Specialist respiratory service

 Respiratory - Kids' Physiotherapy Ltd

Who may benefit from a respiratory (chest) physiotherapy assessment and treatment?

There are many groups of children who will benefit from specific respiratory physiotherapy input. These may be children who have either a new or chronic respiratory condition, children who require long term ventilation or children who have other health conditions such as cerebral palsy who have frequent chest infections.

This may include children who have the following conditions:-
•    Children with cerebral palsy who have frequent chest infections and/or the need for suction
•    Children who have sustained a traumatic or acquired brain injury who have frequent chest infections and/ or the need for suction.
•    Children with a poor swallow, gastro oesophageal reflux and/or excessive oral secretions who have frequent chest infections and/or the need for suction.
•    Children who require the help of a ventilator to breathe either following injury or since their birth.
•    Children who have sustained a spinal cord injury that affects their ability to take a deep breath or cough.
•    Respiratory failure.
•    Chronic cardiopulmonary disorders.
•    Chronic lung disease e.g. lung hypoplasia, Interstitial Lung Disease, Cystic Fibrosis, bronchopulmonary dysplasia, bronchiectasis, primary cilial dyskinesia.
•    Upper airway obstruction e.g. vocal cord paralysis, malacia, craniofacial syndromes.
•    Congenital heart disease.
•    Skeletal deformities e.g. kyphoscoliosis, thoracic wall deformities.
•    Neuromuscular disorders e.g. Spinal Muscular Atrophy, myopathy, muscular dystrophies.
•    Congenital central hypoventilation syndrome.
•    Acquired e.g. trauma, tumour, surgery.

 

What problems can these conditions have on the respiratory system?

These conditions can cause several problems:
•    Mucus/secretion retention.
•    Restrictive lung disease.
•    Obstructive lung disease.
•    Risk of reduced lung compliance/chest wall compliance/lung growth.
•    Ineffective cough.
•    Scoliosis/stiff thoracic joints/chest deformity.
•    Weak respiratory muscles.
•    Reduced mobility/exercise tolerance.
•    Recurrent chest infections /pneumonia requiring regular antibiotics and hospital admissions.
•    Shortness of breath.
•    Ventilator dependence.
•    Increased work of breathing.
•    Poor oxygenation.
•    Discomfort/pain.

In a healthy child, mucus in the airways is cleared by the mucociliary system and the ability to cough. The respiratory system is lined with cells that secrete mucus. The mucus membrane of the nose has mucus-coated hair which traps and filters air containing microbes, dust and pollutants. The mucus membrane of the lower respiratory airways contains cilia which are tiny hair like structures that move the bacteria and other foreign matter to the upper airway. An effective cough and swallow is then required to completely clear the mucus from the airways.
When the mucociliary system and the ability to cough are impaired, this can lead to the build up of mucus. Excessive mucus in the airways can cause a cycle of inflammation, pulmonary infection, increased production of excess mucus, and airway obstruction, lung damage, and respiratory failure.
An effective cough relies on several components i.e bulbar muscle function, inspiratory and expiratory muscle strength. If the diaphragm is weak or if there is spinal deformity, this affects the ability to take a deep breath in. Weak expiratory muscles reduce the expulsive force in order to clear the mucus. Cough function is frequently impaired in neuromuscular diseases (eg. muscular dystrophy, spinal muscular atrophy, and multiple sclerosis), neuromotor conditions (eg. cerebral palsy, spinal cord injury, and severe traumatic brain injury) and who require mechanical ventilation either invasively via a tracheostomy or non-invasively.
Restrictive lung disease is where the respiratory muscles are weak or the spine and thorax are deformed. Therefore the ability to take a deep breath in, to generate expiratory force, and to cough effectively are often affected.
Obstructive lung diseases is where airway size is decreased as a result of structural changes, bronchospasm and/or excess mucus limiting the ability to exhale eg Asthma, Cystic fibrosis, Primary ciliary dyskinesia.
Therefore airway clearance therapy can be essential.

 

What treatment can Kids' Physiotherapy provide for respiratory conditions?

Respiratory physiotherapy is an important part of a child’s treatment and involves airway clearance techniques to enhance the clearance of bronchial secretions to try and minimise infection and prevent repeated lung damage. In the short term treatment aims to reduce airway obstruction from mucus/secretions and improve ventilation. In the long term treatment aims to delay the progression of respiratory disease and maintain optimal respiratory function.
A physiotherapy programme should be specific to your child’s needs and their current goals. Kids’ Physiotherapy is able to provide a comprehensive and holistic assessment for your child and put a therapy programme in place. Physiotherapy treatment may involve:
•    Assessment and development of child specific treatment plans and teaching packages.
•    Airway clearance assessment and treatment.
•    Exercise therapy.
•    Inhalation therapy.
•    Postural care advice.
•    Support and advice on adherence with treatment.
•    Assist with weaning or time off the ventilator.
•    Education, training and preventative management for your child, parents, family members and carers.
•    Some children benefit from a programme for nursery/school or advice around activities within PE lessons.

Some children may benefit from specific assessment and advice from a respiratory specialist physiotherapist in addition to the physiotherapy treatment they are receiving from a physiotherapist who is supporting them with their movement (motor) skills or development.

Kids’ physiotherapy looks at your child as a whole and is able to provide a respiratory Physiotherapy programme to meet their needs from the comfort of their own home or within school or nursery, at a time that is convenient to you as a family.

 

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