Thoracic Expansion Exercises (TEE)
Thoracic expansion exercises emphasize the inspiratory phase of breathing and are performed from
functional residual capacity (FRC) to maximal inspiratory capacity (Tucker & Jenkins 1996).
To perform the technique, the patient is positioned appropriate to the goal of treatment, e.g. if secretion removal and subsequent improved ventilation to a particular lung zone is the goal, then thoracic expansion exercises may be performed in the appropriate postural drainage position (Hollis 1998).
The patient is encouraged to breathe in slowly and as deeply as he can through the nose, followed by a relaxed passive expiration via the mouth. To avoid hyperventilation, this is repeated only three more times (Webber & Pryor 1993), before the patient is allowed to return to his tidal volume breathing. A three-second hold at full inspiration with the glottis open may be added (Tucker & Jenkins 1996; Webber & Pryor 1993), or alternatively the patient may be instructed to 'sniff' more air in through the nose at the end of the inspiration.
Verbal cues should be given to the patient to encourage maximal inspiration. Tactile stimulation may also be added by the physiotherapist placing her hands over the chest wall where expansion is required. In this position, proprioceptive stimulation may be added by the therapist delivering a quick stretch to the inspiratory muscles (Tucker & Jenkins 1996). This is achieved by quickly squeezing the chest wall between the therapist's hands at the beginning of the inspiration as though trying to produce an expiration. The inspiration is then allowed to continue to its maximum volume.
Once the patient understands what is required of him, additional resistance may be applied via the physiotherapist's hands to maximize inspiration (Tucker & Jenkins 1996). The resistance should be stronger initially and should decrease as the inspiration progresses, to take into account the changing length–tension relationship of the inspiratory muscles.
Thoracic expansion exercises are thought to prevent atelectasis, to help re-expand collapsed alveoli and to mobilize secretions (Tucker & Jenkins 1996; Webber & Pryor 1993). The increased volume of inspired air promotes flow via collateral channels (Tucker & Jenkins 1996; Webber & Pryor 1993), and this mobilizes mucous plugs and secretions, allowing improved ventilation to these peripheral areas (Tucker & Jenkins 1996; Webber & Pryor 1993).
Another mechanism for increasing airflow to these areas is that of interdependence, where the increased volume of inspired air through patent airways expands alveoli which exert pulling forces on adjacent alveoli thus assisting their expansion (Tucker & Jenkins 1996; Mead et al. 1970; Webber & Pryor 1993).
Thoracic expansion exercises may be combined with other treatment techniques (Tucker & Jenkins 1996), such as postural drainage, chest shaking or vibrations, or as part of the active cycle of breathing technique (Webber 1990). They may be performed unilaterally or bilaterally.
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