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Chest Physical Therapy

Chest physical therapy

Definition

Chest physical therapy is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body. Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises, and coughing. In the early 2000s, some newer devices, such as the positive expiratory pressure (PEP) valve and the flutter device, have been added to the various chest physical therapy techniques. Chest physical therapy is normally done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administering expectorant drugs.

Description

Good respiratory health is not possible without efficient clearance of secretions in the airway. In a healthy person, this is normally accomplished through two mechanisms: the mucociliary clearance system (MCS) and the ability to cough . There are many diseases and disabilities in children linked with poor lung health and an impaired ability to clear secretions. These include cystic fibrosis, asthma, cerebral palsy, muscular dystrophy , and various immunodeficiency disorders. When a child is unable to clear mucus, breathing becomes hard work. He or she must expend extra effort and energy in order to get oxygen. This difficulty can lead to a vicious cycle of recurrent episodes of inflammation, respiratory infections, lung damage, increased production of excess mucus, and possibly airway obstruction. Chest physical therapy is one way to reduce the risks of an inefficient clearance of airway secretions. Depending on the specific technique and health situation, chest physical therapy may be used on children from newborns to adolescents.

Various methods of chest physical therapy have been used since the early 1900s to help manage airway clearance disorders. The techniques have been refined since that time. The procedure may be performed by a respiratory therapist, a nurse, or a trained family member. However, chest physical therapy presents some challenges and requires skill and training in order to be safely and effectively performed.

Chest physical therapy is a method of clearing the airway of excess mucus. It is based on the theory that when various areas of the chest and back are percussed, shock waves are transmitted through the chest wall, loosening the airway secretions. If the child is positioned appropriately, the loosened secretions will then drain into the upper airways, where they can then be cleared using coughing and deep breathing techniques. The following techniques are all part of chest physical therapy.

Turning

Turning from side to side permits lung expansion. The child may turn on his or her own, or be turned by a caregiver. Turning should be done at a minimum of every two hours if the child is bedridden. The head of the bed can also be elevated in order to promote drainage.

Coughing

Coughing helps to break up secretions in the lungs so that the mucus can be expectorated or suctioned out if necessary. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. This procedure is repeated several times a day.

Deep breathing

Deep breathing helps expand the lungs and forces an improved distribution of the air into all sections of the lungs. The patient either sits in a chair or sits upright in bed and inhales then pushes the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

Because of the mind-body awareness required to perform coughing and deep breathing exercises, they are unsuitable for most children under the age of eight.

Postural drainage

Postural drainage uses the force of gravity to assist in effectively draining secretions from the smaller airways into the central airway where they can either be coughed up or suctioned out. The child is placed in a head- or chest-down position and is kept in this position for up to 15 minutes. To obtain the head-down positions, the use of a pillow, beanbag chair, or couch cushions can be helpful. Often, percussion and vibration are performed in conjunction with postural drainage.

Percussion

Percussion involves rhythmically striking the chest wall with cupped hands. It is also called cupping or clapping. The purpose of percussion is to break up thick secretions in the lungs so they can more easily be removed. Percussion is performed on each lung segment for one to two minutes at a time. Mechanical percussors are available and may be suitable for children over two years of age. The percussor is moved over one lobe of the lung for approximately five minutes, while the patient is encouraged to performing coughing and deep breathing techniques. This process is repeated until each segment of the lung is percussed.

Vibration

As with percussion, the purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Positive expiratory pressure (PEP)

PEP therapy has been extensively tested and is equivalent to standard chest physical therapy. It is an airway clearance method that is administered by applying a mechanical pressure device to the mouth. By breathing out with a moderate force through the resistance of the device, a positive pressure is created in the airways that helps to keep them open. This positive pressure permits airflow to reach beneath the areas of mucus obstruction and to move the mucus toward the larger airways where it can be expectorated. This technique may be suitable for alert, cooperative children over the age of four.

Flutter

The flutter valve is a hand-held mucus clearance device designed to combine positive expiratory pressure (PEP) with high frequency airway oscillations. The device looks like a pipe containing an inner cone that cradles a steel ball sealed with a perforated cover. Exhalation through the device results in a vibration of the airway walls, which in turn loosens secretions. It may be a suitable technique for children aged five years and over.

A child is considered to have responded positively to chest physical therapy if some, but not necessarily all, of the following changes occur:

  • increased volume of sputum secretions
  • changes in breath sounds
  • improved chest x ray
  • increased oxygenation of the blood as measured by arterial blood gas sampling
  • the child's report of increased ease in breathing

Precautions

Chest physical therapy should not be performed on those children with the following:

  • bleeding in the lungs
  • head or neck injuries
  • fractured ribs
  • collapsed lungs
  • acute asthma
  • pulmonary embolism
  • active hemorrhage
  • some spinal injuries
  • open wounds or burns

Preparation

The child should be taught about the necessity and rationale for chest physical therapy. It may be a challenge to get children to cooperate with the procedure. Providing a toy, watching a video, or giving a reward may be ways to encourage cooperation.

