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Cardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldCCardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldCardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldEnglishRespiratoryPreschooler (2-4 years);Pre-teen (9-12 years);School age child (5-8 years);Toddler (13-24 months);Teen (13-18 years)Back;Lungs;ChestRespiratory systemNon-drug treatmentAdult (19+) CaregiversNA2020-06-12T04:00:00ZHealth (A-Z) - ProcedureHealth A-Z<p>Cardiopulmonary physiotherapy treatment (CPT) is used to clear mucus from the airways. Learn about the benefits of CPT and the different techniques you can learn to help clear your child’s airways.</p><h2>What is cardiopulmonary physiotherapy treatment?</h2><p>Cardiopulmonary physiotherapy treatment (CPT) is used to treat conditions that can cause mucus buildup in the lower airways of the lungs. CPT techniques can help to loosen mucus in the lungs and move it out of the airways. Clearing the airways helps to treat some types of pneumonia, which may help to improve lung function. If your child has a medical condition that causes mucus buildup in the lower lungs, CPT techniques may help to decrease the frequency of future lung infections. </p> <div class="pdf-page-break"></div> <p>If your child requires treatment, a physiotherapist can assess and determine an appropriate treatment plan for your child at home. They will also teach you how to effectively and safely add CPT into your child’s daily routine. CPT techniques your child’s physiotherapist may prescribe at home include:</p><ul><li>modified postural drainage (positioning) </li><li>percussion</li><li>expiratory vibrations</li><li>suctioning </li><li>mobility and play (e.g. seating strategies, tummy time, yoga ball)</li></ul><h2>Key points</h2><ul><li>Cardiopulmonary physiotherapy treatment can be used in children who have conditions that may cause mucus buildup in the lower areas of the lungs.</li><li>A trained physiotherapist can help you create an individualized pulmonary clearance program/strategy to complete on a regular basis with your child.</li><li>Types of treatments used include modified postural drainage, percussion, expiratory vibrations, suctioning, and mobility and play.</li><li>Percussion and expiratory vibrations can be used in combination with modified postural drainage positions.</li></ul><h2>CPT treatment options</h2><h3>Modified postural drainage</h3><p>Modified postural drainage (MPD) uses gravity to help move mucus from the smaller, lower airways in the lungs up to the larger airways. The mucus is then coughed or suctioned out. </p><p>MPD is performed by placing your child in different positions, based on the location of the different segments of the lungs. This helps with drainage of the lungs. See the section below on "positioning and target area" to learn more about these positions.</p><p>MPD is usually used in combination with other CPTs such as percussion and vibrations. </p><p>Do not tip the head down for postural drainage due to the risk of reflux and subsequent aspiration. </p><h3>Percussion</h3><p>Percussion is used to help loosen and remove the mucus stuck to the walls of the airways. </p><p>To perform percussion, your child is placed in one of the MPD positions (see diagram _________). Then, using a cupped hand, or palm cup (see below), you will gently tap on a designated area of your child’s back or chest for approximately 3-5 minutes. </p> <p>A cupped hand forms to the curve of your child’s chest and creates an air pocket that makes the percussion more comfortable for your child. As a result, the percussion should make a “hollow” sound (not a slapping sound). Percussion should be firm, but never painful, and should not create redness on the skin. A thin blanket can be placed on the chest wall for comfort. </p><p>Be careful not to percuss over your child’s spine, breastbone, stomach or ribs as this can injure your child.</p><div class="asset-2-up"> <figure><span class="asset-image-title">Cupped hand position</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_CuppedHands_Position02_IMG1546.jpg" alt="Slightly cupped hand with palm facing down" /></figure><figure><span class="asset-image-title">Palm cups</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PosturalDrainage_PalmCups.jpg" alt="Two palm cups used for percussions" /></figure></div><h3>Expiratory vibrations</h3> <figure><span class="asset-image-title">Flat hand</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_CuppedHands_Position01_IMG1475.jpg" alt="flat hand with palm facing down" /></figure> <p>Vibrations are used to help gently shake the mucus so it can move from the smaller airways into the larger airways as a child exhales. </p><p>To perform vibrations, place your child in one of the MPD positions recommended by your child’s physiotherapist. Then, using a flat hand (see below) the caregiver places a firm hand on the chest wall over the lung segment of focus.</p><p>The caregiver tenses the muscles of the arm and shoulder to create fine oscillatory movements (vibrations) combined with compression of the child's chest wall during exhalation. The vibrations should be performed in the direction of rib movement. Exhalation should be as slow and as complete as possible.