Physiotherapy

Question

Hello,
Our 10 months-old daughter has already had the opportunity to see 3 different physios (when vacation of its main physio) and it turns out that none has the same technique ...
One washes the nose with physio serum at each session and makes her cough and drool / spit (this is rather productive) while others do not at all, and another makes movement with both hands (one on the lungs and the other under the diaphragm) and makes them join while others take my daughter seat and put both hands on her chest in a softer way ...
How can I know what is the right method? Is it necessary that it causes coughing? Is it more effective when the child spits / drools or it does not matter?
Are there even "mandatory" actions even though the methods may be different?
Thank you for your answers.

Answer

Hello,
Bronchial drainage is the basic treatment of cystic fibrosis. Regarding the "evidence-based medicine," it is difficult to say that a technique is better than another: it is actually impossible to apply to the assessment of bronchial drainage techniques the methodological rigor that is used to scientifically evaluate the effectiveness of a drug comparing to a placebo (as in a so called randomized, double-blind, placebo controlled study design). Hence there are very different techniques in different countries and within countries.
Theoretically, whatever techniques are there they must take into account five steps, some of which may be difficult to apply in an infant who can not actively participate in the drainage:
- Maintain proper hydration by salt intake and adequate water intake in order to reduce the viscosity of mucus: this requires special vigilance in infants in general since they dehydrate quickly and a CF infant in particular who does not feel thirsty when dehydrated;
- Clear the airways - say the bronchi but also the nostrils. Regarding the bronchi, if they are hyper-reactive, it may be necessary to administer, before the physiotherapy session, a bronchodilator (on prescription) ; regarding the nostrils, it is important, especially with an infant who can not blow its nose, to check that they are not obstructed and, when appropriate, to do a nasal washing (that you can learn to do yourself);
- Promote the air inhaled in the small airways, downstream secretions, by slow, deep breaths: this is hardly feasible in an infant;
- Blow up secretions with a sufficient expiration flow, which requires the maneuvers of the physiotherapist you describe and that can impress. The onset of cough by the pressure on the throat above the breastbone is not very comfortable and should not be used except in very special circumstances by a very experienced person;
- Evacuation of the sputum is spontaneously done by the swallowing reflex: it is obviously unrealistic to ask a 1 year infant to spit.
Very soon, however, the little child can better and better participate in the care and become aware of his breathing by games blow on a toy that mimics the sails of a windmill, make mist on a mirror, blowing out a candle ...
You can also yourself, if you wish, apply to participate in training sessions with respiratory physiotherapy: do not hesitate to contact your CF Center or the French CF Association for dates of training depending on your place of residence.
Hope that answers your question.
Sincerly.
Dr Gilles RAULT

31.07.2013