Livres

Guy Postiaux is the author of:

  • - "Kinésithérapie respiratoire et auscultation pulmonaire", aux éditions Deboeck-Université à Bruxelles et aux Editions Universitaires à Paris (déc. 1990-épuisé).
  • - "La kinésithérapie respiratoire de l'enfant", aux éditions Deboeck-Université à Bruxelles. 3ème édition, avril. 2003. Avec CD d'auscultation pulmonaire.
  • - "Fisioterapia respiratoria en el nino". Ed Mc Graw Hill Interamerica, Madrid, 1999. Avec CD d'auscultation pulmonaire.
  • - "Fisioterapia Respiratoria Em Pediatria" éd. Artmed Editora. Porto Alegre, Brazil. 2003.
  • - Co-auteur de: "Dysphagie, Evaluation et Rééducation des Troubles de la Déglutition", aux éditions Deboeck-Université à Bruxelles. éd 2002. avec CD-ROM.

Goals of the book?

"This book has a double vocation, one to be a treatise and one to be a practical manual. How can those two concepts meet in one book?

The purpose of the treatise is to state on the question about the CPT techniques and to support them with scientific arguments that justify their indications, their potential and proven effects. Actually is it a kind of catalog. And any catalog needs a classification.

Usual classification of CPT techniques, based on nosology, is not satisfying , because, beyond its lack of pedagogic structure, it underestimates often the semiology and the specific physiology that guide the pratician on the field.

The realisation of the manual to a practical end, allowed me to propose another classification of CPT techniques that constitutes the skeleton of the present book. The title already contains its main key : the description of nCPT techniques inconceivable without the guidance of auscultation. The clinical observation on its own is incomplete if the therapeutic reasonning is not based on ventilatory mechanics. It is finally the association between sthetacoustic and mechanics that permitted to establish, from a staged concept of bronchial obstruction, an anatomical and functionnal classification of CPT techniques and to conciliate treatise and manual.

The proposed classification of CPT techniques rests on the four possible ventilatoires modes a human being is capable of : breathe in, breathe out, slowly or rapidly. The aim is to provoque, in the sake of broncho-pulmonary clearance, slow and rapid inspirations or expirations, whatever the etiology of the obstruction is. Those four groups of techniques are the essential tools, the so-called principal techniques of bronchial clearance with straight effects on clearance. The other methodologic tools are only adjuvants : positioning, instrumental aids, vibrations, … have only indirect effects, useful, but still less efficient than the previous.

The major aim of the present manual is to teach how to observe but above all how to auscultate, in order to operate a pertinent technical choice depending on the age of the little patient, and after that , to evaluate the achieved result. These three steps have indeed been examined closely by sufficient and necessary objectivations. This book results from a large number of clinical observations, particularly stethacoustical, treated by Fast Fourrier Transform analysis process.

However the relationships between the doctor and the physiotherapist cannot suffer any ambiguity. It should not be necessary to remind and justify that the use of the stethoscope by the PT is only a tool to observe a physico-acoustical signal, and not to pose a diagnosis. The stethoscope will help him to orient the therapeutic choice and to control its effects. The reasoning is not based on receipes, traps of a simple technical manual. The richness of this type of PT certainly lies in its semiologic basement : the specific assessment of CPT, and not nosologic. The specific, individual character of each disease escapes anyway systematisation.

My avowed ambition is that the present book would contribute to the recognition of what should already be considered as a specialization of CPT : nCPT of the child. This fascinating discipline does not only require a broad knowledge, but also a certain know-how the young PT can build by working with an elder due to the potential risks it implies, specially for the very young children, but also because auscultation can only be tought on the field by a trained teacher. "

Table of content

Chapter 1. Environemental contexts requesting CPT

  1. Epidemiology
  2. Physiopathology
  3. Obstruction and hyperinflation are the consequences and the common features of infantile respiratory diseases

Chapter 2. Obstruction and hyperinflation

  1. Obstruction and hyperinflation mechanisms
  2. Instrumental evaluation of obstruction and hyperinflation
  3. Clinical appraisal of obstruction and hyperinflation
  4. Clinical examination and safety measures are the garantuee of a targetted and efficient CPT

Chapter 3. Auscultation

  1. Introduction
  2. Acoustic physics elements: vibratorions and acoustic parameters
  3. Methodology of acoustical analysis
  4. Psychoacoustics applied to auscultation
  5. Systematic of auscultation in pediatrics, sounds heard at the mouth, percussion
  6. Practice of auscultation
  7. Annotation mode of respiratory sounds
  8. Some demonstrative examples

Chapter 4. Decision tree and nCPT assessments

  1. Analytical decision tree in nCPT
  2. Physiotherapic definition of the bronchial obstruction
  3. Specific nCPT decision tree
  4. nCPT to fail defense mechanisms of the bronchial tree

Chapter 5. General principles of CPT

  1. Goals of nCPT in pediatrics
  2. Controverses about conventionnal cCPT
  3. Mechanical bases : nCPT uses the entry signal of the respiratory system
  4. 2 years and 8-12 years: two important transition periods

Chapter 6. Main techniques of nCPT in pediatrics

  1. Slow expiratory techniques to clear the small airways:ELPr, PTE, AD, ELTGOL,
  2. Forced expiratory techniques to clear the proximal airways: TEF,TD, TP
  3. Slow inpiratory techniques to clear the peripheral lung: IS, EDIC
  4. Forced inspiratory techniques to clear extrathoracic airways: DN, DRR, TE, GPR.
  5. Summary: classification of the techniques

Chapter 7. Complementary techniques of bronchiall clearance

  1. Postural Drainage: PD
  2. IPPB, PLB, VD, PEP-mask®, TheraPEP®, Flutter-VRP1®,…
  3. Vibrations, cries, and physical exercises

Chapter 8. nCPT in neonatalogy

  1. Neonatal medicine : outstanding progress of reanimation and therapeutic properties of the pulmonary surfactant
  2. nCPT in neonatology : specific application of the general principles
  3. nCPT methodology in neonatology
  4. Association of vibrations, positive pressure, cough and succioning

Chapter 9. Control and follow-up parameters

  1. Anamnestic and clinical guidelines of nCPT
  2. Indications and contra-indications of nCPT

NOTES

The book contains numerous notes of physiology, physiopathology, semiology and technique:

Pathology notes

  • Asthma in infancy
  • Bronchiolitis
  • Kartagener's syndrom
  • Gastro-esophageal reflux
  • Bronchial secretion in cystic fibrosis
  • Atelectasis
  • Pneumopathy
  • Ventilatoire asynchronism
  • Middle lobe syndrome
  • Bronchiectasis
  • Acute Respiratory Distres Syndrome of the newborn
  • Hyaline Membrane Disease
  • Bronchopulmonary Dysplasia
  • Sudden infant death syndrome
  • Otitis media
  • Nasal obstruction in infancy
  • Whooping cough
  • Chronic obstructive lung disease in infancy

Physiology notes

  • Mucociliary transport
  • Collateral ventilation
  • Mechanics in lateral decubitusl, linked to pulmonary development
  • Mechanism of cough
  • Origin of the ventilation/perfusion mismatch
  • The naso-pharynx
  • The larynx
  • Pulmonary surfactant
  • Gas exchanges of the newborn
  • Blood Oxygen transport
  • Alveolar volume

Semiology notes

  • Pediatric stridor
  • Rhinorrhea
  • Pain in pediatrics

Technical notes

  • Inhaled therapy
  • Pulmonary transplantation
  • CPT and antibiotics
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