No. Some do both. I guess it depends on what clinic you go to and what each dr. recommends. Most of the kids that I know only do Vest, but each person is different. I do know some kids just don't like the vest. My son prefers it over manual. We were getting to the point where it was a huge fight every time we did manual. He would just cry and fight the whole time. It's still a small fight to get his Vest on, but once we actually get it on, he's fine. lol!!!!
Sometimes if he's sick (congested) I'll do a little extra manual, but usually just have him do Vest a few extra times a day.
Hope that helps?