title: Changes in intracranial pressure associated with chest physiotherapy.
abstract: BACKGROUND
  Management of intracranial hypertension is pivotal in the care of brain-injured patients.
  
  
  METHODS
  We report the case of a patient with both a closed head injury and anoxic encephalopathy, who subsequently experienced episodes of refractory intracranial hypertension. The patient's care was complicated by the development of a pneumonia, which required frequent turning of the patient and chest physiotherapy. Conventional wisdom suggests that these interventions may stimulate the patient and worsen intracranial pressure, and therefore should be avoided.
  
  
  RESULTS
  Our observations on this patient, however, contradict this belief. This single-subject study presents data to support the use of chest physiotherapy in patients at risk for intracranial hypertension.
  
  
  CONCLUSIONS
  Further, the evidence is compelling that a randomized-controlled trial is indicated to test the hypothesis that chest physiotherapy may actually result in short-term resolution of high intracranial pressure, and thus provide one more clinical tool in the management of elevated intracranial pressure.
authors.affiliation: The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. dmolson@email.unc.edu
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Thoyre
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Turner
authors.forename: Stacey
authors.initials: S
authors.lastname: Bennett
authors.forename: Carmelo
authors.initials: C
authors.lastname: Graffagnino
mesh_terms: D000328:Adult; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications* / Q000628:therapy; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications* / Q000628:therapy; D019586:Intracranial Hypertension / Q000209:etiology* / Q000517:prevention & control*; D026741:Physical Therapy Modalities; D053717:Pneumonia, Ventilator-Associated / Q000628:therapy*; D016896:Treatment Outcome