Inclusion Criteria:  Forty to sixty years old patients had undergone mechanical ventilation for ≥ 48 hours in a controlled mode and had been weaned after a successful spontaneous breathing trial with suboptimal or poor CPF < 270 L/min. Patients were able to assume a sitting position. All participants were aware, cooperative, competent, able to comply with treatment, and able to understand and follow instructions.  Exclusion Criteria:  Presence of significant or active hemoptysis, untreated or recent pneumothorax, bullous emphysema, lung trauma, or recent lobectomy. Patients with comorbidities interfering and compromising the success of either weaning or extubation, like cardiac arrhythmia, pericardial effusion, congestive heart failure, or acute coronary syndrome. Patients who had originally inadequate training performance of the respiratory muscle such as those having NMD, i.e., myopathy or neuropathy. Impaired consciousness/inability to communicate. Patients who had a neurological deficit resulted in bulbar affection. Patients with indications for MV, but contraindicated for physical therapy like pulmonary embolism. Patients who had undergone tracheotomy before extubation also were excluded or who had experienced less than 24 hours of mechanical ventilation. Patients with unstable hemodynamics or cardiac instability. Current undrained pleural effusion or previous pneumothorax or barotrauma. Uncontrolled severe COPD, poorly controlled asthma, and severe bronchospasm. Patients with visual or/and auditory problems.