Techniques of Neurophysiological Facilitation of Respiration

Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition

NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing

Neurophysiological Facilitation

Techniques

There are six techniques used in the NPF

Perioral pressure
Intercostal stretch
Thoracic vertebral pressure
Co-contraction of the abdomen
Applied manual pressure
Anterior stretch-lifting of the posterior basal area (Basal Lift)

Perioral Pressure

Method

Perioral pressure is provided by applying pressure with the therapist's finger on the top lip between the nose and lip. The pressure is maintained for the length of time that the therapist wishes the patient to breathe in the activated pattern. (wearing of surgical gloves is advised to avoid picking up a contaminant and/or carrying contaminants from one patient to another).

Perioral pressure

Observation

• Expanded epigastric movement
• As the stimulus is maintained the epigastric excursions may increase so that movement is transmitted to the upper thorax and the patient appears to be deep breathing

Mechanism

Initiates the primitive reflex of sucking and swallowing

Intercostal Stretch

Method

Intercostal stretch is provided by applying pressure to the upper border of a rib in order to stretch the intercostal muscle in a downward(not inward) direction. The stretch position is then maintained while the patient continues to breathe in his/her usual manner. This procedure can be performed unilaterally or bilaterally on any rib.

Intercostal Stretch

Observation

Stretched area results increased movement

Mechanism

Intercostal stretch reflex

Thoracic Vertebral Pressure

Method

• Vertebral pressure high - manual pressure applied to thoracic vertebrae in the region T2 - T5

• Vertebral pressure low - manual pressure applied to thoracic vertebrae in the region T9 - T1

Vertebral pressure

Observation

Vertebral pressure high

• Expanded epigastric movements
• Deep-breathing

Vertebral pressure low

• Increased respiratory movements of the apical thorax

Mechanism

Dorsal-root-mediated intersegmental reflex

Co-contraction of the Abdomen

Method

Provided by the therapist by pressing adequate pressure on the lower ribs and pelvis on the same side, so that pressure is applied at right angles to the patient.

Co-contraction of the Abdomen

Observation

• Expanded epigastric movement
• Muscle contraction increased

Mechanism

Abdominal muscles activated by stretch receptors

Moderate Manual Pressure

Method

Mild pressure of the open hand(s) is maintained over the area in which expansion is desired

Co-contraction of the Abdomen

Observation

Gradually increased movement of the rib under the area of pressure

Mechanism

Stretch reflex

Anterior Stretch-Lifting of the Posterior Basal Area (Basal Lift)

Method

Basal lift is applied by placing the hands under the posterior ribs of the supine patient and lifting gently upwards. The lift is maintained and provides a maintained stretch and pressure posteriorly and stretch anteriorly as well.

Basal Lift

Observation

• Expansion posterior basal area
• Expanded epigastric movements

Mechanism

Stretch receptors in intercostals. back muscles

Indication

• Neurologically impaired adult patients who are hypoventilating or have retained secretions (impaired tracheobronchial clearance, reduced lung volumes)
• Used to alter the respiratory patterns and relieve the symptoms of hyperventilation syndrome (control of breathing).
• Unconscious and non-alert patients
• NPF is a useful technique to improve short term ventilation with lower consciousness.

Contraindication

• Children under the age of 7 years because of differences in the anatomy, physiology and neurology of respiration
• Patients with hyperinflated lungs
• Rib and sternum fractures
• Respiratory failure
• Floating ribs
• Sensitive mammary tissue in female patients.

Evidence

• Perioral pressure followed by Intercoastal stretch has increased minute ventilation (Ve) and oxygen saturation (Spo2) in short term ventilated patients with lower consciousness.
• Anterior stretch-lifting of the posterior basal area (Basal Lift), Abdominal co-contraction and Intercoastal stretch has improved spontaneous tidal volume(Vt), minute volume(Ve) and middle chest expansion in short term mechanical ventilated patients
• Also, Anterior stretch-lifting of the posterior basal area (Basal Lift) has improved spontaneous respiratory rate (RR) significantly in short term mechanically ventilated patients.