physiotherapy for a 15 year old teenager

Question

I would like to know which is the most effective and safe physiotherapy technique for a 15 year old boy with CF. I read somewhere that we must not perform clapping and shaking because they may cause pneumothorax or several other complications. Do breaths suffice? Which is your opinion about the vest?

Answer

Dear friend,
Your son is at an age, when he must gradually start to take full responsibility of the treatment of his CF health problem. That means that he must be an active participant in the physiotherapy regime. There are various active and safe airway clearance techniques. Your son can be trained to use one such technique, or more if he wants to, in order to utilize it initially under supervision and later on independently under the periodic supervision of a physiotherapist.

By breaths I assume you refer to the autogenic drainage technique. If it is properly used, it can be an effective and safe airway clearance technique.

If, however, you feel that your son does not implement it correctly, or if he wishes to try something else, there are other techniques, such as the flutter, the PEP mask or the active cycle of breathing techniques. In any case the most important factor is the training procedure and the will of your son to learn correctly an airway clearance technique. Naturally, the general medical and physical condition plays a significant role in choosing such a technique, since sometimes these conditions may or may not favor the choice of a particular technique. Finally, you should keep in mind that your son must choose a technique he feels comfortable, efficient and confident with, in order to keep on using it, since many times the problem lies not in the choice and use of a technique, but in the adherence to the physiotherapy regime.
Furthermore, he should engage in a sport or an aerobic physical activity, in order to prevent any possible future musculoskeletal complications and to preserve his pulmonary function to the highest possible level.

I believe that the role of clapping and shaking in causing a pneumothorax, if they are performed correctly and prudently, and the physiotherapist or carer involved is aware of the medical condition of the patient at any given time, is negligible. Over the last 10-15 years clapping and shaking – especially the former- are mostly used worldwide in very young patients, where active participation is not possible.

Regarding the vest it is a controversial issue and there is no published research with definitive results. In any case it does not seem to be more effective than the other active airway clearance techniques. According to the manufacturers one great advantage is that the patient does not have to do anything, just put the vest on and switch it on. To me this seems as a disadvantage, since it makes the patient a passive recipient of the treatment and it does not encourage him to take active control of his condition, whilst such an attitude may prove detrimental to the adherence. Another point is the extremely high cost, at least in Greece.
Yours friendly,
Kostas Katsoulakis

10.01.2012