Contract-Relax (CR) Technique in the Management of Diaphragmatic Paresis After Cardiac Surgery

"Standard rehabilitation for diaphragmatic paresis~* EFA (Expiratory Flow Acceleration) at the upper thoracic level.~* PEP (Positive Expiratory Pressure).~* Expectoration if necessary (coughing up and spitting out)"

"The diaphragmatic CR is done in a semi-sitting position.~The CR is composed of 4 steps :~* First maximum inspiration expiration with position of the hands of the physiotherapist on the last ribs and without resistance (Goal: taking rhythm).~* Second maximum inspiration expiration : Free inspiration, expiration with pressure on the last ribs to bring the diaphragm into internal stroke.~* Maximum inspiration against resistance, then maximum expiration with increased pressure.~* Maximum inspiration with dynamic release of resistance (Goal: hyperextension of the diaphragm) followed by maximum expiration with resistance to allow an increase in expiratory flow."