Journal of Undergraduate Research
Volume 5, Issue 8 - May 2004

Creating an Art Out of Breath

Natasha Gaziano

INTRODUCTION

What are the chances of a person with cystic fibrosis working with a Certified Movement Analyst? What are the chances of a person with cystic fibrosis participating in Laban’s primal pattern of breath-cellular breathing techniques? After following the Laban Movement Analysis course, I experienced firsthand the positive effects of studying Laban’s breathing and relaxation techniques. After each class, I felt as if my breathing was significantly improved and similar to the airway clearance technique, autogenic drainage. As one who lives with cystic fibrosis, I have learned to maintain my optimum health, it is necessary to incorporate a strict schedule of airway clearance at least twice a day for thirty minutes, eat a healthy diet high in fat, protein, and carbohydrates, and exercise daily.1

After a few weeks of participating in the Laban Movement Analysis course, I noticed an improvement in my breathing and my overall well-being. I observed the similarities between Laban breathing techniques and autogenic drainage. When combining both techniques, I experienced outstanding results: an increase in breathing stamina especially during exercise, a better awareness of my body, a clearer mental focus, and a more positive outlook. From this new discovery, the concept for this research project was conceived. I wanted to share this beneficial experience with other cystic fibrosis individuals. But how could this be accomplished? Thus, the idea of producing an “exercise type video “that could demonstrate the technique to others with cystic fibrosis seemed like the most logical approach. With my mentor, Joan Frosch, we began to merge the best of both worlds to form an eclectic blend of medical and artistic research in the Creating An Art Out of Breath. This research project proposes to turn personal self-discovery into an opportunity that has not been fully explored---Laban’s breathing with autogenic drainage. The results of this research could impact individuals around the world who live with the genetic disease cystic fibrosis.

CYSTIC FIBROSIS

Cystic fibrosis is a chronic, progressive genetic disease that affects approximately 30,000 children and young adults in the United States. It is not a new disease but one that was only recognized in 1938 by Dr. Dorothy Andersen.2 In the 1950’s, children born with cystic fibrosis did not live beyond early childhood but today with the advances in medical treatments, the average life expectancy is 30 years of age.1

This life-shortening disease causes the body to produce abnormally thick mucous, which affects the respiratory, and digestive systems. The sticky mucous clogs the lungs and leads to chronic lung infections. Since there is no cure for the disease, chest physiotherapy is an integral part in the management of cystic fibrosis. The purpose of airway clearance is to reduce airway obstruction by improving the clearance of mucus secretions from the lungs, to reduce the severity of infection by clearing infected material, and to maintain optimal respiratory function and exercise tolerance.3 Each individual with cystic fibrosis requires an individual regimen to manage his/her airway clearance and it may change due to the change of symptoms, the individual’s personal preference, or the progression of the disease.4

PROMINENT TYPES OF AIRWAY CLEARANCE TECHNIQUES

Postural Drainage and Percussion (clapping)

Involves positioning the body to allow gravity to assist in the drainage of secretions while the percussion of the chest with clapped hands increases the rate of removal of secretions from a particular lobe of the lung.5

Flutter Technique - A simple hand held piece of equipment that was built in Switzerland in 1986, the Flutter Valve, is used for effective airway clearance through exhaling breath at a constant rate.6

Flutter Technique - A simple hand held piece of equipment that was built in Switzerland in 1986, the Flutter Valve, is used for effective airway clearance through exhaling breath at a constant rate.6

Autogenic Drainage was devised by the Belgian physiotherapist Jean Chevaillier and is an effective self-performed airway clearance technique.7 Basically, autogenic drainage is a breathing technique that moves mucous from the small to the large airways of your lungs where it can be removed by huffing and coughing. Through a series of breathing exercises, individuals with cystic fibrosis are able to dislodge and collect mucus from the lungs and then clear these secretions.8 Autogenic drainage allows an individual with cystic fibrosis the independence to do their own therapy and have more control of their daily care.

Autogenic Drainage was devised by the Belgian physiotherapist Jean Chevaillier and is an effective self-performed airway clearance technique.7 Basically, autogenic drainage is a breathing technique that moves mucous from the small to the large airways of your lungs where it can be removed by huffing and coughing. Through a series of breathing exercises, individuals with cystic fibrosis are able to dislodge and collect mucus from the lungs and then clear these secretions.8 Autogenic drainage allows an individual with cystic fibrosis the independence to do their own therapy and have more control of their daily care.

