Journal of cardiopulmonary rehabilitation
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J Cardiopulm Rehabil · Jul 1998
ReviewAlternatives to percussion and postural drainage. A review of mucus clearance therapies: percussion and postural drainage, autogenic drainage, positive expiratory pressure, flutter valve, intrapulmonary percussive ventilation, and high-frequency chest compression with the ThAIRapy Vest.
The purpose of this article is to review published studies on the efficacy of old and new mucus clearance techniques and to develop recommendations for different groups of patients. Mucus clearance is a problem in cystic fibrosis, bronchiectasis, and many other pulmonary conditions. Percussion and postural drainage (P & PD) was the traditional method of facilitating mucus clearance, but the many hazards and contraindications along with the onerous nature and resultant poor patient compliance of this procedure have led to the development of alternative therapies. ⋯ The Intrapulmonary Percussive Ventilation device and high-frequency chest compression with the ThAIRapy vest involve more elaborate and expensive equipment, yet these devices provide mucus clearance assistance to patients who lack the ability to perform the simpler techniques. Both mechanized modalities promote independence and self-care in the patient, and the effectiveness of both has been supported by the limited research published to date. Which alternative to recommend depends on the ability, motivation, preference, needs, and resources of each patient.
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J Cardiopulm Rehabil · Mar 1998
ReviewHelping older patients to cope with cardiac and pulmonary disease.
Family challenges, depression, and age-related developmental and psychological issues must be considered when structuring interventions for elder cardiopulmonary patients. Elderly patients tend to have difficulty coping when they face novel, unpredictable circumstances and are left to flounder in suspenseful anticipation. Furthermore, if support is not forthcoming during such times--or if they are treated in ways that strip them of control rather than in ways that bolster their sense of control--elderly patients are at great risk of quickly developing a passive, learned helplessness that can significantly complicate their rehabilitation. ⋯ Our task-driven health-care system, replete with its growing emphasis on brevity of treatments and cost-effectiveness, can create a style and pace of delivering care that demoralizes an elderly patient. The results can be devastating: "When the spirit is broken, one has no will to marshall coping skills". But health-care providers who are attuned to the psychosocial issues relevant to the later life stages can make a profound difference in enhancing both rehabilitation and quality of life for elderly cardiopulmonary patients and their loved ones.