Guy Postiaux suggests a new and global classification of CPT techniques, based on a physico-mathematical model of the respiratory system which relies on Weibel's morphometric model and on Röhrer's Equation. This model allows the structuration of the teaching.
It is the association of stethacoustics and ventilatory mechanics which allows, from a staged concept of bronchial obstruction, to end up with an anatomical and functional classification of the techniques. The scientific data available with the bronchial clearance can build this classification.
It seems usual classification of CPT techniques, based on the diagnosis (nosologic), thought as it is today, is not sufficient. Beyond the lack of pedagogy, it underrates specific semiology and physiology that guide the pratician's action on the field.
Another classification is proposed here for CPT techniques, supported by documented scientific arguments, justified indications and counter-indications and their potential or proven benefits.
The set up CPT techniques proposed here would not be possible without auscultation. The results of physico-acoustic research carried over the last 20 years at the ILSA, allowed the simplification of auscultation nomenclature. It also allowed the definition of objective stethacoustic parameters which constitutes a direct objective reference leading the nCPT action.
The publication of the CORSA group (Computerized Respiratory Sound Analysis, Eur Respir Rev n°77,2000) which defines the standards of the breath sounds analysis, provides the researcher in stethacoustic and in physiotherapy guided by auscultation, an essential reference tool to apply a correct assessment. Let us hope this publication will bring other PT to use the mode of objectivation to contribute other CPT techniques.
Despite the progress, an adequate teaching in auscultation is not systematically provided in schools and universities. And that despite the fact that auscultation was recognized as a major clinical method allowing the observation of a bronchial obstruction (Recommandations of "Journées Internationales de Kinésithérapie Instrumentale" - JIKRI, Lyon nov. 2000). Still prospective and multicenter studies are necessary to help precise its sensitivity and specificity. A major piece of work is still to be done by younger PT having curiosity in science, to build on what has been carried out over 20 years and to bring additional objective results of cheap acoustic measurements techniques.
Following techniques are proposed by Guy Postiaux:
ELTGOL: Expiration Lente Totale Glotte Ouverte en infraLatéral
EDIC: Exercice à Débit Inspiratoire Contrôlé (en supralatéral)
ELPr : Expiration Lente Provoquée
TP: Toux Provoquée
PTE : Pompage Trachéal Expiratoire
DRR : Désobstruction Rhinopharyngée Rétrograde
DDR + I
GPR : Glosso-Pulsion Rétrograde