</p><h2>Positioning and target area </h2><p>For the following lung segments refer to the inset picture. These pictures show the correct positions for CPT. In the diagrams, shaded areas indicate hand placement where the chest should be percussed or vibrated. A physiotherapist may prescribe only specific segments, or all of them. </p><p> <strong>Note</strong>: All of these positions can be done either on a flat surface, such as a bed, or on your lap. This depends on your child’s age, comfort and needs, as well as how comfortable you feel. </p><div class="pdf-page-break"></div><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P02_UpperLobe_AnteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – anterior segments</h3><p>Position your child flat on their back and treat between their collarbone and nipple. Avoid treatment over breastbone in the centre. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P03_UpperLobe_RightPosteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – right posterior segment</h3><p>With your child positioned flat on their stomach, place a pillow or rolled blanket under the right side of their chest to elevate it slightly. Treat over their right shoulder blade. Avoid treating over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P04_UpperLobe_LeftPosteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – left posterior segment</h3><p>With your child positioned flat on their stomach place 1-2 pillows under the left side of their chest in order to elevate it 45 degrees. Treat over their left shoulder blade. Avoid treatment over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P05_MiddleLobe.jpg" alt="" /> </figure> <h3>Right middle lobe</h3><p>Position your child on their left side at a ¾ turn toward their back. Place a pillow or rolled blanket behind your child for them to lean back against. You can also place a blanket or pillow between their legs for added comfort. Treat close to the right armpit over nipple line . </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P05_Lingula.jpg" alt="" /> </figure> <h3>Lingula (middle of left lung)</h3><p>Position your child on their right side at a ¾ turn toward their back. Place a pillow or rolled blanket behind your child for them to lean against. You can also place a blanket or pillow between their legs to stop them from rolling completely onto their back. Treat close to the left armpit over nipple line. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P06_LowerLobe_AnteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – anterior segments </h3><p>Position your child flat on their back, with a pillow under their legs. Treat over their ribs, about two fingers above the lower edge of the ribcage. Avoid treating over the stomach and very lowest ribs.</p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P07_LowerLobe_LateralSegment.jpg" alt="" /> </figure> <h3>Lower lobe – lateral segments</h3><p>Position your child on their right side, using a rolled blanket or pillow to support them. Treat over their left side, about two fingers above the lower edge of their ribcage. To treat the right side, position your child on their left side.</p></div></div><div class="pdf-page-break"></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P08a_LowerLobe_PosteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – posterior segments </h3><p>Have your child lie flat on their stomach with a pillow under their lower legs. Treat over their ribs, about two fingers above the lower edge of their ribcage. Avoid treating over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_PD_Baby_P08b_LowerLobe_PosteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – posterior segments (alternative option) </h3><p>Depending on their condition, some children are not able to lie flat on their stomachs. For these children, have them lie as far over onto their stomach as possible, with a blanket rolled up under their left side and a pillow between their legs to stop them from lying completely flat. </p></div></div></div> <br> <div class="pdf-page-break"></div><h3>When should you stop CPT? </h3><p>If your child develops increased work of breathing, stop routine CPT and seek assistance from your health-care provider. CPT could make these symptoms worse, and an assessment from a physician, nurse practitioner or trained health-care professional is needed to determine if this treatment is indicated.</p><div class="pdf-page-break"></div><h2>Suctioning </h2><p>Suctioning is a procedure that helps to clear mucus from the airway when a child cannot cough effectively. </p><p>If your child has a complex condition which could require suctioning, talk to your child’s health-care team before performing this procedure. Suctioning requires special equipment and very specific training for safety.</p><p>For more information on suctioning, please see <a href="/article?contentid=3850&language=english">Secretions and suctioning: General knowledge</a>.</p><h2>Cough assist </h2><p>If your child has been prescribed a <a href="/Article?contentid=2447&language=English">cough assist machine</a>, talk to their physiotherapist to learn if this can be used in combination with your child’s regular pulmonary clearance routine. </p><p>For more information on cough assist machines, please see <a href="/article?contentid=2447&language=english">Cough assist machine: How it helps to clear mucus from the lungs</a>.<br></p>

 

 

