Direct indications are breathing problems itself. Breathing problems can involve both breathing in (inhalation) and breathing out (exhalation). Treat the sternal, costal, and diaphragmatic areas to improve inspiration. Exercise the abdominal muscles to strengthen forced exhalation.

Indirect indications are for chest mobilization, trunk and shoulder mobility, active recuperation after exercise, relief of pain, relaxation and to decrease spasticity.

All the procedures and techniques are used in this area of care. Hand alignment is particularly important to guide the force in line with normal chest motion. Use the stretch reflex to facilitate the initiation of inhalation. Continue with Repeated Stretch through range (Repeated Contractions) to facilitate an increase in inspiratory volume. Appropriate resistance strengthens the muscles and guides the chest motion. Preventing motion on the stronger or more mobile side (timing for emphasis) will facilitate activity on the restricted or weaker side. Combination of Isotonics is useful when working on breath control. The patient should do breathing exercises in all positions. Emphasize treatment in functional positions.

— Place both hands on the sternum and apply oblique downward pressure (caudal and dorsal, towards the sacrum) (O Fig. 13.20 a).

— Apply pressure on the lower ribs, diagonally in a caudal and medial direction, with both hands. Place your hands obliquely with the fingers following the line of the ribs (O Fig. 13.20 b). Exercise the upper ribs in the same way, placing your hands on the pectoralis major muscles.

O Fig. 13.20. Breathing in the supine position: the sternum; b pressure on the lower ribs

: a pressure on a

O Fig. 13.20. Breathing in the supine position: the sternum; b pressure on the lower ribs

: a pressure on

— Use one hand on the sternum, the other on the back to stabilize and give counter pressure.

— Ribs: Put your hands on the area of the chest you wish to emphasize. Give the pressure diagonally in a caudal and medial direction to follow the line of the ribs. Point your fingers point in the same direction. In side lying the supporting surface will resist the motion of the other side of the chest).

— Give pressure caudally along the line of the ribs. Place your hands on each side of the rib cage over the area to be emphasized. Your fingers follow the line of the ribs.

Prone on Elbows (O Fig. 13.23)

— Place one hand on the sternum and give pressure in a dorsal and caudal direction. Put your other hand on the spine at the same level for stabilizing pressure.

— Use the prone position hand placement and pressures.

Fig. 13.21. Breathing in a side lying position

Fig. 13.22. Breathing in the prone position
O Fig. 13.23. Breathing in a prone position supported on the forearms

Fig. 13.21. Breathing in a side lying position

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