Guidelines No guidance is currently available from the FDA or from the VNS manufacturer and the professional literature is non-existent on the topic. Large-bore tubing connects the vest to the air-pulse generator. High-frequency chest wall oscillation (HFCWO) device is an airway clearance therapy in the form of a wearable vest for COPD and other diseases. Next Article Contraindications for Chest Physiotherapy. OHFO Device. The Vest™ is a portable oscillatory bronchial drainage system that provides external thoracic percussion. Unstable head and/or neck injury 4. A percussive vest can be a convenient and portable option. Respiratory Care Stabilisation Discharge Home Care Improve airway clearance to reduce the risk of re-hospitalisation with home use of The Vest™ System.1 1. To do so could cause a choking hazard. The SmartVest SV2100 is a high-frequency chest wall oscillation (HFCWO) device. the back across the top of the chest, and not straight across under the arms. Conditions like COPD and cystic fibrosis can result in major mucus build-up in your airways, making it hard to take a deep breath. The Vest® Airway Clearance System, Model 205 was developed to provide effective Airway Clearance Therapy. Contraindications: Unstable neck injury. This bronchial drainage system includes a vest connected to a pulse generator and enables patients to self-administer the technique of high frequency chest compression to assist with ... Contraindications. complications and adverse effects of chest physical therapy. Every five minutes the … Subcutaneous emphysema 5. Airway clearance therapy using traditional manual chest physiotherapy or HFCWO vest therapy can provide improvement both in pulmonary function and quality of life in patients with chronic hyper-secretive diseases. Fracture of spine, with or without Halo vest, collar or orthosis Open wound or incision in the chest wall, abdomen or back CPT targets atelectasis, lung collapse and secretion retention. Pediatr Pulmonol 1995;20(1):50-55. Physiotherapy doesn't necessarily have to be “ no pain no gain ”. Depending on what you are taking your Rehab for, there should be a proper treatme... high frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each Contains all text of procedure or modifier long descriptions. Evidence for the use of airway clearance techniques is often difficult to evaluate, in part due to agreement that top-level evidence on this topic is lacking. It monitors the patient's heart continuously, and if the patient goes into a life-threatening arrhythmia, the LifeVest delivers a shock treatment to restore the patient's heart to normal rhythm. 17. The Vest® Airway Clearance System, Model 205 was developed to provide effective Airway Clearance Therapy. Flexitouch Plus is clinically proven to decrease the chronic swelling associated with lymphedema. ICP > 20 mmHG Unstabilized head/neck injury Active hemoptysis/hemmorhage Spinal surgery or injury empyema bronchopleural fistula pulmonary edema pleural effusion PE Age, confused or anxious rib fractures/wounds thoracostomy. Increased intracranial pressure B. People with CF need airway clearance therapy (ACT). o Pulmonary bullae. x Background. Contraindications. Conventional chest physiotherapy is also known as traditional chest physiotherapy. The vibration of the vest against the chest wall helps to loosen mucus. Manual techniques chest physiotherapy contraindications Chest physiotherapy can be administered by a respiratory therapist, although techniques can often be taught to family members of patients. Cystic fibrosis changes the mucus, making it thick and hard to clear. Complex Child is an online monthly magazine about caring for a child with complex medical needs or a disability. current haemoptysis. Hill-Rom Holdings Inc has introduced the Monarch Airway Clearance System, a mobile device that provides high frequency chest wall oscillation (HFCWO) therapy in a mobile vest with a customizable, personalized fit.. Contraindications WARNING:If the patient conditions exist that cause the use of The Vest® Airway Clearance System, Model 105 to present a risk to the patient, do not use the unit except as directed by a physician. Death or serious injury could occur. The Aerobika® device is drug-free, clinically supported, and easy to use, providing a better quality of life by reducing cough and shortness of breath 1, 2.. Chest physiotherapy is a group of treatment techniques that improve lung function. snug to the body. Patients who use vest therapy have been shown to experience fewer pneumonias, fewer hospitalizations, 1-5 and better results on pulmonary function tests, 6,7 which measure how well the lungs are working. What are the absolute contraindications for High Frequency Chest Wall Oscillation (HFCWO)? There is controversy surrounding