Aftercare

Many children may wish to perform oral hygiene measures after therapy to lessen the poor taste of the secretions they have expectorated.

Risks

The risks and complications associated with chest physical therapy are dependent upon the health of the child. Although chest physical therapy normally poses few problems, in some patients it may cause the following:

  • oxygen deficiency if the head is kept lowered for drainage
  • increased intracranial pressure
  • temporary lowering of blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhalation of secretions into the lungs
  • heart irregularities

KEY TERMS

Coughing In chest physical therapy, coughing is used to help break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs.

Deep breathing Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales.

Mucociliary escalator The coordinated action of tiny projections on the surfaces of cells lining the respiratory tract, which moves mucus up and out of the lungs.

Percussion An assessment method in which the surface of the body is struck with the fingertips to obtain sounds that can be heard or vibrations that can be felt. It can determine the position, size, and consistency of an internal organ. It is performed over the chest to determine the presence of normal air content in the lungs, and over the abdomen to evaluate air in the loops of the intestine.

Postural drainage The use of positioning to drain secretions from the bronchial tubes and lungs into the trachea or windpipe where they can either be coughed up or suctioned out.

Vibration The treatment that is applied to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Parental concerns

Because chest physical therapy is often prescribed for childrven with chronic health problems, parents are often required to learn the techniques so the procedure can be performed regularly at home. Many parents are fearful they might hurt their child or may perform the procedure incorrectly. They should be reassured that thousands of parents have learned how to perform chest physical therapy and do so safely and effectively.

Resources

PERIODICALS

"MaintainingHealthyLungs:The Role of Airway Clearance Therapy."The Exceptional Parent 31(August2001):12633.

ORGANIZATIONS

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. Web site: <www.cff.org>.

WEB SITES

"Chest Physical Therapy." Dr. Joseph F. Smith Medical Library, 2003. Available online at <www.chclibrary.org/micromed/00042330.html> (accessed December 8, 2004).

"Cystic Fibrosis Center, Airway Clearance Center." University of Wisconsin Medical School Department of Pediatrics, 2004. Available online at <www.pediatrics.wisc.edu/patientcare/cf/acc.html> (December 8, 2004).

Deanna M. Swartout-Corbeil, RN

Tish Davidson A.M.

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Chest Physical Therapy

Chest Physical Therapy

Definition

Chest physical therapy is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body. Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises, and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs. Some people who may receive chest physical therapy include people with cystic fibrosis or neuromuscular diseases like Guillain-Barré syndrome, progressive muscle weakness (myasthenia gravis ), or tetanus. People with lung diseases such as bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD) also benefit from chest physical therapy. People who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do some people who are bedridden, confined to a wheelchair, or who cannot breathe deeply because of postoperative pain.

Precautions

Chest physical therapy should not be performed on people with

  • bleeding from the lungs
  • neck or head injuries
  • fractured ribs
  • collapsed lungs
  • damaged chest walls
  • tuberculosis
  • acute asthma
  • recent heart attack
  • pulmonary embolism
  • lung abscess
  • active hemorrhage
  • some spine injuries
  • recent surgery, open wounds, or burns

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes, outpatient clinics, and at the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone from a respiratory care therapist to a trained member of the patient's family. Different patient conditions warrant different levels of training.

Chest physical therapy consists of a variety of procedures that are applied depending on the patient's health and condition. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.

Turning

Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times a day.

Deep breathing

Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

Postural drainage

Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion

Percussion is rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Vibration

As with percussion, the purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Preparation

The only preparation needed for chest physical therapy is an evaluation of the patient's condition and determination of which chest physical therapy techniques would be most beneficial.

Aftercare

Patients practice oral hygiene procedures to lessen the bad taste or odor of the secretions they spit out.

KEY TERMS

Coughing Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times per day.

Deep breathing Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

Percussion This consists of rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Postural drainage This technique uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.

Turning Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Vibration The purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Risks

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, in some patients it may cause

  • oxygen deficiency if the head is kept lowered for drainage
  • increased intracranial pressure
  • temporary low blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhaling secretions into the lungs
  • heart irregularities

Normal results

The patient is considered to be responding positively to chest physical therapy if some, but not necessarily all, of these changes occur:

  • increased volume of sputum secretions
  • changes in breath sounds
  • improved vital signs
  • improved chest x ray
  • increased oxygen in the blood as measured by arterial blood gas values
  • patient reports of eased breathing

Resources

ORGANIZATIONS

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) 344-4823. http://www.cff.org.

