLhma
!"#$%&#'()* ,-#$*).# /
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2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

1LS DLSCkI1ICN INDICA1ICN
back pressure ln Lhe alrway
- uec 88, lnc 1v, & lmprove
exerclse Lolerance
- 0+#1*'&(.%"2 !3456 >.+1#>')
#?@(+*&(.%
CLCSSC-
PA8?nCLAL
88LA1PlnC


- lnc lnsplraLory capaclLy & vlLal
capaclLy ln presence of severe mm
weakness
- non- lnvaslve meLhod for
supporLlng venLllaLlon
- Plgh SCl (Cuadrlpleglc),
- osL- ollo
SLCMLn1AL
88LA1PlnC
a. LaLeral cosLal
expanslon
b. osLerlor basal
expanslon

c. 8lghL mlddle lobe
or llngula expanslon
d. Aplcal expanslon



- used Lo expand locallzed areas of
Lhe lungs whlle keeplng Lhe oLhers
quleL

- lmporLanL for bedbound posL-
surglcal paLlenL ln seml-uprlghL
poslLlon

- ALelecLasls
- neumonla
- osL- surglcal cases

ADDI1ICNAL 8kLA1nING 1LCnNIULS
1. kLVLN1ING AND kLLILVING LISCDLS CI DSNLA
L's wlLh CCu may suffer from dyspnea wlLh physlcal exerLlon or when ln conLacL
wlLh allergens. revenLlon of dyspnea can be done by conLrolled breaLhlng Lechnlques,
paclng acLlvlLles and becomlng aware of Lhe whaL acLlvlLy preclplLaLes aLLack. 1eachlng Lhe
pL abouL Lhe slgns of dyspnea may help Lo recognlze aLLacks Lhen pL wlll prompLly sLop Lhe
acLlvlLy and use conLrolled, pursed llp breaLhlng.

!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
0*1(%A - performance of funcLlonal acLlvlLles llke walklng, sLalr cllmblng or work-relaLed Lasks
wlLhln pL's venLllaLory capaclLy.

rocedure:
1. L poslLlon: relaxed, forward-benL posLure ( forward-benL poslLlon can sLlmulaLe
dlaphragmaLlc breaLhlng as Lhe vlscera drops forwards maklng room for Lhe dlaphragm Lo
descend more.
2. use pursed-llp breaLhlng durlng explraLlon Lo conLrol hls breaLhlng.
3. use dlaphragmaLlc breaLhlng durlng lnhalaLlon and mlnlmlze use of accessory muscles.
4. 8epeaL sLeps 2 and 3 unLll dyspnea subslded.

2. CSI1IVL LkIkA1Ck kLSSUkL 8kLA1nING or os|t|ve Lxp|ratory ressure (L)
1herapy
- CeLs alr lnLo Lhe lungs and behlnd Lhe mucus uslng exLra (collaLeral) alrways. L
holds alrways open, keeplng Lhem from closlng. A L sysLem lncludes a mask or
mouLhplece aLLached Lo a reslsLor seL by your Cl care Leam. 1he person breaLhes ln normally
and breaLhes ouL a llLLle harder agalnsL Lhe reslsLance.
- breaLhlng Lechnlque ln whlch reslsLance comlng from a speclally deslgned
mouLhplece or mask ls applled durlng exhalaLlon
- an alLernaLlve Lo posLural dralnage

8aLlonale:
- Lo moblllze accumulaLed secreLlons Lhus lmprove clearance (as lL hold Lhe alrways open
durlng exhalaLlon)

rocedure:
1. L poslLlon: slLLlng comforLably wlLh elbows resLlng on a Lable.
2. 1 asks pL Lo lnhale (Lldal and acLlve buL noL forced) and exhale Lhrough a mouLhplece or
mask.
3. 1 asks Lhe pL Lo hold Lhe lnhalaLlon for 2-3 seconds, Lhen exhales, 10-13 cycles.
4. 1 asks Lhe pL Lo remove Lhe mouLhplece or masks, Lake several huffs" and Lhen cough.

8x: L breaLhlng x 4-6 Llmes x 13 mlnuLes x Cu

!"#$%&#'()* ,-#$*).# /
!"). ). 0123 % .'&&2#4#1(%$3 "%1560'(7 )( *%110( 8# '.#5 %. % $#9#$#1*#:

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

3. kLSIkA1Ck kLSIS1ANCL 1kAINING (kk1)
- aka venLllaLory muscle Lralnlng, lnsplraLory (or explraLory) muscle Lralnlng,
lnsplraLory reslsLance Lralnlng, flow-conLrolled endurance Lralnlng

8aLlonale: Lo Lraln Lhe muscles of lnsplraLlon by
(1) lmprovlng venLllaLlon ln pL's wlLh pulmonary dysfuncLlon assoclaLed wlLh weakness,
aLrophy or lnefflclenL dlaphragm
(2) lmprovlng Lhe cough mechanlsm ln pL's wlLh weak abdomlnals or explraLory muscles

CuLcome measures:
- Lhlckness of Lhe dlaphragm
- maxlmal volunLary venLllaLlon
- decreased use of accessory muscles
- lncreased cough effecLlveness
- vlLal capaclLy, lLv1, lnsplraLory mouLh pressure uslng a splromeLer

recauLlons!!!
uo noL over faLlgue Lhe dlaphragm because unllke exLremlLy muscles, lL cannoL fully resL
Lhus lL does noL fully recover. Slgn of faLlgue ls use of accessory muscles.

VLN1ILA1Ck MUSCLL 1kAINING
- focus on Lralnlng Lhe muscles of lnsplraLlon
o 3 forms of VM1
A. ulaphragmaLlc Lralnlng uslng welghLs
- appllcaLlon of welghLs (3-3 lb) over eplgasLrlc area
8. lnsplraLory reslsLance Lralnlng
- paLlenL lnhales Lhrough a devlce made of narrow Lubes of
varylng dlameLers.
- Lhe narrower Lhe Lube Lhe greaLer Lhe reslsLance
C. lncenLlve 8esplraLory SplromeLry
- form of level reslsLance Lralnlng
- used Lo prevenL alveolar collapse ln posL-op paLlenLs &
sLrengLhen weak lnsplraLory muscles ln neuromuscular dlsease
paLlenLs
!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
0:9B!C<54;D2 !E.(F @+.).%A#F +#"("&*%1# &+*(%(%A .> &G# F(*@G+*A$ "(%1#
&G# F(*@G+*A$ H()) #*"(), >*&(A'#I
8LvLn1lnC & 8LLlLvlnC SPC81PnLSS Cl 88LA1P A11ACkS
1. ConLrolled 8reaLhlng
2. 0*1(%A - performance of funcLlonal acLlvlLles wlLhln Lhe llmlLs of a paLlenL's
breaLhlng paLLern capaclLy.
3. use uyspnea-8ellevlng oslLlons

II. CnLS1 MC8ILI2A1ICN LkLkCISL
! exerclses LhaL comblne acLlve movemenLs of Lhe Lrunk or exLremlLles wlLh deep
breaLhlng
A. GCALS
1. MalnLaln or lmprove moblllLy of Lhe chesL wall Lrunk & shoulders
2. 8elnforce or emphaslze Lhe depLh of lnsplraLlon or conLrolled lnsplraLlon
8. SLCIIIC LkLkCISLS
1. 1o moblllze one slde of Lhe chesL
2. 1o moblllze Lhe upper chesL & sLreLch Lhe pecLoralls muscle
3. 1o moblllze Lhe upper chesL & shoulders
4. 1o lncrease explraLlon durlng deep breaLhlng
3. Wand exerclses

III. CCUGnING LkLkCISL
! Serles of AcLlons LhaL occur when aLlenL Coughs:
1. ueep lnsplraLlon occurs
2. CloLLls closes and vocal cords LlghLen
3. Abdomlnal muscles conLracL and dlaphragm elevaLes
4. CloLLls open
3. Lxploslve explraLlon occurs.
! Cough pump ls effecLlve up Lo Lhe 7
Lh
generaLlon of bronchl ln normal lndlvlduals.
! Pull vS CCuCP

ADDI1ICNAL MLANS CI IACILI1A1ING A CCUGn
1. Manual asslsLed cough
- for paLlenL wlLh abdomlnal weakness
!"#$%&#'()* ,-#$*).# /
!"). ). 0123 % .'&&2#4#1(%$3 "%1560'(7 )( *%110( 8# '.#5 %. % $#9#$#1*#:

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

- can be applled by elLher Lhe LheraplsL or Lhe paLlenL
2. SpllnLlng
3. PumldlflcaLlon
4. 1racheal Llckle
- used wlLh lnfanLs and uncooperaLlve dlsorlenLed paLlenLs
0:9B!C<54;2 ln Leachlng an effecLlve cough never allow Lhe paLlenL Lo suck alr by gasplng.
- Avold forceful coughlng ln CvA & aneurysm
DCB<54;5;J K *)&#+%*&(E# &. 1.'AG(%A
K *)) @*&(#%&" H(&G *+&(>(1(*) *(+H*,"
IV. CS1UkAL DkAINAGL
- Clearlng Lhe alrways of secreLlons by placlng Lhe paLlenL ln varlous poslLlons Lo
aLLaln gravlLy-asslsLed dralnage of mucus
GCAL: 1o faclllLaLe dralnage secreLlons lnLo segmenLal bronchus

INDICA1ICNS:
revent accumu|at|on of secret|ons kemove secret|ons
Chronlc bronchlLs
cysLlc flbrosls
osL-general anesLhesla surglcal px
posL-op paln resLrlcLlng chesL
expanslon & coughlng
x on prolonged bed resL
Medlcally sLable px on venLllaLor
neumonla
ALelecLasls
acuLe lung lnfecLlons
CCu
very weak or elderly
x wlLh arLlflclal alrways
CCN1kAINDICA1ICNS
1. Severe hemopLysls
2. Severe pulmonary edema
3. CongesLlve hearL fallure
4. ulmonary embollsm
3. neumoLhorax
6. Cardlac arrhyLhmla
7. Severe hyperLenslon
!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
8. 8ecenL Ml
9. 8ecenL neurosurgery
CIN1S 1C CCNSIDLk
1. noL done dlrecLly afLer a meal
2. referably ln Lhe mornlng & early evenlng
3. lf secreLlons are Lhlck & coplous, do 2-4 Llmes/day
4. MalnLenance- 1-2 Llmes per day
3. MalnLaln poslLlon for 3-10 mln, lf LoleraLed, or unLll producLlve, lf unproducLlve afLer
3-10 mlns change poslLlon
6. 1oLal duraLlon of LreaLmenL should noL exceed 40-43 mln
7. whenever posslble sLand before paLlenL so 1 can observe hls color
8. aLlenL should do relaxed deep breaLhlng whlle dralnlng
1. Lncourage sharp, double cough, use vlbraLlon afLer several deep breaLhs Lo ellclL a
cough.
INDICA1ICN 1C DISCCN1INUL CS1UkAL DkAINAGL
1. x-ray ls relaLlvely clear
2. aLlenL on regular home program
3. aLlen afebrlle for 24-48 hours
4. Pave normal or near normal breaLh sounds on ausculLaLlon
1LCnNIULS USLD DUkING CS1UkAL DkAINAGL
a. Deep breath|ng
b. Deep cough|ng
c. ercuss|on - rhyLhmlc & alLernaLe sLrlklng of Lhe chesL wall over speclflc lung segmenLs
wlLh cupped hands Lo dlslodge reLalned secreLlons
ConLralnldcaLlons:
1. Cver bony promlnence
2. over breasL Llssue ln females
3. over fracLures, splnal fuslon or osLeoporoLlc bone
4. over Lumor area
3. pulmonary embolus
6. unsLable anglna
7. presence of fluld pus, blood, cavlLaLlons ln lungs
8. chesL wall paln
!"#$%&#'()* ,-#$*).# /
!"). ). 0123 % .'&&2#4#1(%$3 "%1560'(7 )( *%110( 8# '.#5 %. % $#9#$#1*#:

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved

d. V|brat|on
e. Shak|ng
MCDIIILD CS1UkAL DkAINAGL
! CongesLlve hearL fallure paLlenLs wlLh orLhopnea
! osL-neurosurgery paLlenLs where head down poslLlon ls Cl
! CardloLhoraclc posL-surglcal paLlenLs wlLh chesL Lubes/monlLorlng wlres

CS1UkAL DkAINAGL CSI1ICNS

V. Act|ve Cyc|e of 8reath|ng 1echn|que (AC81)
- lnvolves a seL of breaLhlng Lechnlques. lL can be changed Lo meeL each person's
needs. lL geLs alr behlnd mucus, lowers alrway spasm and clears mucus. lL lncludes:
8reaLhlng conLrol - normal, genLle breaLhlng wlLh Lhe lower chesL whlle relaxlng
Lhe upper chesL and shoulders.
1horaclc expanslon exerclses - deep breaLhs ln. Some use a Lhree-second breaLh-
hold Lo geL more alr behlnd Lhe mucus. 1hls may be done wlLh chesL clapplng or
vlbraLlng, followed by breaLhlng conLrol.
lorced explraLlon Lechnlque - huffs of varled lengLhs wlLh breaLhlng conLrol.


SLGMLN1
DkAINLD
CSI1ICN SI1L CI LkCUSSICN
AnLerlor Aplcal SlLLlng, leanlng backward on chalr under clavlcle
osLerlor Aplcal SlLLlng, leanlng forward on Lable Above scapula

AnLerlor Suplne, plllows
under knees & Lhlgh
Males- over nlpple
lemale- above breasL
(L) osLerlor x from prone resLlng on slde, head/shoulder elevaLed
43(1llL Lable). 18"(plllow)
(L) scapula
osLerlor llaL on bed, x Lurn from prone, lle on lefL slde scapula
Llngula x from suplne on slde, 30 head down poslLlon under Lhe (L) breasL
Mlddle lobe x from suplne on lefL slde 30 head down poslLlon under breasL
AnLerlor basal Suplne, plllow below knees
43 head down poslLlon
Cver lower porLlon of
rlbs bllaLerally
osLerlor basal rone, plllow below knees
43 head down poslLlon
Cver lower porLlon of
rlbs bllaLerally
(L) laLeral slde lylng on , 43 head down poslLlon Lower laLeral aspecL of
(L)rlb cage
LaLeral slde lylng on (L), 43 head down poslLlon Lower laLeral aspecL of
rlb cage
Superlor rone, plllow under abdomen ulrecLly below scapula
!"#$%&#'()* ,-#$*).# /
!"#$ #$ &'() * $+,,(-.-'/*0) "*'12&+/3 #/ 4*''&/ 5- +$-1 *$ * 0-6-0-'4-7

2012 | DLS-HSI, CRS PT Dept. | All Rights Reserved
VI. Autogen|c Dra|nage (AD)
- means "self-dralnage." lL uses varled alrflows Lo move mucus. lL alms Lo reach very hlgh
alrflows ln dlfferenL lung parLs. 1hls moves mucus from small Lo large alrways. Au has Lhree
parLs:
ulslodglng mucus
CollecLlng mucus
Clearlng mucus
1he person lnhales Lo dlfferenL levels and Lhen ad[usLs how Lhey breaLhe ouL Lo helghLen
alrflow and move mucus. AL flrsL, Au Lakes hard work and pracLlce. lL ls besL for people over
8 years old.

Reference for I IV:
8#$'-03 97 : 9&(5)3 ;7<7 =>??@A7 !"-0*,-+/#4 BC-04#$- D&+'1*/#&'$ *'1 !-4"'#E+-$3 F/" -17

Reference for V VII:
www.cfvoice.com/info/articles/airway_clearance.jsp

https://docs.google.com/open?id=0BwB7enu3pGzLYXZNeVBnNnA3RWs
(ACBT Video)