Manual/Mechanical Techniques

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Chapter 36 Manual/Mechanical Techniques

36.1 Percussion and Vibration of the Chest

OVERVIEW.

Percussion is a manual technique of administering rhythmic, alternating, cupped-hand movements over lung segments to dislodge and mobilize secretions that adhere to lung tissue. Vibration is a technique of administering small-amplitude rapid shaking over lung tissue to mobilize secretions.¹ In both techniques, forces are applied over the thorax.

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Seven sources cited a total of 46 concerns for percussion and vibration of the chest. Concerns ranged from 5 to 34 per source, with a physical therapist citing the largest number and another three physical therapy sources citing the fewest number. The largest proportion of concerns was related to diseases of the respiratory system (>25% of concerns). The most frequently cited concern was osteoporosis of the ribs and hemoptysis. The AARC listed two absolute contraindications: active hemorrhaging with hemodynamic instability and unstable spinal injury.

OTHER CONCERNS: INTRAVENTRICULAR HEMORRHAGES IN PREMATURE INFANTS.

In a 1987 RCT, Raval et al ² reported a higher incidence of IVH (grade 3 and 4) in preterm infants, less that 2000 g, with respiratory distress syndrome who received vibration, percussion, postural drainage, and suctioning than in controls who received only suctioning. In a 1998 case control design (chart review), Harding et al³ noted that of 454 infants, 13 preterm babies who had received two to three times as many chest PT treatments in the second to fourth week of life as compared with controls had encephaloclastic porencephaly (a form of brain damage).