Percussion Physiotherapy and Its Indications

Introduction:

Percussion is one of the manual techniques used by physical therapists in treating patients with conditions such as cystic fibrosis, chronic pulmonary obstructive disease, and other lung diseases. This technique involves clapping the chest with hands or other recommended equipment to clear out the excessive mucus contents in the lung towards the large airways so the mucus can be brought up and coughed out. It is performed with other techniques, such as postural drainage and vibration. This article will discuss the indications of percussion and how it works in detail.

What Is Percussion Physiotherapy?

Extreme mucus secretions and retention in the lung can interfere with respiration and disrupt the exchange of oxygen and carbon dioxide in the lungs in patients with lung diseases. Patients with increased mucus accumulation in the lungs may improve from chest physiotherapy if performed in the recommended method. One of the effective methods in mucus secretion removal is the percussion technique. An individualized program of secretions removal techniques can improve breathing and gas exchange capabilities. Percussion physiotherapy includes dependent programs that rely on a therapist or a caregiver. This technique involves a rhythmic force applied to the patient's chest wall. The percussion technique is applied on a specific area of the chest wall that corresponds to an underlying involved lung segment.

When Is Percussion Physiotherapy Indicated?

The percussion technique is commonly indicated in patients with respiratory complications who are at high risk of mucus retention in the lung, such as:

• Respiratory diseases involving excess production of high viscous mucus secretions, such as cystic fibrosis, bronchiectasis, chronic pulmonary obstructive disease, and chronic bronchitis.

• Patients who are bedridden for a long time.

• Patients under artificial ventilation who are stable.

• Patients who underwent surgery under general anesthesia and who have incisions that are painful, causing restricted breathing and coughing.

• Elderly patients.

How Does Percussion Physiotherapy Work?

In the lungs of normal and healthy patients, the oxygenated air moves easily through it with the help of tiny hairs referred to as cilia. The mucus lining in the lungs is thin and slippery and plays a huge role in the lung's defense response by trapping unnecessary irritants and expelling them out of the body by coughing them out. This prevents infection. Whereas in patients with lung diseases such as cystic fibrosis, the mucus lining becomes sticky and thick with high viscosity. These thick mucus blocks the air ducts and airway passages, making breathing difficult.

In the percussion technique, the physical therapist uses rhythmic clapping with the hand in a cupped position on the chest wall. Percussion is thought to release excess mucus secretions from the wall of the airways and into the lumen of the airway. This helps in breaking the thick and sticky mucus in the lungs so it can be brought out by coughing. Coupling the percussion technique with the appropriate postural drainage positions for a specific lung segment enhances the probability of secretion removal. Postural drainage is a technique that uses gravity to drain excess mucus secretions from the lungs by changing the patients to various positions.

What Are the Types of Equipment Required for Percussion?

• The commonly used equipment for percussion is the hands of a caregiver or therapist at a cupped position.

• Percussor cups, padded nipples, or pediatric masks are used in providing percussion to infants.

• Pneumatic or electric percussors are available in different frequencies and intensities for elderly and adult patients.

What Are the Necessary Preparations Required for Percussion?

The necessary basic guidelines for percussion physiotherapy are:

• The patients are placed in a comfortable position for the therapy.

• Percussions are not performed on bare skin; they are applied over a thin towel to make it comfortable for the patient.

• The therapists maintain proper bed levels to avoid fatigue.

• The length and duration of the sessions depend on the severity of the condition.

• The recommended timing to perform the therapy is early morning and night.

• It is advised to perform percussions before a meal or two hours after a meal to avoid vomiting.

• The percussion therapy is performed to drain the involved lung segments hence proper anatomical considerations of the lung are necessary for the therapy to be successful.

What Happens During the Percussion Therapy?

The therapist performs the chest percussions over the lung segments that need to be drained with a cupped hand in an alternating rhythmic pattern. They will repeatedly clap over the specific areas of the chest, but it is painless. The cupped hand traps a cushion of air, and the position must be maintained until the treatment ends. This makes a hollow sound with each percussion. Percussions are avoided over the spine, breastbone, and stomach. Percussions over the lower rib (floating ribs) are avoided since it has only a single attachment. This technique breaks up the thick fluid, allowing them to move through the large airways freely. They are performed in coordination with the gravity-assisted postural drainage technique to enhance its effectiveness. This technique is typically administered for three to five minutes over each involved lung segment. The patients are encouraged to perform three to four chest expansions during the percussion. The percussions are performed during both the inspiration and expiration. The mobilized excess mucus secretion to the central airway is expelled out of the lungs using the forced expiratory technique or coughing.

The therapist will perform one session of percussion therapy per day in various positions, such as

• Seated over the table.

• Supine position with a pillow under the knee for support.

• Lying down on the abdomen with pillows under the hip.

The percussions are performed over specific areas of the chest, such as:

• The area between the collarbone.

• Over the sides of the chest.

• The upper and lower back area on both sides.

What Are the Contraindications for Performing Percussion?

Percussions are contraindicated in patients with the following condition such as:

• Patients with cardiac failure.

• Patients with hemoptysis.

• Contraindicated to perform over fractures.

• Over tumors.

• Patients with pulmonary embolism.

• Patients with a recent history of neurosurgery.

Conclusion:

Percussion physiotherapy is one of the chest physical therapy which is performed in patients with severe lung diseases such as cystic fibrosis. It is used in conjunction with the postural drainage technique and forced expiration technique to receive the maximum efficacy of the treatment. This therapy has been shown to improve lung functions in patients with abundant mucus accumulation. However, it cannot be used in patients with minimal secretions, such as primary pneumonia and stable chronic bronchitis. Percussion physiotherapy is indicated in patients with a mucus secretion of more than 30 milliliters per day.