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Chest Physical Therapy

Chest Physical Therapy

Definition

Chest physical therapy (CPT) is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body.

Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, breathing exercises, coughing, and incentive spirometry. CPT is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs.

Patients who may receive chest physical therapy include those with cystic fibrosis, neuromuscular diseases (such as Guillain-Barre syndrome), progressive muscle weakness (such as myasthenia gravis), or tetanus. People with lung diseases such as pneumonia, bronchitis, and some forms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis, also benefit from chest physical therapy. CPT should not be used in the treatment of patients diagnosed with asthma.

People without specific lung problems but who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do those who are bedridden or confined to a wheelchair. In addition, CPT may be part of treatment after surgery for patients who develop difficulty taking deep breaths.

Precautions

While the doctor ultimately determines which type of therapy can be performed, health care professionals know that not all forms of chest physical therapy are appropriate for all patients. Postural drainage and percussion should not be administered to patients who:

  • have just eaten or are vomiting
  • have acute asthma or tuberculosis
  • have brittle bones or broken ribs
  • are bleeding from the lungs or are coughing up blood
  • are experiencing intense pain
  • have increased pressure in the skull
  • have head or neck injuries
  • have collapsed lungs or a damaged chest wall
  • recently experienced a heart attack
  • have a pulmonary embolism or lung abscess
  • have an active hemorrhage
  • have injuries to the spine
  • have open wounds or burns
  • have had recent surgery

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes, outpatient clinics, and in the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone ranging from a respiratory care therapist to a trained member of the patient's family. Patients can be taught to perform some therapies.

Lengths of therapies and their costs vary. Some therapies may be part of ongoing treatment for a chronic condition. Special equipment may be needed for some procedures, such as percussion, and may be covered by the patient's health plan.

Chest physical therapy encompasses a variety of procedures; which ones are applied depends on the patient's needs. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.

Turning

Turning from side to side permits lung expansion. Patients who cannot turn themselves are turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. However, for patients with conditions like COPD, it can be painful to cough normally. An important part of chest physical therapy is teaching patients to clear their airways by gentler methods, such as with a controlled cough or by "huffing."

Before either technique, patients are advised to sit upright and drink a glass of water. For the controlled cough, patients purse their lips and take a deep breath. They hold their breath for several seconds and then make two brief, gentle coughs. Huffing also starts with pursing the lips and taking a deep breath. After holding the breath for several seconds, patients exhale by using the stomach muscles to push the air out. The vocal chords remain open so that the cough has almost a whispery sound. Coughing and huffing are repeated several times a day as needed.

Deep breathing exercises

Deep breathing helps expand the lungs and forces better distribution of the air into all areas. The patient may initially need to lie down to do these exercises, but eventually it is done while sitting upright, then while walking.

Patients may find it helpful to monitor their breathing by placing a hand on their abdomen to provide a sense of their regular breathing pattern. The patient then starts by taking a deep breath through the nose, then purses the lips as if to whistle. The patient then exhales the air slowly through pursed lips. The exhalation should take twice as long as the inhalation. A patient may start by inhaling for two seconds and then exhaling for four. After taking several deep breaths, the patient breathes at a normal rhythm and begins another cycle of deep breathing. The patient builds up to taking deeper breaths, following a schedule given by the health care team. Generally, COPD patients practice deep breathing exercises for 20 minutes each day.

Incentive spirometry

The incentive spirometer helps the patient improve lung function. This self-administered therapy involves inhaling into a tube attached to a device. The specific technique and goal depends on the type of spirometer. The patient receives directions from the doctor, nurse, or respiratory therapist.

With a breath flow-oriented device, the patient inhales through a tube to raise a ball inside the plastic spirometer chamber. The drop in pressure causes the ball to rise, and the goal is to keep the ball in the air for as long as possible.

For a volume-oriented device, the patient sets a pointer on the chamber at the desired breath volume level. The patient inhales into the tube and attempts to raise a piston inside the chamber so that the volume marker reaches that level.

Hybrid volume accumulators combine a floworiented device with a volume-oriented device. A piston inside a cylinder responds to negative pressure from the patient's inhalation.

Some devices have a component designed for exhalation. If the model does not include an exhaling function, the patient breathes out air naturally.

At the end of the session, the patient takes a deep breath and then coughs. The length of therapy and the number of exercises done depend on the patient's condition and is determined by a respiratory therapist or other health professional.

