Chest Physical Therapy

Chest Physical Therapy

(CPT) For Cerebral palsy Child

What is CPT?

Chest Physical Therapy (CPT) is something you can do to help your child
breathe better.  Sometimes there is too much mucus, or it is too thick. It blocks
the air from moving in and out of your child’s lungs.  Mucus makes it hard for
your child to breathe.  Mucus that sits too long in the lungs can also grow germs
that can make your child sick.  CPT helps to loosen your child’s mucus, so your
child can cough it up.
Think about how you would take Jell-O
out of a mold.  You tilt the mold over,
then shake it and tap it to loosen the Jell-O
.  Mucus is like that Jell-O , and CPT
helps to get it out.

Airways   Air moves through these and into your lungs.  The airways of the nose
and throat lead to the big airways in the chest.  The big airways branch off into
smaller airways in the lungs.  The big airways are like a trunk of a tree, and the
small airways, like the branches.
Chest Physical Therapy (CPT)  is something you can do to loosen your child’s
mucus.  The three parts to CPT are postural drainage, percussion and deep
breathing and coughing.Percussion  is clapping  the chest.  Percuss
means to tap sharply.  A drum is a percussion  instrument.
 Percussion  in CPT can be done with  either a cupped hand  or an electric percussor.
The clapping shakes the  inside of the chest and  loosens mucus, so it is easier to cough out.
Postural Drainage  moves the mucus by changing the child’s position.  Mucus,
like water, moves from high places to low places.  Tilting the child helps move
the mucus from the small airways at the bottom of the lungs to the large airways
in the middle.  The most mucus moves into the large airways when you do
percussion and postural drainage together.
Deep breathing and coughing  helps to move the loosened mucus.
Lobe  is a section of the lung.  The left lung has two lobes, and the right lung
has three lobes.

• Before Doing CPT

• It is best to do CPT before meals or at least one to two hours after eating.  
  This will make it less likely that the child will feel sick to the stomach or
  throw up.
• The best times for CPT are early morning and at bed time.  Early morning
  CPT helps remove the mucus that built up over night.  Bed time CPT
  takes out the mucus of the day, and helps the child cough less at night.
    Your doctor may want you to do CPT more often.
• Your doctor may prescribe medicine to open the airways.  This may come as an
  SVN (small volume nebulizer) or an MDI (metered dose inhaler).  This
  medicine should be taken before CPT.  The medicine, positioning and
  percussion all work together to clear the mucus from the lungs.
• The person doing the CPT should take off all rings and jewelry on the hands or
  wrists.
• If the child’s clothing is tight or has thick seams, remove it.
• If the child is wearing clothes with buttons, remove it.
• Have the child wear a t-shirt or put a soft cloth over the spot that will be  
  percussed.

• What You Need:

• A place to do CPT.  You will need a bed, pillows, a couch, floor or a special
  table (slant board).
• Your hand or a percussor.
• A clock or a timer, to know how long to percuss.

• How to do:

• Always percuss over the ribs.  Never percuss below the ribs or on the stomach.
  The lungs are in the chest, protected by the ribs.  Never percuss on the
  backbone, breast bone, nipples or on any IV tubes or feeding tubes.
• Do CPT in each spot for
  p 2 minutes   p 3 minutes or  p ____ minutes.
    (Health Care Provider:  check one)
  Your doctor will tell you how long to percuss.
  One session of CPT should take 20 to 40 minutes.
• Usually, CPT is done in all the positions and percussion in all the spots.  
  Your doctor may have you do more in some areas, where the chest x-ray  shows more mucus.
• If your child’s mucus has bright red blood in it, stop the CPT and call your
  doctor.



 1 Top Upper Lobes

• Sit the child up.  Tilt the child half way between sitting up and laying flat.
• Percuss between the nipple and collarbone on the left side of the chest for
  2 minutes  3 minutes or minutes.
• Percuss between the nipple and collarbone on the right side of the chest for
   2 minutes   3 minutes or minutes.


2  Back Upper Lobes

• Sit the child up.  Tilt the child half way between sitting up and laying flat.
• Percuss over the shoulder blade on the left side of the back for
   2 minutes p 3 minutes  or  minutes.
• Percuss over the shoulder blade on the right side of the back for
   2 minutes   3 minutes  or  minutes.





3 Front Upper Lobes

• Lie child on his or her back.
• Percuss between the nipple and the collarbone on the left side for 2 minutes  3 minutes or  minutes.
• Percuss between the nipple and the collarbone on the right side for  2 minutes 3 minutes or minutes.




4 Front Right Middle Lobe

• Lie child down on his or her left side, feet higher than head.
• Percuss below the right arm, but above the bottom edge of the ribs, for
 2 minutes  3 minutes  or  minutes.





5  Side of Right Lung

• Lie child on his or her back, feet higher than head.
• Turn the child to his or her left, half way between back and side.
• Percuss between the child’s right nipple and underarm for
   2 minutes   3 minutes  or  minutes.







6  Front Left Lower Lobe•

 Lie child on his or her back, feet higher than head.
• Turn the child to his or her right, half way between back and side.
• Percuss between the child’s left nipple and underarm for  2 minutes   3 minutes
  or minutes.





7  Side of Left Lung

• Lie child down on his or her right side, feet higher than head.
• Percuss below the left arm but above the bottom edge of the ribs for
  2 minutes  3 minutes  or   minutes.




8  Back Lower Lobes

• Lie child on his or her stomach, feet higher than head.
• Percuss over the middle of the right ribs, above the bottom edge of the ribs for
   2 minutes  3 minutes or  minutes.
• Percuss over the middle of the left ribs above the bottom edge of the ribs for
   2 minutes   3 minutes
  or   minutes.

• After the treatment:

• Your child may cough more during or after CPT.  Coughing helps your child
  get rid of the loosened mucus.
• Your child may cough up to one or two hours after CPT.  Even if no mucus
  comes up, the CPT is working.
• After swallowing a lot of mucus, your child may feel sick to the stomach or  
  throw up.  As soon as your child is old enough to learn to spit, teach him
  or her how to spit the mucus into a tissue.
• If your child does not stop throwing up, call your doctor.

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