Connected CareConnected CareConnected CareCEnglishNAChild (0-12 years);Teen (13-18 years)NANANAAdult (19+) CaregiversNALanding PageLearning Hub<p>This learning hub is intended for community health-care providers and the Connected Care Paediatric Education Program. You will be able to access handouts on tracheostomy care, feeding tubes, vascular access devices, and subcutaneous injections.</p><p>This learning hub is intended as a resource for community health-care providers and the Connected Care Paediatric Education Program. You will be able to access multilingual handouts on tracheostomy care, G and GJ tubes, NG tubes and vascular access devices.</p><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">G and GJ tubes</h2></div><div class="panel-body list-group" style="display:none;"><p>G and GJ tubes are feeding devices that give liquid nutrition, medications and other fluids directly into a child's stomach or small intestine. Learn more about this feeding method and why a child may need a feeding tube in this section.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Making the decision to get a feeding tube</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2822&language=English">G/GJ tubes: Making the decision to get a feeding tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3825&language=English">G/GJ tubes: Frequently asked questions</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Types of G and GJ tubes</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2536&language=English">G/GJ tubes: Corflo PEG tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3387&language=English">G/GJ tubes: Corflo PEG J tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2908&language=English">G/GJ tubes: Balloon G tubes</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2535&language=English">G/GJ tubes: Mic-Key low-profile GJ tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3886&language=English">Surgically inserted G tubes</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3887&language=English">Surgically inserted J tubes</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Primary tube insertion</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3818&language=English">Primary tube insertion by image guidance</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>G and GJ tube management</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3824&language=English">Equipment and supplies for feeding tube care</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2905&language=English">G/GJ tubes: Caring for your child and their G tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3039&language=English">G/GJ tubes: What to do if your child's feeding tube is blocked</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2910&language=English">G/GJ tubes: What to do if your child's feeding tube is pulled out</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3041&language=English">G/GJ tubes: What to do if your child's feeding tube moves</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3827&language=English">Venting a G tube to manage fullness and bloating</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3398&language=English">Peritonitis related to G and GJ tubes</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3036&language=English">G/GJ tubes: Permanent feeding tube removal</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3826&language=English">G/GJ tubes: Troubleshooting tube feeding</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right 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href="/Article?contentid=3040&language=English">Normal saline: How to prepare at home</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2909&language=English">G/GJ tubes: Using silver nitrate to treat granulation tissue</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Nasogastric tubes (NG tubes)</h2></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=984&language=English">How to insert your child's NG tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2457&language=English">NG tube: Feeding your child</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2456&language=English">NG tube: Common problems</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Anaesthesia and pain management</h2></div><div class="panel-body list-group" style="display:none;"><p>Many procedures require some form of anaesthesia, whether it is used to numb a specific part of the body or used to help your child fall into a deep sleep so they do not feel anything. Learn about the different types of anaesthesia and how they are used.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3001&language=English">Local anaesthesia</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1260&language=English">Sedation</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1251&language=English">Sedation: Caring for your child at home</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=1261&language=English">General anaesthesia</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Vascular access devices</h2></div><div class="panel-body list-group" style="display:none;"><p>Vascular access devices are special intravenous lines that let children receive medicines without frequent needle insertions. 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Learn more about subcutaneous injections including how to give at home and the medications enoxaparin and tinzaparin.