@sueinmn I am living proof of spinal stenosis and osteoporosis making it impossible to use vest. I used it successfully for about 5 yrs. Then started getting severe pain in neck and shoulder every time I used it. Stopped using and now know I have severe spinal stenosis in entire cervical region, arthritis, and osteoporosis. I still do airway clearance, just no vest. Getting mucous out but probably not as well as with vest. In my 70’s now so I guess for us seniors arthritis, osteoporosis, and spine issues are conditions that should be considered. Our copay was rather large (over 5k) for the vest/machine which is now equipment I cannot use.