the use of high-frequency chest physiotherapy devices for indications other than CF. over their chest at the location where the device is implanted. Contraindications Hill-Rom is releasing its new Monarch airway clearance system, a powered vest that delivers high frequency chest wall oscillation (HFCWO) therapy to patients requiring regular treatments. Both earbud and clip-on headphones can cause interference. To the Editor: The excellent review entitled “Does chest physical therapy work?” (Chest 1985; 88:436-44) by Kirilloff and colleagues was noted with great interest. Chest Physiotherapy Using the Vest - UTMB.edu Contraindications to chest physiotherapy all are relative and include the following: Bleeding diathesis (including therapeutic anticoagulation) Discomfort due to physical positions or manipulations. Using a breathing circuit called a Phasitron, mini bursts of gas are delivered into the lungs at rates between 100 – … • Adult supervision is required to use the therapy on children. ACT can be done manually with physical therapy or with a device called the VEST. View This Abstract Online; Alternatives to percussion and postural drainage. Chest physiotherapy (CPT) with bronchial drainage is the standard treatment for mobilization and removal of airway secretions in many types of respiratory dysfunction especially in chronic lung disease, such as cystic fibrosis, brochiectasis, bronchitis, bronchial asthma, primary ciliary dyskinesia syndrome. Yuan and colleagues (2010) stated that airway secretions and infections are common in cerebral palsy (CP) and neuromuscular diseases. The Vest Airway Clearance System provides high-frequency chest compression using an inflatable vest and an air-pulse generator. Our Vest™ specialists consult with patient’s clinicians and physiotherapists before providing a demonstration or evaluation, to ensure that the Vest™ is an appropriate therapy option. •After the patient takes a deep breath, clinicians exert slight to moderate pressure on the chest wall, and initiate o Loculated pleural effusion or empyema. Yuan and colleagues (2010) stated that airway secretions and infections are common in cerebral palsy (CP) and neuromuscular diseases. This document addresses the use of high frequency chest compression devices (HFCC) (such as the Vest ™ Airway Clearance System or the Medpulse ® Respiratory Vest System) as an alternative to conventional chest physical therapy to promote the clearance of respiratory secretions in individuals with impaired ability to cough or otherwise expel them on their own. The VEST is a jacket that vibrates and shakes the mucus in the lungs so that the patient can cough it up. * Relative contraindications include the following: o Coagulopathy. The phrase bronchopulmonary hygiene is preferred by the NBRC to encompass the following cluster of related therapeutic activities: postural drainage, percussion, vibration, and directed cough. Therapy is typically performed twice a day for 20-30 minutes. Chest physiotherapy (CPT) is a treatment to loosen mucus and thick fluids in the lungs. Chest physical therapy (CPT or Chest PT) is an airway clearance technique (ACT) to drain the lungs and may include percussion (clapping), vibration, deep breathing, and huffing or coughing. Helping patients breathe easier Widely recognized as the gold standard in High Frequency Chest Wall Oscillation (HFCWO) therapy, The Vest ® Airway Clearance System has been prescribed by more physicians than any other HFCWO device. Chest Physiotherapy. physiotherapy upon the FEV1 in chronic bronchitis Med J Aust 1975;1:33-35. 24. As of 2013, this field contains the consumer friendly descriptions for the AMA CPT codes. When connected to an air-pulse generator, the vest can inflate and deflate quickly with air (5-20 times per second), creating a vibration-like environment within the lungs and intermittent increases in airflow. The Medafore Promise. The vest vibrates the chest to loosen and thin mucus. High-quality CPR without interruption The AutoPulse ® Resuscitation System provides high-quality automated CPR to victims of sudden cardiac arrest. o Skin infection over the chest tube insertion site. chest physiotherapy for the treatment of atelectasis in the pediatric patient. It is a small and portable device designed to aid in the loosening and removal of mucus build-up in the lungs. Listed contraindications are relative unless marked as absolute (A). 