Postural drainage

Postural drainage uses gravity to assist in draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. This therapy generally lasts a maximum of 30 minutes. If various positions are tried to induce a cough, the patient may remain in one position for from five to 15 minutes. The health care team guides the patient in determining the amount of time needed. Each position reaches a specific area of the lungs. Chest drainage positions include:

  • the patient seated with head back
  • the patient seated with head bent forward
  • the patient lying face up with feet higher than the head
  • the patient lying face down with feet higher than the head
  • the patient lying first on one side, then the other, with feet higher than the head

Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Patients at home are given schedules set by their doctor or respiratory therapist. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion

Percussion, also called cupping or clapping, involves rhythmically striking the chest wall with cupped hands. Mechanical devices can also be used. Percussion results in breaking up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Vibration

Vibration therapy is done for one minute after percussion therapy or may be used instead of percussion therapy for patients who may be too sore or frail to tolerate percussion. The purpose is also to help break up lung secretions. Vibration can be performed either mechanically or manually. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Preparation

Preparation for chest physical therapy starts with an evaluation of the patient's condition to determine which chest physical therapy techniques would be most beneficial. Since most therapies are done at home, patient education is extremely important. The doctor, nurse, physical therapist, or respiratory therapist instructs the patient or caregiver in chest physical therapy techniques. The therapy should be explained and demonstrated by the health professional. Then the patient or caregiver should try the therapy. This will demonstrate whether the patient understands the therapy or if more instruction is needed.

Aftercare

Patients should be advised to practice oral hygiene procedures to lessen the bad taste and odor of the secretions that they spit out.

Complications

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, the health care team should be aware that in some patients it may cause:

  • oxygen deficiency if the head is kept lowered for drainage
  • increased intracranial pressure
  • temporary low blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhaling secretions into the lungs
  • heart irregularities

Results

The health care team should tell patients that CPT is often an ongoing treatment, with some or all therapies done daily. A positive response to treatment can be assessed by:

  • increased volume of sputum secretions
  • ease in breathing
  • changes in breath sounds
  • improved vital signs
  • improved chest x ray
  • increased oxygen in the blood as measured by arterial blood gas values

Health care team roles

The doctor typically orders chest physical therapy for a patient. A nurse or respiratory therapist provides therapy when a patient is hospitalized. For people seen on an outpatient basis, the emphasis is generally on patient education.

Patient education

Effective patient education is vital because chest physical therapy is often performed at home. A doctor, nurse, or respiratory therapist explains and demonstrates techniques such as breathing, percussion, and incentive spirometry. The patient or caregiver performs the therapy under the health professional's observation to be sure it can be done correctly independently.

Nurses and respiratory therapists also participate in public awareness education, such as anti-smoking campaigns.

Training

Chest physical therapy is part of training for physicians and nurses specializing in cardiopulmonary treatment, and for respiratory therapists (also known as respiratory care practitioners). Therapists must have at least an associate degree, which is earned after completion of a two-year program. There are also four-year bachelor degree programs for this profession. Graduates with both types of degrees are certified after passing the examination given by the National Board for Respiratory Care.

Resources

BOOKS

Frownfeller, Donna, et al. Principles & Practices of Cardiopulmonary Physical Therapy, 3rd Edition. St. Louis, MO: Harcourt Health Sciences, 1996.

Haas, Francois, and Sheila Sperber Haas. The Chronic Bronchitis and Emphysema Handbook. New York: John Wiley & Sons, 2000.

Hough, Alexandra. Physiotherapy in Respiratory Care. London, UK: Chapman & Hall, 1996.

ORGANIZATIONS

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. 〈http://www.aarc.org〉.

American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062-2348. (847) 498-1400. 〈http://www.chestnet.org〉.

American Lung Association. 1740 Broadway, New York, NY 10019. (212) 315-8700. 〈http://www.lungusa.org〉.

American Physical Therapy Association. 〈http://www.apta.org〉.

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) FIGHT-CF. 〈http://www.cf.org〉.

National Board for Respiratory Care. 830 Nieman Road, Lenexa, KS 66214. (913) 599-4200. 〈http://www.nbrc.org〉.

National Heart, Lung, and Blood Institute. National Institutes of Health. Building 31, 4A21, 9000 Rockville Pike, Bethesda, MD 02005. 〈http://www.nhlbi.gov〉.

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Chest Physical Therapy

Chest physical therapy

Definition

Chest physical therapy (CPT) is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body.

Chest physical therapy includes postural drain-age, chest percussion, chest vibration, turning, breathing exercises, coughing, and incentive spirometry. CPT is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs.

