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Active Cycle of Breathing(p.137-141, 155-159)
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Aims
• Clearance of bronchial secretions• ↑ lung function
ACBT
BC TEE Huffing
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Breathing control
• Resting period between active parts of cycle• Tidal breathing, own rate and depth• Upper chest and shoulders relaxed• Diaphragmatic breathing• Inspiration and expiration barely audible
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Thoracic expansion exercises
• Deep breathing emphasizing inspiration• 3-second end-inspiratory hold• Collateral ventilation pathways• Repeat 3 times• Proprioceptive stimulation• “Sniff”• Combined with percussion, shaking or
vibration
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Collateral ventilation pathways
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Forced expiratory technique“Huffing”
• Combination of one or two huffs with BC (5-10s or 10-20s)
• Huffing from low or high lung volumes • With forced expiratory manouvre = dynamic
compression and airway collapse• This less with huffing• As effective, less effort, not as exhausting• Forced but not violent
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ACBT
• Adapted for each patient• In sitting or PD-position• End of Rx = unproductive low lung volume
cough (2 cycles)
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ACBT
BC
TEE
BCHUFF
BC
FET
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ACBT
BC
TEE
BC
HUFF
BC TEE
BC
HUFF
BCFET
FET
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Oscillating positive expiratory pressurep .149-154
• Flutter device• With expiration = PEP and oscillating vibration of
air in airway• Slow breath in, little deeper than normal, hold for
3-5 s.• Expiration through flutter, little faster than
normal, repeat 4-8 times• Deep breath, hold at full inspiration, forced
expiration, can repeat• BC and huff or cough
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Flutter device
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Bubble PEP
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Incentive spirometryp. 163-169
• Increase inspiratory capacity• Slow, deep inspiration with visual feedback• Generate a predetermined flow or achieve
certain volume
• End inspiratory hold• Pattern of breathing = expansion of lower
chest and diaphragmatic breathing
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Incentive spirometry
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References
• Pryor, J.A. and Prasad, S.A. 2009. Physiotherapy for respiratory and cardiac problems. Adult and paediatrics. Edinburgh: Churchill Livingstone
• Images courtesy of Google search engine