2. Traditionally, the phrase chest physical therapy (CPT) is used by many practitioners to include the same activities. manipulation of the chest is the physician’s treatment of choice for increasing the clearance of mucus in patients with pulmonary disorders. Every 2 hours. Lung Flute. Wollmer P, Ursing K, Midgren B, Eriksson L. Inefficiency of chest percussion in the physical therapy of chronic bronchitis. However, the headphones used with MP3 players can interfere with both devices. Chest physiotherapy (CPT), positive expiratory pressure (PEP) valve, Cardinal Health’s Flutter device, Smiths Medical’s Acapella system, Medical Acoustics’ Lung Flute device, airway clearance vests, and Smiths Medical’s EzPAP device are among the options. Subcutaneous emphysema; Recent epidural spinal infusion or spinal anesthesia; Recent skin grafts, or flaps, on the thorax; Burns, open wounds, and skin infections of the thorax; Subcutaneous pacemaker; Tuberculosis of the lungs; Lung contusion; Bronchospasm; Osteomyelitis of the ribs; Coagulopathy; Complaint of chest-wall pain The machine makes the vest vibrate at high frequency to break up the secretions. 18. Contraindications: * The need for emergent thoracotomy is an absolute contraindication to tube. Hide glossary Glossary. Vest Therapy (High Frequency Chest Wall Oscillation) The "vest" is a machine made up of two parts: an air-pulse generator and an inflatable vest that wraps completely around the chest The air pulse generator creates rapid bursts of air that make the vest inflate and deflate against the chest wall. chest physiotherapy, OR d. Standard chest physiotherapy has been administered in accordance with the medical care plan, but has proven to be ineffective in achieving the desired outcome, AND e. There must be no contraindications for the use of the Chest wall oscillation vest – Airway clearance system. The machine mechanically performs chest physical therapy by vibrating at a high frequency. There is controversy surrounding the use of high-frequency chest physiotherapy devices for indications other than CF. The Vest™ is a portable oscillatory bronchial drainage system that provides external thoracic percussion. Large-bore tubing connects the vest to the air-pulse generator. A high-frequency chest wall vibrating/oscillating device is currently available (the ABI Vest). The LifeVest ® wearable cardioverter defibrillator (WCD) is designed to protect patients at risk of sudden cardiac death (SCD), when a patient’s condition is changing and permanent SCD risk has not been established.. The LifeVest™ is a personal defibrillator worn by a patient at risk for sudden cardiac arrest (SCA). Contraindications for all positions. Most MP3 headphones contain a magnetic material that can interfere with ICDs and pacemakers. Homnick DN, White F, de Castro C. Comparison of effects of an intrapulmonary percussive ventilator to standard aerosol and chest physiotherapy in treatment of cystic fibrosis. Contraindications: Increased ICP. What is the Chest Physiotherapy Vest? The MetaNeb® System combines lung expansion, secretion clearance, and aerosol delivery into a single integrated therapy session—without having to switch between different devices. Unfasten the back panel lower tabs from the front panel of the garment. Attach the end of the Connector Hose to the Connector Port on the Vest … Respir Care 2002;47(10)L1162-1167. The effect of chest. Alternatives to chest percussion by hand include use of mechanical vibrators and inflatable vests. The USCD already had in place a protocol identifying the Therapy Vest and the IPV as primary choices and the G5, Flutter and Acapella as secondary options. Chest physiotherapy is given to patients with presence of consolidations or secretions in any lobe of the lung which enables them to breathe properly or produce cough. The present global pandemic of COVID-19 has brought the whole world to a standstill, causing morbidity, death, and changes in personal roles. People who have chronic bronchitis, bronchiectasis, COPD and cystic fibrosis often produce an excessive amount of mucus. port being accessed under vest. It was advocated first in 1915. Individuals with a contraindication for external manipulation of the thorax as defined by the American Association of Respiratory Care (AARC) are excluded from use of the bronchial drainage system vest. This mucus is where infections can occur. Contraindications. In CB, the applied pressure and the elasticity of the material are important. Easy to use and battery-operated, AutoPulse squeezes the patient’s entire chest to improve blood flow to the heart and brain. Both infections and inflammation cause more mucus to be made. The area between the layers of tissue that line the lungs and the chest cavity, known as the pleural space, can get filled with either transudate or exudate forms of fluid. Bend your knees and lean forward at the hips, keeping your spine nice and straight. ... As an adjunct to chest physical therapy. Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Put the vest on over a thin layer of clothing. Contraindications and Precautions. To achieve a successful physiotherapy management we must know the conditions where we have not to give the treatment so that the current status of... The Vest Heat Exchanger fits inside the Vest Sleeve and comes ... the back across the top of the chest, and not straight across under the arms. chest physiotherapy vest contraindications what is a percussion vest chest percussion vest cost high frequency chest wall oscillation contraindications cpt vest settings 3 Jul 2011 Introduction The Vest Airway Clearance System facilitates removal of secretions from the lungs. The machine mechanically performs chest physical therapy by vibrating at a high frequency. ... mechanical vibrators and inflatable vests. Slip the inflatable garment over the user’s head with the Air Hose Ports in front. Intermittent pressure pulses create vibrations and air movement throughout the airways (“mini-coughs”) Helps loosen and move secretions. This therapy refers to a vest device that is worn by the patient. I am a student of physiotherapy and have worked with this modality. SWD stands for Short Wave Diathermy. It is a deep heating modality which uses h... High frequency chest wall percussion is a machine that delivers chest physiotherapy by means of pulsed pressure, helping the patient to mobilize airway secretions. Chest physiotherapy (CPT) is a non‐pharmacological therapy to facilitate airway secretion removal. N.L. o Loculated pleural effusion or empyema. This causes the chest wall to be gently compressed and released, which creates airflow within the lungs. It consists of a non-stretching inflatable vest linked to an air pulse generator by two flexible hoses. * Relative contraindications include the following: o Coagulopathy. The need for additional manipulation of the chest to assist in secretion removal. The therapy, which is administered by breathing through a special device helps: 1. View chest physiotherapy.odt from NURSING 1211 at Keiser University, Tampa. • Deep water jogging in pool with floatation vest Progression Criteria • Noticeable increase in abdominal strength • Can accomplish full and pain free lumbar flexion and lateral flexion range of motion • Ability to hold bridge and side plank for 30 seconds without pain How it works. In addition to the use of body positioning, deep breathing and effective cough to facilitate clearance of secretions from the airways, a variety of manual techniques are used in conjunction with postural drainage to maximize the effectiveness of the mucociliary transport system. Some of the contraindication for chest physiotherapy includes: Unstable angina. The acapella® Vibratory PEP Therapy System combines the benefits of both PEP therapy and airway vibrations to mobilize or loosen pulmonary secretions and can be used in virtually any spatial orientation. It is recommended that top straps angle up from . We have many years’ experience working in collaboration with clinicians, providing effective therapies to supplement existing patient regimes. They take several different forms (a mouthpiece, a mask, a vest, etc.) Therapy Monitoring: Another key differentiator between manual chest physiotherapy and vest therapy is the latter’s ability to track therapy performance in real time. In the hospital, a nurse or respiratory therapist will clap on your child’s chest with a cupped hand. These would include all of the following except: A. One of these techniques utilizes high-frequency chest wall compression a.k.a "The Vest" (® Hill-Rom). There is a weight limit of 350-pounds. Recent stroke C. The pt has just eaten D. Small VC in a bedridden pt • Try to do your treatment with The Vest® Airway Clearance System before a meal or at least 30 minutes after a meal to avoid the feeling of an upset stomach. Much the same way Chest Physiotherapy works by Eighteen patients with stage IIIA, IIIB, or IV lung cancer (3 females and 15 males) were included. I am a 33 years female physiotherapist and I tell you what's the ground reality. OK,so after I passed my BPT, I looked for govt jobs but govt Hosp,... Eur J Respir Dis 1985;66:233-239. Alternatives to percussion and postural drainage. These vests produce vibrations at variable frequencies and intensities in order to help loosen and to thin mucus, and separate it from airway walls, so it can be coughed up. For therapy to be effective, Huff Cough and regular coughing must be done during and after the treatments. Bronchospasms 2. perfusion and improves oxygenation by splinting airway, little effect on hemodynamics, mini bursts on insp. The Flexitouch system is used by more than 100,000 patients to self-manage lymphedema and nonhealing venous leg ulcers. physiotherapy teams. Vest Therapy (High Frequency Chest Wall Oscillation) The "vest" is a machine made up of two parts: an air-pulse generator and an inflatable vest that wraps