Patients who may receive chest physical therapy include those with cystic fibrosis, neuromuscular diseases (such as Guillain-Barré syndrome), progressive muscle weakness (such as myasthenia gravis), or tetanus. People with lung diseases such as pneumonia , bronchitis , and some forms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis, also benefit from chest physical therapy. CPT should not be used in the treatment of patients diagnosedwith asthma .

People without specific lung problems but who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do those who are bedridden or confined to a wheelchair. In addition, CPT may be part of treatment after surgery for patients who develop difficulty taking deep breaths.

Precautions

While the doctor ultimately determines which type of therapy can be performed, health care professionals know that not all forms of chest physical therapy are appropriate for all patients. Postural drainage and percussion should not be administered to patients who:

  • have just eaten or are vomiting
  • have acute asthma or tuberculosis
  • have brittle bones or broken ribs
  • are bleeding from the lungs or are coughing up blood
  • are experiencing intense pain
  • have increased pressure in the skull
  • have head or neck injuries
  • have collapsed lungs or a damaged chest wall
  • recently experienced a heart attack
  • have a pulmonary embolism or lung abscess
  • have an active hemorrhage
  • have injuries to the spine
  • have open wounds or burns
  • have had recent surgery

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes , outpatient clinics, and in the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone ranging from a respiratory care therapist to a trained member of the patient's family. Patients can be taught to perform some therapies.

Lengths of therapies and their costs vary. Some therapies may be part of ongoing treatment for a chronic condition. Special equipment may be needed for some procedures, such as percussion, and may be covered by the patient's health plan.

Chest physical therapy encompasses a variety of procedures; which ones are applied depends on the patient's needs. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.

Turning

Turning from side to side permits lung expansion. Patients who cannot turn themselves are turned by a caregiver . The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. However, for patients with conditions like COPD, it can be painful to cough normally. An important part of chest physical therapy is teaching patients to clear their airways by gentler methods, such as with a controlled cough or by “huffing.”

Before either technique, patients are advised to sit upright and drink a glass of water. For the controlled cough, patients purse their lips and take a deep breath. They hold their breath for several seconds and then make two brief, gentle coughs. Huffing also starts with pursing the lips and taking a deep breath. After holding the breath for several seconds, patients exhale by using the stomach muscles to push the air out. The vocal chords remain open so that the cough has almost a whispery sound. Coughing and huffing are repeated several times a day as needed.

Deep breathing exercises

Deep breathing helps expand the lungs and forces better distribution of the air into all areas. The patient may initially need to lie down to do these exercises, but eventually it is done while sitting upright, then while walking.

Patients may find it helpful to monitor their breathing by placing a hand on their abdomen to provide a sense of their regular breathing pattern. The patient then starts by taking a deep breath through the nose, then purses the lips as if to whistle. The patient then exhales the air slowly through pursed lips. The exhalation should take twice as long as the inhalation. A patient may start by inhaling for two seconds and then exhaling for four. After taking several deep breaths, the patient breathes at a normal rhythm and begins another cycle of deep breathing. The patient builds up to taking deeper breaths, following a schedule given by the health care team. Generally, COPD patients practice deep breathing exercises for 20 minutes each day.

Incentive spirometry

The incentive spirometer helps the patient improve lung function. This self-administered therapy involves inhaling into a tube attached to a device. The specific technique and goal depends on the type of spirometer. The patient receives directions from the doctor, nurse, or respiratory therapist.

With a breath flow-oriented device, the patient inhales through a tube to raise a ball inside the plastic spirometer chamber. The drop in pressure causes the ball to rise, and the goal is to keep the ball in the air for as long as possible.

For a volume-oriented device, the patient sets a pointer on the chamber at the desired breath volume level. The patient inhales into the tube and attempts to raise a piston inside the chamber so that the volume marker reaches that level.

Hybrid volume accumulators combine a flow-oriented device with a volume-oriented device. A piston inside a cylinder responds to negative pressure from the patient's inhalation.

Some devices have a component designed for exhalation. If the model does not include an exhaling function, the patient breathes out air naturally.

At the end of the session, the patient takes a deep breath and then coughs. The length of therapy and the number of exercises done depend on the patient's condition and is determined by a respiratory therapist or other health professional.

