[Update on manual bronchial clearance techniques (adults and adolescents)]. / Mise au point sur les techniques manuelles de désencombrement bronchique (adultes et adolescents).

In adults and teenagers, airway clearance physiotherapy techniques (ACPT) are various and numerous. However, they for still awaiting scientific validation. Among ACPTs, Slow Expiration with the Glottis Opened in the Lateral Posture (ELTGOL), Autogenic Drainage (DA), and Active Cycling Breathing Technique (ACBT) present a Grade B level of evidence with weak recommendations. Even though these maneuvers are widely applied, precise description of chest physiotherapy (CP) is largely absent from the scientific literature; it is difficult to standardize its implementation and reproduce the results; scientific validation and faithful execution of the techniques are consequently problematic. In this paper, the authors aim to depict each of the three CP techniques as precisely as possible; with this in mind, graphic modeling of the different respiratory exercises is presented in such a way that they can be easily learned, applied and reproduced by physiotherapists.

[Respiratory physiotherapy in pediatric practice]. / La kinésithérapie respiratoire en pédiatrie.

Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.

Nasal irrigation practice habits in infants: A Belgian survey: Nasal irrigation practice habits in infants.

BACKGROUND: Nasal irrigation is widely used in infants to relieve nasal obstruction. However, the nasal irrigation technique has not been standardized, and nasal irrigation practice habits (NIPH) in infants have not been investigated. Our objective was to provide an overview of NIPH in infants among parents, childcare workers, and healthcare professionals living in Belgium. METHODS: Parents, childcare workers, physiotherapists, nurses, pharmacists, and physicians were invited to fill in an electronic survey questioning their NIPH in infants. The survey was disseminated through social networks, practitioners' associations, and creches. RESULTS: The questionnaire was fully completed by 359 participants. A ready-made solution was used by 93% of participants, of whom 92% used physiological saline. The prophylactic use of nasal irrigation was considered appropriate or very appropriate by 65% of all participants. The irrigation frequency was particularly heterogeneous among participants. The optimal solution propulsion speed and solution volume to be used depended on the group of participants being interviewed. At least 37% of parents and 20% of physicians did not take a stand on the optimal irrigation volume to use in each age category. On average, 83% of participants described performing nasal irrigation by lying the infant on one side and delivering the solution through the top nostril. Finally, 74% of respondents declared that no risk was associated with this technique. CONCLUSION: Although some common NIPH viewpoints among the surveyed participants were identified, several disagreements were reported, reflecting the absence of a standardized method of nasal irrigation.

One-minute sit-to-stand test as an alternative tool to assess the quadriceps muscle strength in children.

BACKGROUND: Clinical tools for assessment of the skeletal muscle strength are scarce and have rarely been validated in children. The aims of this study were to verify the construct validity of the one-minute sit-to-stand test (1-MSTST) to evaluate the quadriceps strength in healthy children between 12 and 18 years old and to correlate these outcomes with the anthropometric parameters. METHODS: Healthy children were recruited and consecutively performed 1-MSTST and maximal voluntary contraction of the quadriceps (QMVC). RESULTS: Eighty-three children (15±2 years old) were analyzed. Contrarily to the QMVC, neither the number of 1-MSTST repetitions nor the sit-to-stand work (1-MSTST expressed as the product of body weight) differed between genders. The QMVC was not correlated with the number of repetitions (rho=-0.056; P=0.617) but correlated with 1-MSTST when expressed as a product of body weight (r=0.491; P<0.001). The QMVC was also correlated with age (r=0.314; P=0.004), height (r=0.672; P<0.001), weight (r=0.721; P<0.001) and BMI (r=0.451; P<0.001) whereas 1-MSTST did not correlate with any of these parameters. The leg length was related to the results of both tests. CONCLUSION: We demonstrated that the one-minute sit-to-stand test can be considered as a valid and valuable alternative to evaluate the muscle strength when expressed as the product of body weight.