completely around the chest. Another type of airway clearance aid is a high-frequency chest wall oscillation device. Acute head or neck injury or surgery; Increased intracranial pressure The system promotes airway clearance and improves bronchial drainage utilizing high frequency chest wall oscillation (HFCWO), also known as vest therapy. Using “The Vest” is also a common type of Airway Clearance Therapy for Cystic Fibrosis patients. Chest Physical Therapy (CPT or Chest PT) or Postural Drainage & Percussion (PD&P) is an ACT that often includes postural drainage and chest percussion. Absolute contraindications • Head or neck injury that has not been stabilized • Do not eat or drink during a therapy session. Learn about Causes, Symptoms, Treatment and Therapy Options from the number one heart center, Cleveland Clinic. fibrosis, 1) chest physiotherapy (CPT) is not recommended for the routine treatment of uncompli- cated pneumonia; 2) ACT is not recommended for routine use in patients with COPD; 3) ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient Unfasten the back panel tabs from the main hook-and-loop fastener, and separate the front and back panels of the Chest Vest. Complaint of chest wall pain 3. The air-pulse generator creates pressure pulses that cause the vest Chest wall physiotherapy is the standard treatment for managing airway clearance and involves manual techniques aimed at clearing the lungs by percussion (clapping), vibration, deep breathing and huffing or coughing. Let me clear all your doubts : Why did you decide to become a physiotherapist? * I always thought I wanted to go into a career where I could help p... lung contusion. The SmartVest SV2100 airway clearance system is designed to deliver high-frequency chest oscillation to promote airway clearance and improve bronchial drainage. Contraindications for Cheat Physiotherapy Th the Edffor: The excellent review entitled "Does chest physical therapy workr (Chut 1985; 88:436-44) by Kirilloft' and colleagues was noted with great interest. Unstable vitals ( blood pressure, pulse, SPO2 etc). While there are several medications that can help loosen mucus, making it easier to breathe, Strategically placed pivot points that support the hips, laterals, and head are for ergonomic seating. question. The f. There are no medical contraindications to the use of the Vest. The Monarch system is cleared for use by patients 15 years old and above, according to Hill-Rom’s website. Adjust duration and intensity of percussion depending upon patient’s condition and response to therapy. Marina, 25, doing chest physical therapy with a vest. These machines may be known by their brand names (The Vest ® System, inCourage ®, Smart Vest ®, and AffloVest ® ). These devices are expensive but covered by most insurance plans. Your CF care team will help you to order a vest device. SmartVest SV2100 Specifications. The Vest Airway Clearance System provides high-frequency chest compression using an inflatable vest and an air-pulse generator. Contraindications to chest physiotherapy all are relative and include the following: Chest physiotherapy may be administered by a respiratory therapist, although the techniques can often be taught to family members of patients. Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, and vibration, to augment mobilization and clearance of airway secretions. Bronchopulmonary hygiene therapy. MetaNeb. 3. There are a variety of techniques used as "Chest Physical Therapy" (CPT), for patients with airway diseases. Hydrotherapy; Percussion and chest wall vibrations – that remove secretions faster than positioning alone. haemodynamic instability. HFCWO has been proven to be an effective therapy for a wide range of conditions. It involves the use of an inflatable vest that produces vibrations at a very fast frequency which helps to loosen up secretions in the airways of the lungs. PROCEDURE – Chest Physiotherapy Using the Vest Policy 7.3.11 Page 1 of 6 Chest Physiotherapy Using the Vest Formulated: 07/03 Effective: 07/07/03 Revised: 12/12/14 Revised: 04/17/18 Chest Physiotherapy Using the Vest Introduction Vest therapy is indicated when external manipulation of the chest … immobility, The Vest ® airway clearance system can offer a practical solution to aid airway clearance. System. Page 20 The Vest™ Airway Clearance System, Model 105 User Manual (145330 REV 1) FITTING THE CHEST VEST 1. Death or serious injury could occur. Chest physiotherapy is a broad term used in research that incorporates physiotherapy treatment techniques that address the removal of secretion and... Product Specifications System: inCourage Airway Clearance Therapy, Model ICS-1M-US-A Respiratory Technologies, Inc. Flutter Mucus Clearance. Some patients wear a special CPT vest hooked up to a machine. 