Postural drainage

Postural drainage uses gravity to assist in draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. This therapy generally lasts a maximum of 30 minutes. If various positions are tried to induce a cough, the patient may remain in one position for from five to 15 minutes. The health care team guides the patient in determining the amount of time needed. Each position reaches a specific area of the lungs. Chest drainage positions include:

  • the patient seated with head back
  • the patient seated with head bent forward
  • the patient lying face up with feet higher than the head
  • the patient lying face down with feet higher than the head
  • the patient lying first on one side, then the other, with feet higher than the head

Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Patients at home are given schedules set by their doctor or respiratory therapist. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion

Percussion, also called cupping or clapping, involves rhythmically striking the chest wall with cupped hands. Mechanical devices can also be used. Percussion results in breaking up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Vibration

Vibration therapy is done for one minute after percussion therapy or may be used instead of percussion therapy for patients who may be too sore or frail to tolerate percussion. The purpose is also to help break up lung secretions. Vibration can be performed either mechanically or manually. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Preparation

Preparation for chest physical therapy starts with an evaluation of the patient's condition to determine which chest physical therapy techniques would be most beneficial. Since most therapies are done at home, patient education is extremely important. The doctor, nurse, physical therapist , or respiratory therapist instructs the patient or caregiver in chest physical therapy techniques. The therapy should be explained and demonstrated by the health professional. Then the patient or caregiver should try the therapy. This will demonstrate whether the patient understands the therapy or if more instruction is needed.

Aftercare

Patients should be advised to practice oral hygiene procedures to lessen the bad taste and odor of the secretions that they spit out.

Complications

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, the health care team should be aware that in some patients it may cause:

  • oxygen deficiency if the head is kept lowered for drainage
  • increased intracranial pressure
  • temporary low blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhaling secretions into the lungs
  • heart irregularities

Results

The health care team should tell patients that CPT is often an ongoing treatment, with some or all therapies done daily. A positive response to treatment can be assessed by:

  • increased volume of sputum secretions
  • ease in breathing
  • changes in breath sounds
  • improved vital signs
  • improved chest x ray
  • increased oxygen in the blood as measured by arterial blood gas values

Caregiver concerns

The doctor typically orders chest physical therapy for a patient. A nurse or respiratory therapist provides therapy when a patient is hospitalized. For people seen on an outpatient basis, the emphasis is generally on patient education.

Patient education

Effective patient education is vital because chest physical therapy is often performed at home. A doctor, nurse, or respiratory therapist explains and demonstrates techniques such as breathing, percussion, and incentive spirometry. The patient or caregiver performs the therapy under the health professional's observation to be sure it can be done correctly independently.

Nurses and respiratory therapists also participate in public awareness education, such as anti-smoking campaigns.

Training

Chest physical therapy is part of training for physicians and nurses specializing in cardiopulmonary treatment, and for respiratory therapists (also known as respiratory care practitioners). Therapists must have at least an associate degree, which is earned after completion of a two-year program. There are also four-year bachelor degree programs for this profession. Graduates with both types of degrees are certified after passing the examination given by the National Board for Respiratory Care.

Resources

BOOKS

Frownfeller, Donna, et al. Principles & Practices of Cardiopulmonary Physical Therapy, 3rd Edition. St. Louis, MO: Harcourt Health Sciences, 1996.

Haas, Francois, and Sheila Sperber Haas. The Chronic Bronchitis and Emphysema Handbook. New York: John Wiley & Sons, 2000.

Hough, Alexandra. Physiotherapy in Respiratory Care. London, UK: Chapman & Hall, 1996.

ORGANIZATIONS

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. http://www.aarc.org.

American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062-2348. (847) 498-1400. http://www.chestnet.org.

American Lung Association. 1740 Broadway, New York, NY 10019. (212) 315-8700. http://www.lungusa.org.

American Physical Therapy Association. http://www.apta.org.

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) FIGHT-CF. http://www.cf.org.

National Board for Respiratory Care. 830 Nieman Road, Lenexa, KS 66214. (913) 599-4200. http://www.nbrc.org.

National Heart, Lung, and Blood Institute. National Institutes of Health. Building 31, 4A21, 9000 Rockville Pike, Bethesda, MD 02005. http://www.nhlbi.gov.

Liz Swain

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"Chest Physical Therapy." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Encyclopedia.com. 21 Oct. 2018 <http://www.encyclopedia.com>.

"Chest Physical Therapy." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Encyclopedia.com. (October 21, 2018). http://www.encyclopedia.com/caregiving/encyclopedias-almanacs-transcripts-and-maps/chest-physical-therapy

"Chest Physical Therapy." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Retrieved October 21, 2018 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/encyclopedias-almanacs-transcripts-and-maps/chest-physical-therapy

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Notes:
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  • In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.

Chest Physical Therapy

Chest physical therapy

Definition

Chest physical therapy (CPT) is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs , strengthen respiratory muscles, and eliminate secretions from the respiratory system .

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body.

Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, breathing exercises, coughing, and incentive spirometry. CPT is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs.

