Page 10 P H Y S I O T H E R A P Y September, 1958. Glosso - Pharyngeal Breathing M A R G A R E T P. B A K E R , M .C .S.P., M .A .P .A ., Senior P hysiotherapist, R oyal C hildren’s Hospital, O rthopaedic Section, M t. E liza, Victoria, A ustralia. (Reproduced by kind permission o f “Physiotherapy” Journal o f Chartered Society o f Physiotherapy, M ay, 1958 and the Author.) TH E problem o f how to increase the Vital Capacity o f patients with severe and increasing scoliosis w ho require spine grafts has been a puzzling one. Their initial low Vital Capacity is usually diminished after application o f a Risser jacket, and further diminished as correction proceeds. The expanded lung on the convex side becom es restricted, while the contracted lung tissue on the concave side is stretched out and called on to do more work. The latter is non-elastic through disuse, and requires powerful respiratory m uscles to utilize it efficiently. In January, 1956, I first heard o f G losso-Pharangeal Breathing (G .P .B .) being used in the Respirator Ward at Fairfield H ospital for Infectious Diseases, M elbourne, and prom ptly paid a visit there. 1 received a great deal o f help and instruction from the physiotherapists and patients and cam e away very heartened by the atmosphere o f hope and expectation in those hitherto chronic wards. A new era is dawning for respirator cases and courageous efforts are being made by staff and patients to enable endless days in a respirator to com e to an end. G .P.B. is performed by the patient filling the mouth cavity with air, closing the mouth and nasal apertures, an forcing the air into the lungs using the larynx as a pump. This is called ‘striking’ and after several strokes the air in the lungs is released and that volum e is the Tidal Volume. Som etim es there occurs a leakage o f air from the nasal apertures due to the patient being unable to close these by raising the soft plate, and in these cases the patient has to hold his nose tightly. I was rather diffident at attempting to teach G .P .B . to children. H owever, our first two patients were co-operative and intelligent girls o f ten and eleven years respectively. They were both in plaster jackets, but by means o f diagrams and the practice o f prescribed exercises they mastered the art o f stroking in a remarkably short time. Our aim in using G .P.B . was to gain maximum inspiration to stretch the lung tissue, thereby facilitating the work o f the deficient respiratory muscles. Patients have a pre-jacket routine, and as far as physio­ therapy is concerned, this consists of: weekly vital capacity readings, breathing and m obilizing exercises, head su s­ pension, m uscle tests, swimming, and learning to ‘frog’ or G.P.B. It is desirable for patients to master ‘frogging’ before the plaster jacket is applied, but so far all have mastered the technique even if they have not been proficient before having their plaster jackets on. We now have a tradition o f ‘frogging’ and the ‘old hands’ help the new boys and girls and take a pride in seeing how quickly their pupils can master it. The patients inspire as deeply as possible using their respiratory m uscles, and then stroke as many tim es as they can before releasing the air in the lungs. This procedure we term a ‘blow -ou t.’ The number o f strokes varies very much with each patient; som e com plain o f vertigo and these cases are discouraged from taking their maximum number o f strokes. Patients perform three blow-outs daily before doing ordinary breathing exercises. It was found that the best time for thes^ exercises was just before a meal when the stom ach was em pty, as the constriction o f the plaster prevents expansion o f the stomach and lungs simultaneously. G .P.B . is also used to stim ulate the cough reflex after operation, which assists in the expectoration o f mucus. So far our results have been