173 showed that in hospitalized patients with cystic fibrosis, high-frequency chest compression with the vest conventional chest physiotherapy was equally safe and effective when used during acute pulmonary exacerbations. o Pulmonary, pleural, or thoracic adhesions. High-frequency chest wall oscillation (HFCWO) is an airway clearance technique in which external chest wall oscillations are applied to the chest using an inflatable vest that wraps around the chest. Every five minutes, the … Mucus loosening Airway Clearance Techniques ... Airway Clearance Devices HFCWO/HFCC vest therapy Loosening Metaneb and IPV - Loosening effect Pain (visual analog scale), pulmonary … Continue reading With chest physical therapy (CPT), the person gets in different positions to use gravity to drain mucus (postural drainage) from the five lobes of the lungs. It is designed to help patients mobilize retained secretions—helping them avoid respiratory infections, hospitalizations and reduced lung function. Overview Of Therapy Intrapulmonary percussive ventilation (IPV) is a form of chest physical therapy administered to the airways by a pneumatic device. SVN with PEP Therapy; Airway Clearance. Physiotherapy For Pleural Effusion. large pleural effusion or empyema. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms. Patients are free to sit, stand or recline. Uncontrolled hypertension. o Skin infection over the chest tube insertion site. We will help you get the best possible airway clearance system for the lowest possible price. With chest physical therapy (CPT), the person gets in different positions to use gravity to drain mucus (postural drainage) from the five lobes of the lungs. The Vest® Airway Clearance System is not intended to treat any specific underlying disease or condition, but rather to provide airway clearance therapy. Vest therapy can help break the serious cycle of excess mucus, lung infections and further lung damage for patients living with chronic respiratory conditions.. The vest, which weighs 13 pounds (about six kilograms) and comes with a portable carrying case, is intended for patients with chronic breathing difficulties, such as cystic fibrosis. I thing Being a ICU physiotherapist, I can answer this question quite appropriately.. Vitals do not significantly reflects contraindications for ch... IPV IS AS EFFECTIVE AS CPT, FLUTTER OR CHEST VEST THERAPY … Connors AF, Hammon WE, Martin RJ, Rogers RM . o Pulmonary, pleural, or thoracic adhesions. The vest creates an airflow that helps to move mucus from the airway walls. 1. The demographic characteristics and the clinical history of the patients were recorded. Chest physical therapy (CPT or Chest PT) is an airway clearance technique (ACT) to drain the lungs, and may include percussion (clapping), vibration, deep breathing, and huffing or coughing. pulmonary embolism. PEP Therapy. The system consists of a disposable vest attached to an Air Pulse Generator that rapidly inflates and deflates the disposable vest. There have been concerns about potential electromagnetic interference (EMI) and lead integrity problems during the use of vibrating CPT devices in patients with cardiac implantable electronic devices (CIEDs). Chest physical therapy includes a variety of physical methods for loosening mucus from the lungs so that it can be coughed out. ... vests and hand-held chest percussors) cannot be used, such as with patients with chest injuries, burns, fresh surgical wounds or injured/broken ribs. Types of chest PT include chest percussion, controlled coughing & incentive spirometry. 3 ... R = Relative Contraindication – Therapy for these conditions should be used only under AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients (2013) PDF. The MetaNeb System and The Vest™ Airway Clearance System both are proven therapies for airway clearance. The main goal of these therapies is to augment secretion mobilization & airway clearance[1]. The Vest Hill-Rom (HFCWO device) £6,995.00 No initial cost £10.00 per day minimum rental 3 month 2 year 3 months ... , significant dependence on chest physiotherapy need, reliance on others to assist with mucus clearance and physical demand on patient and carers to perform treatment. The Vest Airway Clearance System provides high-frequency chest compression using an inflatable vest and an air-pulse generator. With postural drainage, the person gets in varied positions (postures) that drain mucus from different lung parts. Chest Physical Therapy (CPT) Chest physical therapy (CPT) is a treatment that helps remove mucus from the lungs. o Pulmonary bullae. I would perform clapping chest physiotherapy 2-3 times per day for roughly 20 minutes per treatment. Then slowly lower the weight to the starting position.

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