Manual Techniques

• Percussion:

  • Percussion is rhythmic "clapping" of cupped hands over area of retained secretions
  • May be performed by an assistant
  • Thought to produce energy wave transmitted through chest wall causing turbulence and compression of air within airways in babies
  • This causes vibration and consequent loosening of secretions which may be cleared by additional techniques
  • Use in conjunct with Thoracic Expansion Exercises to prevent desaturation
  • In babies use intermittent percussion
• Vibration and Shaking:

  • Techniques consist of intermittent chest wall compression performed through expiratory phase of thoracic expansion exercises
  • Performed over the area of secretions
  • Increases peak expiratory flowrate and therefore shears mucus off the airway walls
  • Correct timing is essential!
• Technique of shaking and vibration:

  • Vibrations – performed using therapist's hands and arms to create oscillations of small amplitude and high frequency
  • Shaking – utilises therapist's arms and body to create oscillations of large amplitude and lower frequency
• Precautions/Contraindications:

  • Osteoporosis
  • Haemoptysis
  • Fractured ribs
  • Bronchospasm
  • Breathlessness
  • Surgical incisions
  • Be careful in the presence of ICDs and portacaths