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Overview</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=998&language=English">Subcutaneous injections: Injecting at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Enoxaparin</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=129&language=English">Enoxaparin</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=993&language=English">Enoxaparin: Injecting at home</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Tinzaparin</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=253&language=English">Tinzaparin</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=994&language=English">Tinzaparin: Injecting at home</a></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Pulmonary clearance</h2></div><div class="panel-body list-group" style="display:none;"><p>Pulmonary clearance is used to clear mucus from the airways. Find out about the different types of pulmonary clearance and how to safely perform each type on your child.</p></div><ol class="list-group" style="display:none;"><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Cardiopulmonary physiotherapy treatment (CPT)</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3876&language=English">Cardiopulmonary physiotherapy treatment in a baby (0-12 months)</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3877&language=English">Cardiopulmonary physiotherapy treatment for children older than 1 year old</a></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Cough assist</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2447&language=English">Cough assist machine: How it helps to clear mucus from the lungs</a></li></ol></li><li><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h3>Suctioning and secretions</h3></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3850&language=English">Suctioning and secretions: General knowledge</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3851&language=English">Suction machines, catheters and depths</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3852&language=English">Preparing suctioning equipment and supplies</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3858&language=English">Cleaning suctioning equipment and troubleshooting problems</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3855&language=English">How to perform nasal suctioning</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3856&language=English">How to perform oral suctioning</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3857&language=English">How to perform nasopharyngeal and oropharyngeal suctioning</a></li></ol></li></ol></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Tracheostomy care</h2></div><div class="panel-body list-group" style="display:none;"><p>A tracheostomy is a surgical procedure to make an opening into the trachea. Learn about the different parts of a tracheostomy tube, how to safely care for and properly change your child’s tube and clean their equipment.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/_layouts/15/Catalog.aspx?Url=https%3A%2F%2Fauthoring%2Eaboutkidshealth%2Eca%2Fakh%2FPages%2FConnected%2DCare%2DEnglish%2Easpx">Tracheostomy and ventilation manual for family caregivers</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3264&language=English">Tracheostomy and tracheostomy tube: How they help your child</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2466&language=English">Tracheostomy: How to care for your child's stoma</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2469&language=English">Tracheostomy: How to suction your child's tracheostomy tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2467&language=English">Tracheostomy: How to change your child's tracheostomy tube</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2470&language=English">Tracheostomy: What to do in an emergency</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=2468&language=English">Tracheostomy: How to prepare for safe travel</a></li></ol></div><div class="panel panel-primary"><div class="panel-heading clickable"> <span class="pull-right panel-heading-collapsable-icon"> <i class="mdi mdi-chevron-down"></i></span><h2 class="panel-title">Virtual care</h2></div><div class="panel-body list-group" style="display:none;"><p>Find information about virtual care visits and what to expect.</p></div><ol class="list-group" style="display:none;"><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3889&language=English">Virtual care at SickKids</a></li><li class="list-group-item"><a class="overview-links" href="/Article?contentid=3910&language=English">Virtual care: How to accurately measure your child’s height and weight at home</a></li></ol></div>https://assets.aboutkidshealth.ca/AKHAssets/health_tech_jr_learning_hub.pngconnectedcare

 

 

