“How can I apply this information in my clinical practice?”
* Clinical measures of respiratory rate, heart rate, and chest wall excursion do not require expensive equipment or training. An inexpensive pulse oximeter provides therapists with clinically important oxygen saturation and heart rate measures. The number of hospitalizations for respiratory illnesses may also serve as a marker of respiratory health.
* Therapists can use positioning to promote expansion in areas of limited chest wall mobility, such as the lateral or posterior aspects. Chest physical therapy techniques are valuable augments to positioning. Adaptive physical activity may also improve cardiorespiratory function.
* Therapists can apply this information to persons with multiple disabilities in settings such as home care, group homes, schools, and skilled nursing facilities.
“What should I be mindful about in applying this information?”
* Therapists should be mindful that the rationale for positioning persons with cerebral palsy with severe mobility limitations and scoliosis should include not only respiratory function but also function of other internal organ systems, skin integrity, soft tissue extensibility, bone density, and comfort. Position changes may also accommodate functional needs, such as using vision and performing cognitive tasks.
* Using a variety of positions is beneficial. Prone positioning may promote improved respiratory function. Supported standing is another option. Upright positioning may promote social interaction, alertness, vocalization, and use of vision. Although sitting may improve respiratory function, prolonged sitting may compromise muscle length and skin integrity.
* In assessing vital signs, laying hands on the patient may change parameters such as breathing pattern or depth. The effect of a thoracolumbosacral orthosis must also be considered.
* The authors noted that these individuals' primary breathing pattern was diaphragmatic. Measuring upper chest, mid-chest, and abdominal expansion may demonstrate the full effects of position changes on chest wall excursion.
* Therapists should also be mindful of signs of distress, such as changes in facial expression, increased muscle tone, flushing, or pallor. Blood pressure may also need to be monitored.
* The clinical bottom line for this article may be that persons with cerebral palsy with limited mobility and respiratory compromise should be transitioned into a variety of positions throughout the day. The respiratory status of each individual requires ongoing monitoring to determine optimal positioning.
Margaret Barry Michaels, PT, PhD, PCS
Slippery Rock University, Slippery Rock, Pennsylvania
Theresa M. Crytzer, DPT, ATP
Western Pennsylvania School for the Blind
University of Pittsburgh, Pittsburgh, Pennsylvania