respiratory physio

[Martin345]

open question:

why do physios (maybe you?) not like respiratory physio? please list as many reasons as you can. i'm curious to see what you all have to say.

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[somasimple]

Hi Martin,

Many PTs do not like it simply because it is not really easy to met patients spiting and making such noises. I'm daily encountering pts with cystic fibrosis and worked 12 months in a respiratory service at hospital.

I do not forget that without lungs and breathing, I'm only a dead man! I'm using breathing as a first tool with all patients.

So I'm a fan!

[SuperFizz]

I love respiratory physio although I don't get the chance to do it much these days. I have a great Littmans's stethoscope in my clinic but now that I run an outpatient practice I hardly get a chance to use it.

I suppose there was slight dismay on leaving university to find out that after 4 years of cardiopulmonary training (and I exclude CTU/ICU from this comment) the main treatment approach was always postural drainage, percs, vibes, huff, cough, spit - then walk the patient around the ward and give them an incentive spirometer. I am being sarcastic but it is not far from the truth. 4 years to learn that was a pain in the arse. Maybe the teaching needed to be more directed into the finer points of what really matters to the individual. We sure learnt in depth about the conditions, COPD, COAD, CF, Emphysema, Atelectasis, Bronchiectasis, Asbestosis etc. But in practice the routine on the ward was still as shown in the patients notes: DB&LBE, Percs/Vibes, Huff, Cough and walked 50m x 2. Boring - perhaps this is the reason, we don't feel challenged enough and perhaps we can blame the teaching for that?

Now as for ICU/ITU and nasopharyngeal suction, PEEP, CPAP, ultrasonic nebulisers etc, now that way fun. Unfortunately I don't see that in to often in the outpatient clinic

[Martin345]

thanx for your replies

yes superfizz - the routine nature of ward respiratory physio is depressing. there is certainly considerable capacity to do more but the problem arises.... who does the basics? inevitably it is the junior physios and they therefore easily become disappointed unless they get good exposure to the much more meaty stuff.... niv, pulmonary rehab, community work, itu...

the things you mentioned like np suction, ippb, cpap/bipap, us nebs etc should be standard ward stuff.

you can do some good outpatient respiratory stuff but it's huge on the education, minimal on the action. choice of location i suppose...

[charulatak]

I think the reason for not liking cardiorespiratory physiotherapy is due to the lack of enough undergraduate exposure due to limitted hospitals offering undergrad placements, lack of mentors.Also due to high case load,weekend,on call duties etc.
Charulata.

[alophysio]

I agree with you Bernard as well as SuperFizz.

I use breathing control a lot in my outpatients.

I am jaded by the "simple" rountine you do on the wards. I always felt like a second rate nurse doing the dirty work on the wards - even ICU.

I personally prefer outpatient/musculoskeletal work because there is so much more variety (simply because there are more body parts involved) and because I can *see* it, I can *hear* it (crepitus/clunking/clicking/rubbing/etc), I can *feel* it and I am very good at it naturally - good hands but theory needs more work! I can't see or feel the airways, just hear them therefore I don't get as involved.

With cardio physio, I believe it is an essential part of physio and there will always be those who are more interested in it than I am - and I am thankful for that!

I do see simple chesty/pneumonia stuff in my practice but thankfully <0.25%!!!

Keep up the good work - Thank God for you all out there!

[saeidphysio]

Hi
Is it possible give me more information about physiotherapy in C.F /

Thanking you
Saeid

[Physiobase]

Saeid, this would be best posted as a seperate topic , perhaps with a subject heading like "Physio advice for Cystic Fibrosis" 8o

[raghsindia]

hi friends,
i agree with all your comments but i take respiratory physio as a challenge, there is a lot to do by a physio in an icu , i am doing my masters in respiratory physio and i can tell that there is lot to do if we have real interest.
thank you,
raghava.n

[avijansinha]

please sir let me know wt u can do except passive movt,coughing,change the position.be particular that nurse cant do that which u r going to do

[katrussianspy]

I feel that undergraduate training in respiratory physio is very inadequate and this is the primary reason for there being such a dislike for it. Once experience is gained in a hospital setting incorporating a wide range of respiratory exposure I have found that physios really enjoy the work.