Cardiopulmonary physiotherapy treatment (CPT) for children older than 1 year old3877.00000000000Cardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldCardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldCEnglishRespiratoryPreschooler (2-4 years);Pre-teen (9-12 years);School age child (5-8 years);Toddler (13-24 months);Teen (13-18 years)Back;Lungs;ChestRespiratory systemNon-drug treatmentAdult (19+) CaregiversNA2020-06-12T04:00:00ZHealth (A-Z) - ProcedureHealth A-Z<p>Cardiopulmonary physiotherapy treatment (CPT) is used to clear mucus from the airways. Learn about the benefits of CPT and the different techniques you can learn to help clear your child’s airways.</p><h2>What is cardiopulmonary physiotherapy treatment?</h2><p>Cardiopulmonary physiotherapy treatment (CPT) is used to treat conditions that can cause mucus buildup in the lower airways of the lungs. CPT techniques can help to loosen mucus in the lungs and move it out of the airways. Clearing the airways helps to treat some types of pneumonia, which may help to improve lung function. If your child has a medical condition that causes mucus buildup in the lower lungs, CPT techniques may help to decrease the frequency of future lung infections. </p> <div class="pdf-page-break"></div> <p>If your child requires treatment, a physiotherapist can assess and determine an appropriate treatment plan for your child at home. They will also teach you how to effectively and safely add CPT into your child’s daily routine. CPT techniques your child’s physiotherapist may prescribe at home include:</p><ul><li>modified postural drainage (positioning) </li><li>percussion</li><li>expiratory vibrations</li><li>suctioning </li><li>mobility and play (e.g. seating strategies, tummy time, yoga ball)</li></ul><h2>Key points</h2><ul><li>Cardiopulmonary physiotherapy treatment can be used in children who have conditions that may cause mucus buildup in the lower areas of the lungs.</li><li>A trained physiotherapist can help you create an individualized pulmonary clearance program/strategy to complete on a regular basis with your child.</li><li>Types of treatments used include modified postural drainage, percussion, expiratory vibrations, suctioning, and mobility and play.</li><li>Percussion and expiratory vibrations can be used in combination with modified postural drainage positions.</li></ul><h2>Promoting good airway clearance and ventilation</h2><p>Mobility and movement are key strategies assist with pulmonary clearance and improve air entry to your child’s lungs.</p><p>If your child has a condition where lower airway secretions are retained, you can use the above treatment strategies to maintain good lung health and move the mucus out of their lungs efficiently.<br></p><h2>CPT treatment options</h2><h3>Modified postural drainage</h3><p>Modified postural drainage (MPD) uses gravity to help move mucus from the smaller, lower airways in the lungs up to the larger airways. The mucus is then coughed or suctioned out. </p><p>MPD is performed by placing your child in different positions, based on the location of the different segments of the lungs. This helps with drainage of the lungs. See the section below on "positioning and target area" to learn more about these positions.</p><p>MPD is usually used in combination with other CPTs such as percussion and vibrations. </p><p>Do not tip the head down for postural drainage due to the risk of reflux and subsequent aspiration. </p><h3>Percussion</h3><p>Percussion is used to help loosen and remove the mucus stuck to the walls of the airways. </p><p>To perform percussion, your child is placed in one of the MPD positions (see diagram _________). Then, using a cupped hand, or palm cup (see below), you will gently tap on a designated area of your child’s back or chest for approximately 3-5 minutes. </p> <p>A cupped hand forms to the curve of your child’s chest and creates an air pocket that makes the percussion more comfortable for your child. As a result, the percussion should make a “hollow” sound (not a slapping sound). Percussion should be firm, but never painful, and should not create redness on the skin. A thin blanket can be placed on the chest wall for comfort. </p><p>Be careful not to percuss over your child’s spine, breastbone, stomach or ribs as this can injure your child.</p><div class="asset-2-up"> <figure><span class="asset-image-title">Cupped hand position</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_CuppedHands_Position02_IMG1546.jpg" alt="Slightly cupped hand with palm facing down" /></figure><figure><span class="asset-image-title">Palm cups</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PosturalDrainage_PalmCups.jpg" alt="Two palm cups used for percussions" /></figure></div><h3>Expiratory vibrations</h3> <figure><span class="asset-image-title">Flat hand</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_CuppedHands_Position01_IMG1475.jpg" alt="flat hand with palm facing down" /></figure> <p>Vibrations are used to help gently shake the mucus so it can move from the smaller airways into the larger airways as a child exhales. </p><p>To perform vibrations, place your child in one of the MPD positions recommended by your child’s physiotherapist. Then, using a flat hand (see below) the caregiver places a firm hand on the chest wall over the lung segment of focus.</p><p>The caregiver tenses the muscles of the arm and shoulder to create fine oscillatory movements (vibrations) combined with compression of the child's chest wall during exhalation. The vibrations should be performed in the direction of rib movement. Exhalation should be as slow and as complete as possible.