Kinésithérapie respiratoire instrumentale chez l'enfant neurologique central

Children with severe central neurological disorder (cerebral palsy, the multihandicapped) suffer from impaired coordination of their respiratory muscles. The relative immobility of these patients, the chest deformities and the risk of epilepsy and gastroesophageal reflux can lead to disorders of ventilation/perfusion and to difficult swallowing. These disorders may in turn cause atelectasis and choking episodes favoring the occurrence of respiratory infections. In these patients, recurrent chest infection is the first cause of death. Instrumental airway clearance techniques adapted to these patients are reviewed in this report. Techniques such as the Cough-Assist®, Intrapulmonary Percussive Ventilation (IPV®), high-frequency chest wall oscillations (type VEST®), PEP mask or devices delivering intermittent positive pressure breathing (IPPB) can be used in combination with manual techniques or when the latter become insufficient. In practice their application is challenging, but it is worth trying them individually in each patient to assess their effectiveness.