High Frequency Chest Wall Oscillation
High Frequency Chest Wall Oscillation, or HFCWO, works by wearing an air filled vest connected to a compressor pump that provides a vibration force to the lungs. The frequency and pressure of the vibration force can be adjusted to the patients tolerance. Different sized vests allow it to grow with the patient. A treatment should last 20-30 minutes; huffing and coughing should increase the amount of secretions released. Huffing
Huffing is a forced breathing technique that allows mucus to move up through the airways. A patient breathes out forcefully, pushing mucus from deep in the lungs into larger airways, where it can then be coughed out. Unlike coughing, huffing doesnt collapse airways, but rather provides a gentle squeezing to move the mucus up. Picture a tube of toothpaste. If you squeeze just below the opening, you'll get a tiny bit of toothpaste out. If you start down low and gently squeeze while working your way up to the top, you will get much more toothpaste out. Similarly, huffing allows you to clear more mucus up because you are gently working it up from the bottom of your lungs. To Huff
Inhale using your diaphragm (i.e. belly breathing).
Hold this breath for 3 seconds.
Tilt your head up slightly.
Blow out forcefully and slowly through a wide open mouth (as if fogging up a mirror, NOT like blowing kisses). You should not hear any wheezing.
blow out for about 4 seconds. Active Cycle of Breathing
Active cycle of breathing techniques, or ACBT, consist of three different breathing patterns to clear secretions—breathing control, thoracic expansion, and forced expiratory technique. Each one can be performed by itself or in combination with other forms of airway clearance. Breathing Control
In belly breathing, or diaphragmatic breathing, you use your diaphragm to breathe while keeping the upper chest and shoulders relaxed. Breathing control allows for rest while performing ACBT and prevents any increase in airway obstruction. The length of this phase depends on the severity of the patients symptoms. Thoracic Expansion Exercise
This deep breathing exercise emphasizes inhalation. Patients fill their lungs and then hold their breath for 2-3 seconds before breathing out. This allows the air to get behind the mucus to help move it up. Patients should take 3-4 deep breaths in this phase. Forced Expiratory Technique
Combining huffing and breathing control, patients breathe in deeply, hold for 2-3 seconds, then breathe out slowly and forcefully, as if fogging up a mirror. Patients should not wheeze as they blow out. Repeat 2-3 times followed by a cough, if needed, to clear secretions. Follow this method with breathing control. The phases of ACBT are very flexible, allowing you to cycle through the three sessions to move secretions up so you can clear them. Alternate between breathing control and thoracic expansion exercise until you feel the need to cough, and always return to breathing control after huffing to prevent the airways from tightening. ACBT can be combined with postural drainage positions and with HFCWO. Autogenic Drainage
This technique is done by inhaling different volumes of air to move secretions from the outer areas of the airways to the larger ones. It takes a lot of breathing control to do this well. Breathing at low-lung volumes is called the collecting phase because it loosens mucus from the airway walls. Breathing at mid-lung volumes is also called the "collecting phase" because it moves mucus into the larger airways. The final phase, which involves breathing at larger lung volumes to cough and clear the secretions, is called the "evacuating phase." Games
Games and toys can help strengthen the lungs and develop breathing control, while making therapy fun. Wind instruments are a great way to practice breathing control and to give your lungs a good work-out.
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