Abstract

Neurophysiological facilitation (NPF) techniques, including thoracic vertebral compression, intercostal stretching and co-contraction of the abdomen, aim to produce reflex respiratory movement by using external proprioceptive and tactile stimulation that increases the rate and depth of breathing which optimise accessory respiratory muscle function and chest wall mechanics (3,4). Evidence supporting their use in children remains limited. Our aim is to provide scientific insight on the use of neuro physiological facilitation (NPF) of respiration in Paediatric group too. A four-and-a-half-year-old girl presented at eight months of age with cyanosis, feeding difficulty, diaphoresis and tachypnea since birth. Echocardiography revealed D-transposition of great arteries (D-TGA), ventricular septal defect (VSD) and severe pulmonary arterial hypertension (PAH). The Subject Underwent Palliative Senning’s procedure & shifted to ICU for post operative care. On day 20, diaphragmatic palsy was suspected based on the Chest Xray and cine-fluoroscopy revealed right hemi-diaphragmatic palsy. There was complete dependency on Mechanical Ventilator. To facilitate accessory respiratory muscles, Neurophysiological Facilitation (NPF) techniques such as upper thoracic vertebral compression (T2–T5), intercostal stretching, abdominal co-contractions were performed daily. In addition prone positioning and mobilisation were also done along with routine tracheostomy care. On day 77, the child was weaned to CPAP and T-piece support. Almost 120 days after the operation, the tracheostomy was decannulated and the child was maintained on oxygen via nasal cannula. The chest X-ray also showed a slight

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