1. Chest physiotherapy. This broad term covers a range of therapies that includes postural drainage, manual percussion and chest vibrations. These treatments are often preceded by inhaled medications intended to mobilize secretions (humidification, hypertonic saline, Dornase alpha). Chest physiotherapy has been studied extensively in cystic fibrosis(13) but there are no prospective studies of its use in children with NMDs. The lack of any evidence of clear long-term benefit combined with the need for a trained assistant, has limited the application of chest therapy to in-patient treatment of acute exacerbations.