Patients who may receive chest physical therapy include those with cystic fibrosis , neuromuscular diseases (such as Guillain-Barré syndrome), progressive muscle weakness (such as myasthenia gravis), or tetanus. People with lung diseases such as pneumonia , bronchitis, and some forms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis, also benefit from chest physical therapy. CPT should not be used in the treatment of patients diagnosed with asthma .

People without specific lung problems but who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do those who are bedridden or confined to a wheelchair. In addition, CPT may be part of treatment after surgery for patients who develop difficulty taking deep breaths.

Precautions

While the doctor ultimately determines which type of therapy can be performed, health care professionals know that not all forms of chest physical therapy are appropriate for all patients. Postural drainage and percussion should not be administered to patients who:

  • have just eaten or are vomiting
  • have acute asthma or tuberculosis
  • have brittle bones or broken ribs
  • are bleeding from the lungs or are coughing up blood
  • are experiencing intense pain
  • have increased pressure in the skull
  • have head or neck injuries
  • have collapsed lungs or a damaged chest wall
  • recently experienced a heart attack
  • have a pulmonary embolism or lung abscess
  • have an active hemorrhage
  • have injuries to the spine
  • have open wounds or burns
  • have had recent surgery

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes , outpatient clinics, and in the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone ranging from a respiratory care therapist to a trained member of the patient's family. Patients can be taught to perform some therapies.

Lengths of therapies and their costs vary. Some therapies may be part of ongoing treatment for a chronic condition. Special equipment may be needed for some procedures, such as percussion, and may be covered by the patient's health plan.

Chest physical therapy encompasses a variety of procedures; which ones are applied depends on the patient's needs. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.

Turning

Turning from side to side permits lung expansion. Patients who cannot turn themselves are turned by a care- giver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. However, for patients with conditions like COPD, it can be painful to cough normally. An important part of chest

physical therapy is teaching patients to clear their airways by gentler methods, such as with a controlled cough or by "huffing."

Before either technique, patients are advised to sit upright and drink a glass of water. For the controlled cough, patients purse their lips and take a deep breath. They hold their breath for several seconds and then make two brief, gentle coughs. Huffing also starts with pursing the lips and taking a deep breath. After holding the breath for several seconds, patients exhale by using the stomach muscles to push the air out. The vocal chords remain open so that the cough has almost a whispery sound. Coughing and huffing are repeated several times a day as needed.

Deep breathing exercises

Deep breathing helps expand the lungs and forces better distribution of the air into all areas. The patient may initially need to lie down to do these exercises, but eventually it is done while sitting upright, then while walking.

Patients may find it helpful to monitor their breathing by placing a hand on their abdomen to provide a sense of their regular breathing pattern. The patient then starts by taking a deep breath through the nose, then purses the lips as if to whistle. The patient then exhales the air slowly through pursed lips. The exhalation should take twice as long as the inhalation. A patient may start by inhaling for two seconds and then exhaling for four. After taking several deep breaths, the patient breathes at a normal rhythm and begins another cycle of deep breathing. The patient builds up to taking deeper breaths, following a schedule given by the health care team. Generally, COPD patients practice deep breathing exercises for 20 minutes each day.

Incentive spirometry

The incentive spirometer helps the patient improve lung function. This self-administered therapy involves inhaling into a tube attached to a device. The specific technique and goal depends on the type of spirometer. The patient receives directions from the doctor, nurse, or respiratory therapist.

With a breath flow-oriented device, the patient inhales through a tube to raise a ball inside the plastic spirometer chamber. The drop in pressure causes the ball to rise, and the goal is to keep the ball in the air for as long as possible.

For a volume-oriented device, the patient sets a pointer on the chamber at the desired breath volume level. The patient inhales into the tube and attempts to raise a piston inside the chamber so that the volume marker reaches that level.

Hybrid volume accumulators combine a flow-oriented device with a volume-oriented device. A piston inside a cylinder responds to negative pressure from the patient's inhalation.

Some devices have a component designed for exhalation. If the model does not include an exhaling function, the patient breathes out air naturally.

At the end of the session, the patient takes a deep breath and then coughs. The length of therapy and the number of exercises done depend on the patient's condition and is determined by a respiratory therapist or other health professional.

Postural drainage

Postural drainage uses gravity to assist in draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. This therapy generally lasts a maximum of 30 minutes. If various positions are tried to induce a cough, the patient may remain in one position for from five to 15 minutes. The health care team guides the patient in determining the amount of time needed. Each position reaches a specific area of the lungs. Chest drainage positions include:

  • the patient seated with head back
  • the patient seated with head bent forward
  • the patient lying face up with feet higher than the head
  • the patient lying face down with feet higher than the head
  • the patient lying first on one side, then the other, with feet higher than the head

Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Patients at home are given schedules set by their doctor or respiratory therapist. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion

Percussion, also called cupping or clapping, involves rhythmically striking the chest wall with cupped hands. Mechanical devices can also be used. Percussion results in breaking up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Vibration

Vibration therapy is done for one minute after percussion therapy or may be used instead of percussion therapy for patients who may be too sore or frail to tolerate percussion. The purpose is also to help break up lung secretions. Vibration can be performed either mechanically or manually. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Preparation

Preparation for chest physical therapy starts with an evaluation of the patient's condition to determine which chest physical therapy techniques would be most beneficial. Since most therapies are done at home, patient education is extremely important. The doctor, nurse, physical therapist, or respiratory therapist instructs the patient or caregiver in chest physical therapy techniques. The therapy should be explained and demonstrated by the health professional. Then the patient or caregiver should try the therapy. This will demonstrate whether the patient understands the therapy or if more instruction is needed.

Aftercare

Patients should be advised to practice oral hygiene procedures to lessen the bad taste and odor of the secretions that they spit out.

Complications

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, the health care team should be aware that in some patients it may cause:• oxygen deficiency if the head is kept lowered for drainage

  • increased intracranial pressure
  • temporary low blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhaling secretions into the lungs
  • heart irregularities

Results

The health care team should tell patients that CPT is often an ongoing treatment, with some or all therapies done daily. A positive response to treatment can be assessed by:

  • increased volume of sputum secretions
  • ease in breathing
  • changes in breath sounds
  • improved vital signs
  • improved chest x ray
  • increased oxygen in the blood as measured by arterial blood gas values

Health care team roles

The doctor typically orders chest physical therapy for a patient. A nurse or respiratory therapist provides therapy when a patient is hospitalized. For people seen on an outpatient basis, the emphasis is generally on patient education.

Patient education

Effective patient education is vital because chest physical therapy is often performed at home. A doctor, nurse, or respiratory therapist explains and demonstrates techniques such as breathing, percussion, and incentive spirometry. The patient or caregiver performs the therapy under the health professional's observation to be sure it can be done correctly independently.

Nurses and respiratory therapists also participate in public awareness education, such as anti-smoking campaigns.

Training

Chest physical therapy is part of training for physicians and nurses specializing in cardiopulmonary treatment, and for respiratory therapists (also known as respiratory care practitioners). Therapists must have at least an associate degree, which is earned after completion of a two-year program. There are also four-year bachelor degree programs for this profession. Graduates with both types of degrees are certified after passing the examination given by the National Board for Respiratory Care.

Resources

BOOKS

Frownfeller, Donna, et al. Principles & Practices of Cardiopulmonary Physical Therapy, 3rd Edition. St. Louis: Harcourt Health Sciences, 1996.

Haas, Francois, and Sheila Sperber Haas. The Chronic Bronchitis and Emphysema Handbook. New York: John Wiley & Sons, 2000.

Hough, Alexandra. Physiotherapy in Respiratory Care. London: Chapman & Hall, 1996.

ORGANIZATIONS

American Association for Respiratory Care. 11030 Ables Lane, Dallas, TX 75229. <http://www.aarc.org>.

American College of Chest Physicians. 3300 Dundee Road, Northbrook, IL 60062-2348. (847) 498-1400. <http://www.chestnet.org>.

American Lung Association. 1740 Broadway, New York, NY 10019. (212) 315-8700. <http://www.lungusa.org>.

American Physical Therapy Association. www.apta.org.

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) FIGHT-CF. <http://www.cf.org>.

National Board for Respiratory Care. 830 Nieman Road, Lenexa, KS 66214. (913) 599-4200. <http://www.nbrc.org>.

National Heart, Lung, and Blood Institute. National Institutes of Health. Building 31, 4A21, 9000 Rockville Pike, Bethesda, MD 02005. <http://www.nhlbi.gov>.

Liz Swain

Cite this article
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"Chest Physical Therapy." Gale Encyclopedia of Nursing and Allied Health. . Encyclopedia.com. 21 Oct. 2018 <http://www.encyclopedia.com>.

"Chest Physical Therapy." Gale Encyclopedia of Nursing and Allied Health. . Encyclopedia.com. (October 21, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/chest-physical-therapy-2

"Chest Physical Therapy." Gale Encyclopedia of Nursing and Allied Health. . Retrieved October 21, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/chest-physical-therapy-2

Learn more about citation styles

Citation styles

Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).

Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

http://www.mla.org/style

The Chicago Manual of Style

http://www.chicagomanualofstyle.org/tools_citationguide.html

American Psychological Association

http://apastyle.apa.org/

Notes:
  • Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.
  • In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.