</p><h2>Positioning and target area </h2><p>For the following lung segments refer to the inset picture. These pictures show the correct positions for CPT. In the diagrams, shaded areas indicate hand placement where the chest should be percussed or vibrated. A physiotherapist may prescribe only specific segments, or all of them. </p><p> <strong>Note</strong>: All of these positions can be done either on a flat surface, such as a bed, or on your lap. This depends on your child’s age, comfort and needs, as well as how comfortable you feel. </p><div class="pdf-page-break"></div><div class="akh-series"><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P02_UpperLobe_AnteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – anterior segments</h3><p>Position your child flat on their back and treat between their collarbone and nipple. Avoid treatment over breastbone in the centre. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P03_UpperLobe_RightPosteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – right posterior segment</h3><p>With your child positioned flat on their stomach, place a pillow or rolled blanket under the right side of their chest to elevate it slightly. Treat over their right shoulder blade. Avoid treating over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P04_UpperLobe_LeftPosteriorSegment.jpg" alt="" /> </figure> <h3>Upper lobe – left posterior segment</h3><p>With your child positioned flat on their stomach place 1-2 pillows under the left side of their chest in order to elevate it 45 degrees. Treat over their left shoulder blade. Avoid treatment over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P05_MiddleLobe.jpg" alt="" /> </figure> <h3>Right middle lobe</h3><p>Position your child on their left side at a ¾ turn toward their back. Place a pillow or rolled blanket behind your child for them to lean back against. You can also place a blanket or pillow between their legs for added comfort. Treat close to the right armpit over nipple line . </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P05_Lingula.jpg" alt="" /> </figure> <h3>Lingula (middle of left lung)</h3><p>Position your child on their right side at a ¾ turn toward their back. Place a pillow or rolled blanket behind your child for them to lean against. You can also place a blanket or pillow between their legs to stop them from rolling completely onto their back. Treat close to the left armpit over nipple line. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P06_LowerLobe_AnteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – anterior segments </h3><p>Position your child flat on their back, with a pillow under their legs. Treat over their ribs, about two fingers above the lower edge of the ribcage. Avoid treating over the stomach and very lowest ribs.</p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P07_LowerLobe_LateralSegment.jpg" alt="" /> </figure> <h3>Lower lobe – lateral segments</h3><p>Position your child on their right side, using a rolled blanket or pillow to support them. Treat over their left side, about two fingers above the lower edge of their ribcage. To treat the right side, position your child on their left side.</p></div></div><div class="pdf-page-break"></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_P08a_LowerLobe_PosteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – posterior segments </h3><p>Have your child lie flat on their stomach with a pillow under their lower legs. Treat over their ribs, about two fingers above the lower edge of their ribcage. Avoid treating over the spine. </p></div></div><div class="row"><div class="col-md-12"> <figure> <img src="https://assets.aboutkidshealth.ca/AKHAssets/PD_Child_PD_Baby_P08b_LowerLobe_PosteriorSegment.jpg" alt="" /> </figure> <h3>Lower lobe – posterior segments (alternative option) </h3><p>Depending on their condition, some children are not able to lie flat on their stomachs. For these children, have them lie as far over onto their stomach as possible, with a blanket rolled up under their left side and a pillow between their legs to stop them from lying completely flat. </p></div></div></div> <br> <div class="pdf-page-break"></div><h3>When should you stop CPT? </h3><p>If your child develops increased work of breathing, stop routine CPT and seek assistance from your health-care provider. CPT could make these symptoms worse, and an assessment from a physician, nurse practitioner or trained health-care professional is needed to determine if this treatment is indicated.</p><div class="pdf-page-break"></div><h2>Suctioning </h2><p>Suctioning is a procedure that helps to clear mucus from the airway when a child cannot cough effectively. </p><p>If your child has a complex condition which could require suctioning, talk to your child’s health-care team before performing this procedure. Suctioning requires special equipment and very specific training for safety.</p><p>For more information on suctioning, please see <a href="/article?contentid=3850&language=english">Secretions and suctioning: General knowledge</a>.</p><h2>Cough assist </h2><p>If your child has been prescribed a <a href="/Article?contentid=2447&language=English">cough assist machine</a>, talk to their physiotherapist to learn if this can be used in combination with your child’s regular pulmonary clearance routine. </p><p>For more information on cough assist machines, please see <a href="/article?contentid=2447&language=english">Cough assist machine: How it helps to clear mucus from the lungs</a>.<br></p>Cardiopulmonary physiotherapy treatment (CPT) for children older than 1 year oldFalse

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