promising. A ll patients have increased their Vital Capacity and in a few cases doubled it. On discharge patients have.been urged to continue their daily blow-outs and so keep or increase their Vital Capacities, thus aiding their oxygen intake and im proving their general health. They can also take advantage o f the decrease in the mechanical constriction o f the lungs brought about by the correction o f the scoliosis. Cases o f scoliosis too severe for operation have been helped by this method to improve their Vital Capacities. The question arises as to whether we should teach all patients with markedly diminished V .C .’s to perform daily blow-outs as a routine measure. P ersonally I think it would be well worth while. C A S E 1. A d m itte d D is c h a rg e d A ge 15 y ea rs (T .G .) 5 .4 . 5 6 2 8 .3 .5 7 R E M A R K S D a te V.C. V.C . + G .P .B . 2 4 .4 .5 6 2200 ccs L y in g su p in e 2 5 .4 .5 6 In P la s te r J a c k e t 3 0 .4 .5 6 2200 MOO O nly le a rn in g G .P .B . 3 0 .7 .5 6 2300 3100 2 1 .8 .5 6 S p in rg ra ft 2 7 .8 .5 6 2200 3200 2 6 .1 1 .5 6 2700 3500 2 8 .3 .5 7 2500 3000 O u t o f p la ste r, lying D I S C H A R G E D C A S E 2. A d m itte d D isc h a rg e d A ge 10 y ea rs (C .W .) 2 0 .1 0 .5 5 5 .1 1 .5 6 R E M A R K S D a le V.C. V.C . -\-G .P.B . 1 6 .1 .5 6 800 L ying in p la ste r ja c k e t 2 9 .2 .5 6 800 1000 L ying o u t o f p la ste r 1 3 .3 .5 6 S p in e g ra ft 3 0 .4 .5 6 1000 1050 3 1 .7 .5 6 1400 1400 1 1 .9 .5 6 P la s te r ja c k e t rem oved 3 .1 0 .5 6 1500 1600 In b lo c k le a th e r ja c k e t C A S E 3. A d m itte d D is c h a rg e d A ge 15 y ea rs (M .E .) 6 .6 . 5 6 1 2 .6 .5 7 R E M A R K S D a te V.C. V .C .+ G .P .B . 9 . 7 . 5 6 2200 L ying su p in e 3 .8 .5 6 2000 L ying su p in e 1 7 .9 .5 6 2200 L ying su p in e 2 3 .1 0 .5 6 S pine graft 3 0 .1 0 .5 6 1500 4 .1 2 .5 6 2100 2600 P a tie n t slow to le arn G P 7 . 1 . 5 7 2200 2800 5 . 2 . 5 7 2500 3000 2 .4 .5 7 2100 2700 1 3 .5 .5 7 P laste r rem o v ed 1 6 .5 .5 7 2400 2900 L y in g o u t o f p la ste r 1 2 .6 .5 7 D I S C H A R G E D C A S E 4. U .S .) D ate 1 6 .1 .5 6 2 9 . 2 . 5 6 9 . 3 . 5 6 2 3 .3 .5 6 1 1 .4 .5 6 1 1 .5 .5 6 4 .6 . 5 6 4 . 8 . 5 6 2 2 .1 1 .5 6 1 4 .1 2 .5 6 A d m itte d 1 0 . I 1.55 V.C. 600 700 600 800 1300 1400 1100 D is c h a rg e d 1 4 .1 2 .5 6 V.C. -f-G .P .B . 700 900 1100 1500 1200 A g e 10 y ea rs R E M A R K S L ying s u p in e in p la ste r ja c k e t L ying s u p in e o u t o f p la s te r ja c k e t S pine g ra ft 1st stage S pine g ra ft 2 n d stag e R is s e r ja c k e t rem o v ed , lig h t p la s te r ja c k e t a p p lie d D I S C H A R G E D R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) • •• September, 1958. P H Y S I O T H E R A P Y Page 11 In gang tot ons n tiw e perseel, Je p p es tra a t 2 5 2 , Johannesburg. Wat is ’n Ingang? Ons g lo dat ’n in gang m eer is as net ’n deur o f ’n o p en in g waardeur ’n m ens toegang tot ’n perseel kry. Vir ons is d it ’n w eerspieeling van die gees van die eienaars, die atm osfeer w at daar binne heers en die lew ensbeskou in g van die persone w at u gaan o n tm oet. M a g ons u vriendelik uitn ooi om ons ’n besoek te bring by o n s nuw e perseel te ,C A P E -Y O R K ’, Jeppestraat 252, gelee tussen G o u d - en N uggetstrate, Johannesburg? D ie in gang is in Jeppestraat, op die grondverdieping, derde w inkel van die h o ek van G ou dstraat. Sodra die gebou v o lto o i is sal daar v o ld o en d e parkeerplek w ees. Jn die tussentyd druk a sseb lief die .Parkeerknoppie’ in die in gangsp ortaal en u kar sal veilig versorg w ord terwyl u deur ons vertoonkam er luier. 'liUiadVUTrihuZatL ® N on te ,C A P E -Y O R K / ■ Jeppestraat 252 (Ingang v a n a f die grondverdieping) ■ Johannesburg Telefoon: 23-8106 • Posbus 3378 en te Bostonhuis 216-7 • Strandstraat ■ Kaapstad Telefoon: 3-4608 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )