The last time my 16 year old son was in the hospital, they tilted the bed while he did the vest so he was inclined with his head toward the floor. It seemed to help! When we got home, we decided to try it. We put a bunch of pillows under his back and hips, and had him tilt backward. It looked really funny. Right when he started the vest, a friend knocked on the door. My son got out of that position so fast! He was mortified that someone would think he was undergoing some kind of strange torture!