Physiotherapy for people who have suffered neurological damage either at birth or through a Traumatic Brain Injury is usually thought to be associated with Neurological Rehabilitation including stretches, muscle activation activities and sometimes hydrotherapy.
However, many of these individuals also have problems with cough and swallow which is where the input of Respiratory Physiotherapy comes into the picture.
For a multitude of reasons, it is better if these individuals live as much as possible in their own surroundings with the least invasive procedures possible, which is where Specialist Respiratory Physiotherapy can assist in reducing the need for hospital admission or the frequency of suctioning.
Robin McNelis has been working as a Specialist Cardiorespiratory Physiotherapist since 1999 with a wealth of experience in the NHS, Private Hospitals and now works independently to provide services to individuals with complex presentations on how to optimise Respiratory function and minimise need for high impact procedures.
For all that suction is often seen as a quick fix to clear unwanted secretions, it also comes with risks and can cause considerable distress to patients.
It should also be remembered that suction only clears secretions from the mouth or upper airways rather than deep in the lungs and inappropriate, routine suctioning can impact on the efficiency of the natural lung clearance mechanisms.
What is better for the individual patient’s welfare is a systematic approach to maintain good aeration of the lungs and enhance normal lung clearance mechanisms with suction only being used as a last resort when clinically necessary after other techniques have not been fully effective.
Most of these techniques do not need to be carried out on a daily basis by a Specialist Physiotherapist (there is a massive shortage of them in the UK), but instead training can be given to nurses, carers/support workers or relatives and indeed the patients themselves for those who are able follow instructions.
This is a model of care that has been used for decades with children and young people living with Cystic Fibrosis and other similar conditions and has been shown to be successful when specialist training and support can be provided.
If there are concerns about an individual’s Respiratory status, it is useful to use a screening tool developed by the Association of Charted Physiotherapists in Paediatric Care risk_identification_matrix_2024.pdf (csp.org.uk).
This helps to identify risk and guide the assessor to the intervention required, including a Specialist Respiratory Physiotherapy review, referral to ENT, Gastroenterologist or other appropriate actions that are relevant to that individual.
Comprehensive Respiratory Physiotherapy Assessment includes:
- Lifelong medical history and recent presentation/events
- Establishing Normal Range Observations for each individual remembering many people of this group of patients do not fit the EWS chart values when they are well
- Assessing breathing pattern, sounds, secretion patterns, cough and swallow responses (often in collaboration with SALT)
- Reviewing holistic 24 hour routine
One of the pleasing things Robin has found in the cases he has reviewed in collaboration with CCM Ltd is that many things are being done as part of an established 24 hour/7 day routine which help to maintain good lung health, often without the support workers realising the positive impact on lung health!
An example of this was a young man with a TBI who would be helped into a standing frame every day to stretch out his tendons, as per the Neurological Physiotherapy Guidance, with his favourite comedy programmes put on YouTube as a form of distraction.
Once training had been given to explain all the benefits of the change of posture and the positive benefits on lung mechanisms from laughing, support workers realised that on days he was chesty he definitely should follow his normal routine rather than being given a rest day, as had been the case before.
As well as positively highlighting the Respiratory significance of many of the everyday activities and educating about normal mucus and saliva production and clearance, Robin also teaches Respiratory Physiotherapy techniques that can often be incorporated into everyday tasks, especially personal care for some of the more dependent patients – compliance tends to be better if part of a daily routine rather than another stand-alone tasks in a busy day.
Respiratory Physiotherapy training is bespoken to the needs of the specific group of support workers and includes:
- Education on hydration and humidification.
- The difference between mucus, saliva and reflux.
- Positioning and lung health.
- Normal lung clearance mechanisms and how this can be impacted by inappropriate suction, dehydration
- Hands on techniques including percussion and chest shaking
The hope after all this intervention has been put in place is that the induvial patient will have less infections, have less needs for suction and antibiotics, less admissions to hospital and overall a better quality of life.
Maggie Sargent of CCM Ltd would like to add that if all the interventions above are followed, it has been proven that in some cases it has been possible to reduce the role of the qualified nurse because deep suction is no longer necessary, and therefore it is much easier for healthcare assistants to manage.
Find out more about CCM Ltd at ccmservices.co.uk