Schoni advocates this modern approach to physiotherapy by controlled breathing through a three-phase breathing exercises:8

  1. Unsticking the mucous: This is the lowest level of breathing; this phase helps to unstuck or loosen the mucous from the smallest airways.
  2. Collecting: This is mid-level breathing and collects the mucous into the windpipe where it can be removed in phase three.
  3. Evacuating when utilizing three different lung volumes and controlled expiratory flow rate:This is high-level breathing and is performed at normal breathing level but air is forced out to clear mucous from the throat and mouth.

LABAN MOVEMENT ANALYSIS

Laban Movement Analysis teaches the beliefs and practices of Rudolf Laban. His methodologies help us understand movement while providing a framework to describe, analysis and understand physical expression.9 Through the relationship of BODY, EFFORT, SHAPE, and SPACE, we learn to understand movement factors and organize them to reveal “personal, artistic, or cultural style”.10 Laban tells us breath is the key to life, movement and rhythm. Breath influences every aspect of movement. Through participating in the primal pattern of breath-cellular breathing, one can take on a being of wholeness and unity. Everyone benefits from spending time each day tuning-in to his/her own breathing movement.10

Laban Movement Analysis is utilized in diverse professions in problem solving. From detectives and politicians, to professional tennis players and choreographers, the Laban Movement Analysis research methodology can be used to observe, analyze, and provide feedback on the elements of movement.9

APPLICATION OF LABAN MOVEMENT ANALYSIS AND AUTOGENIC DRAINAGE

The purpose of this project is to blend Laban’s relaxation and breathing/movement focus techniques with autogenic drainage techniques to create a program for individuals with cystic fibrosis that can become integrated with their daily airway clearance regiment. The techniques will be formatted into an educational and motivational exercise-type video and distributed in collaboration with Shands Hospital at the University of Florida’s Pediatric Pulmonary Department to adolescents with cystic fibrosis.

Blending together the combination of breathing techniques and images, the video will create a visually and physically satisfying breath exploration. In this experience, the cystic fibrosis individual’s imagination and creativity will take over and help them become more in tune with their body and breath.

The production of a video is felt to be the best mechanism to reach individuals for several reasons. Individuals with cystic fibrosis should not interact with each other because they can spread harmful bacteria to each other.11 Each person with cystic fibrosis who receives a video will have it at their disposal to use when it is convenient for them, and as often as needed for airway clearance. This video will provide them with an imaginary journey that they can revisit as often as they would like. Lastly, autogenic drainage is an airway clearance technique that provides independence to the cystic fibrosis individual for chest physiotherapy.

THE CREATION OF AN EDUCATIONAL VIDEO

The video Creating An Art Out of Breathing comprises three segments:

  1. An Introduction by Natasha Gaziano who explains to the audience of her personal experience with the effects of Laban.
  2. This segment of the video educates the audience on the benefits of autogenic drainage; and, demonstrates the proper techniques. Cindy Capen, MSN, is certified and trained in autogenic drainage and provides the instruction to Natasha Gaziano as she facilitates and demonstrates each of the three phases of autogenic drainage.
  3. The third and last segment of the video is a visual and auditory guided imagery journey that combines autogenic drainage with focused breathing techniques.

AUTOGENIC DRAINAGE PHASES WITH LABAN MOVEMENT

(Note: The following autogenic drainage stages were taken from the North American Conference on Cystic Fibrosis)

The cystic fibrosis individual must begin sitting in a comfortable chair in a quiet place so that he/she is able to concentrate. One hand should be placed on the upper part of the chest and the other hand should be placed just below the ribs to feel your breathing. Then RELAX.6

Guided Imagery: Slowly close your eyes and clear your mind of all unnecessary thoughts. Allow your mind to be open and imaginative. Relax your neck and shoulders. Release the tension in your face, drop your jaw, allow your legs and arms to go limp. “Gradually leave the problems and experiences of your daily life behind “.10

Become aware of your own presence. Listen carefully to the sounds of your own breath. Recognize the rhythm of the diaphragm expanding and contracting. “Notice you are continually filling and emptying. Don’t change it, just notice it and enjoy the inner experience”.10 Feel your breath slowing feeling in and out like the waves on a beach.