As for what we can offer in ICU - if there really was nothing we could offer above and beyond what the nurses do, would we be getting called out? I think that any ICU I have worked on would be dismayed if they were to lose our on-call service as they certainly find it invaluable. This is justification enough for me for our own existence.

[Fiona Schreuder]

If you approach respiratory physio as a technician ie PD, percs, vibs for everyone, then of course it is boring! We are professionals and adult learners and therefore need to create our own challenges. If you think about the underlying physiology and how you are affecting it, even with simple procedures like changing position then respiratory physiotherapy becomes a very interesting and challenging area to work in. I have been working in this area for over 13 years and am still learning more and more about physiology and recent advances. Set yourselves a challenge and always raise the goal posts and any area you work in will be interesting!

[geste123]

What ever you do in the acute set up...that is the routine secretion clearance techniques, it helps in clearing the lungs and improve the sats. but our job doesn't just gets over there....log on to "www.pulmonaryrehab.com.au". You'll find the real resp physio in it. ITS THE PULMONARY REHABILITATION WHICH DEMONSTRATES OUR CLINICAL EXPERTISE AND RESPONSIBILITIES IN A RESPIRATORY SETUP....

hey dont ever stop with coughing and spitting..go ahead with rehab and showcase your skills.

[geste123]

Guys whu r interested can read this meaty stuff in respy fysio!

I jus wanted to find out a classification for all the techniques which would include all that are utilized in respy physio. After a few days of work, i was able to chart out one.

I. Bronchial Hygiene therapy: - includes the following techniques:

- Physio procedures:
1.Postural drainage
2.Suctioning - oro/naso pharyngeal, endo/naso tracheal.

- Active manual techniques:
1.FET's(Directed coughing & Huffing)
2.ACBT
3.Autogenic Drainage
4.ELTGOL

- Adjuncts:
1.Cough assist
2.PAP adjuncts: PEP Devices, CPAP, EPAP.
3.High frequency compression and oscillation: Flutter & Acapella, Intrapulmonary percussive ventilation, Extrathoracic Vest therapy.

II. Lung Expansion therapy: - includes the following techniques:

- Physio procedures:
1.Atelectasis reversal Extrathoracic manipulation.
2.Manual Hyperinflation.

- Active Manual Techniques:
1.Sustained MAximal Inspirations with breath holds (SMI)

- Adjuncts:
1.Incentive spirometry
2.IPPB
3.CPAP

III. Weaning from Ventilator.

IV. Pulmonary Rehabilitation.



Hope you got benefitted by this post...Hav a great future ahead.

[brigitte]

Hi
Is it possible give me more information about physiotherapy in C.F /

Thanking you
Saeid

If you are interested in cf physiotherapy , you can go to the following address : http://www.flower-for-all.org
Please don't hesitate to tell me what you think about it.
Here is my email address : [email protected]

[brigitte]

Hi,
If you are intersted in cf physiotherapy for juniors, don't hesitate to go to :
http://www.flower-for-all.org.
Please tell me what you think about it.
thanks.
brigitte Bouzin
Belgium
email : [email protected]

[hasanj]

Hi ,I love Res.Th you can see the result of your work imm. in other physio treat. you have to wait weeks or monthes to see your jop resul

[sdkashif]

I do not know whether any physio dislikes the respiratory physiotherapy or not? It could be due to personal preference or an aptitude of physiotherapist or the dislikeness could be due to the ignorance and lack of knowledge in the respiratory physiotherapy. Infact, respiratory physiotherapy in my personal experience is very easy, informative and one in which you may see the results of your techniques at the bed side of patients. So a easy and very demanding job for physios. It is just some perosnal views as I have no idea the others would agree or not with me.

[tamara]

I'm young physiotherapist on specialization for Cardiorespiratory Physiotherapy in Institute Igalo in Montenegro.
Thank you all...I learn lot of you.