Quote Originally Posted by rahul View Post
plz tell about MODIFIED POSTURAL DRAINAGE
Postural Drainage positioning has been explained fully as above. You can adapt these positioning or in other words can modify them according to the suitability or needs of the patients. For example, many patients with head injury or raised intracranial pressure can not tolerate the head down positions. Some patients can not lie flat without become dyspnoeic. In some patients ventilation/perfusion mismatch results as a result of some positioning and so these patients may require those positioning in which maximum oxygen saturation is expected. If a patient is likely to become dyspnoeic or breathless by conventional postural drainage, it is better to position him in high side lying position or as flat as possible. The foot of the bed can be elevated as the patient condition improves. Oxygen saturation is maximum in half lying and high side lying and decreases with head down positions.

In some circumstances, it is possible to raise the head of bed, an alternative position can be used. Two or three pillows are used over a 15 cm piles of news papers or magazines and the patient can lie over this so that the chest is tilted downward. It is important that shoulders do not rest on pillows supporting patient's head. This method can be used for drainage of lower segments when necessary and is often a useful method for home postural drainage.

Postural drainage contra indications and precautions should be followed to select the suitibility of postural drainage positions for patients. Have a look over them.

1- Head injuries including CVA (Stroke) because intracranial pressure would be increased.

2- Severe Hypertension as venour return is increased with tipping and this can overload the heart.

3- Following oesophagectomy there can be undue stress on the anastmosis and tipping may cause regurgitation.

4- Severe haemoptysis, when all forms of physiotherapy should be discontinued until there has been discussion with doctors.

5- Aortic aneurysm which would be put under tension as the patient is tipped.

6- Pulmonary oedema which collects in the dependent areas; postural drainage would cause extreme dyspnoea and probably worsen the situation.

7- Surgical emphysema which might track towards the face if the patient is tipped and might result in dyspnoea.

8- Tension Pneumothorax without an intercostal drain. This condition should not require physiotherapy, but must never be tipped as cardiac embarrasment may lead to cardiac arrest.

9- Cardiac Arrhythmias which can be worsened by postural drainge; in some conditions myocardial oxygen demand would be greater and so its sensitivity to abnormal rhythm is increased.

10- Hiatus hernia should not be tippedas the patient may regurtitate gastric juices.

11- The filling cycle of peritoneal dialysis. The descent of diaphragm is impeded during this phase and tipping may cause more respiratory distress.

12- Facial oedema from burns will be inreased with tipping.

13- Eye operations where there may some associated oedema which may be increased in tipping.