Phase One—Unsticking

Breathe in as much air as possible then blow out until all the air is out of your lungs. Feel your stomach muscles squeeze out all of the air. Then take a normal sized breath slowly and hold for three seconds and release air in a relaxed manner. This is repeated five times.

Guided Imagery: Familiarize yourself with the cycle of slowly expanding your body to inhale, releasing your breath out of your body and into the atmosphere. Imagine what your breath would look like if it were your favorite color. Would it be yellow like a sunflower, gently blowing in the breeze? Or would it be a white sailboat gliding through calm waters?

This phase helps unstuck the mucous from the smallest airways. Sometimes this phase has to be repeated until the mucous starts to move. When the cystic fibrosis individual hears crackles as he/she breaths, this means mucous has moved upward and you can move to the next level of breathing.

Phase Two--Collecting

During this mid level breathing exercise, most of the extra air is exhaled from the lungs and then you take a larger than normal sized breath in and hold for three seconds. Breathe out and repeat for five breaths. This phase collects the mucous into the windpipe where it can be removed in phase three.

Guided Imagery: As you inhale again, filling your lungs almost full, imagine you are becoming whole and alive! As you exhale, push out your breath very fast. It sends you soaring and dancing through the open cool air.

Phase Three--Evacuating

The cystic fibrosis individual huffs and coughs. This high-level breathing is performed at normal breathing level but the air is forced out to clear mucous from the throat and mouth.

Guided Imagery: Just one more deep breath, you have almost reached your destination. Open your mind and feel how whole and satisfying it is to feel your lungs completely. As you exhale, push all of the air out. Treat yourself to another ride through space as you tighten your abdominal muscles and fly. You are now empty. Slowly start to relax. Imagine yourself floating back down to earth. Recognize the diaphragm flowing in and out. Continue to focus on the connection between your breath and the outside world. Become yourself again. And when you are ready, slowly open your eyes.


CONCLUSION

This project brought together two diverse worlds: the artistic and the medical to Creating An Art out of Breathing. This research project is a personal experiment that benefited one person with cystic fibrosis. Through the distribution of the video, Creating An Art out of Breathing to adolescents with cystic fibrosis for their daily regiment of airway clearance, it is hopeful that their overall well-being is enhanced. If others get the same results, the impact of this concept could be overwhelming for the cystic fibrosis community. Perhaps this project could plant the seeds for further research.

REFERENCES

  1. “Understanding Cystic Fibrosis: The Basics” online article from WebMD.com, <http://my.webmd.com/content/article/7/1680_53769> published October 1, 2001; accessed January 23, 2004.
  2. Orenstein, D.M. Cystic Fibrosis: A Guide for Patient and Family. Lippincott-Raven, Philadelphia, 1996.
  3. “Physiotherapy in the Treatment of Cystic Fibrosis.” International Physiotherapy Group for Cystic Fibrosis booklet, 2nd ed., 1995.
  4. Hess, D.R. “Secretion Clearance Techniques: Absence of Proof or Proof of Absence?” J. Respiratory Care. 47: 7, July 2002.
  5. Giles, D.R. and J.S. Wagener, et. al. “Short-term Effects of Postural Drainage with Clapping vs. Autogenic Drainage on Oxygen Saturation and Sputum Recovery in Patients with Cystic Fibrosis.” From The Departments of Respiratory Therapy and Pediatrics, The Children’s Hospital University of Colorado School of Medicine, Denver. 1995.
  6. “Airway Clearance Course” unpublished packet. Fifth Annual North American Cystic Fibrosis Conference.
  7. Chevaillier, J. “Autogenic Drainage.” In Lawson, D., Ed. Cystic Fibrosis: Horizons. John Wiley: Chichester, 1984: 235.
  8. Schoni, M.H. “Autogenic Drainage: A Modern Approach To Physiotherapy In Cystic Fibrosis.” J. R. Soc. Med. 1999, 82 (supp.): 32-37.
  9. “About LIMS” online article from Laban/Barteneiff Institute for Motion Studies, <http://www.limsonline.org/aboutlims_prime.html> accessed January 23, 2004.
  10. Hackney, P. Making Connections: Total Body Integration through Bartenieff Fundamentals. Gordon and Breach: Amsterdam, 1998.
  11. Saiman, L. and J. Siegel. “Infection Control Recommendations for Patients with Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-To-Patient Transmission.” J. Soc. for Healthcare Epidemiology of America. 24: 5 (supp.), May 2003.

--top--

Back to the Journal of Undergraduate Research