| What kind of a breather are you?
Filling the lungs fully, with expansion of the diaphragm and abdominal area, is the correct way to breathe. To determine if you are breathing from the diaphragm, lie on your back and place one hand on your chest and the other on your abdomen. Note which moves when you breathe. If the hand on your chest moves more, you are breathing from the upper chest. If your abdomen moves in and out when you breathe, you are breathing correctly. To become a belly breather:
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Many cultures throughout the ages have understood the role that breathing plays in achieving optimal health. In China, breathing is central to the healing art of Qigong and the health-enhancing practice of tai chi. In India, pranayama-or breath control-is a major part of yoga.
Breathing is an automatic function of our bodies, yet something we can control. It is affected by physical and mental stress, injury, illness, anxiety, failure. It is deep and calm when we're relaxed, fast and shallow when we're nervous or stressed.
What affects us affects our breathing. And if our bodies are affected by disease-such as Parkinson's-improving breath support and control can improve a range of symptoms and conditions.
Breathing Your Best: Why It's Important
As children, we naturally breathe deeply, filling the abdomen and expanding the diaphragm. But as we grow older, breathing often becomes shallower. We stop using the diaphragm-breathing from the chest instead-and our lungs don't fill completely with air.When breathing is incorrect, a range of systems within the body is affected: immune, circulatory, endocrine and nervous. In addition, energy production is compromised.
Proper respiration offers the body many benefits. Better breathing increases oxygen intake. It revitalizes the cells, tissues and body organs. It eliminates toxins. And on the psychological level, it helps us relax and focus. Studies have found that correct breathing can help manage stress and stress-related conditions by soothing the autonomic nervous system.
Parkinson's Effect On Breathing
When breathing is done correctly, the chest wall muscles and diaphragm expand as air is inhaled into the lungs. The lungs, in turn, extract oxygen from the air and expel carbon dioxide from the blood into the exhaled air.But there are challenges to breathing for many individuals with Parkinson's disease (PD).
"In PD, the muscles of breathing, like the muscles in the arms and legs, can become rigid and stiff and lose some of their elasticity. Or, they can become weak, making effective breathing techniques very challenging. If the chest wall muscles and diaphragm become rigid, they don't expand completely during inspiration and don't relax completely during expiration," says Maritza Nogueras, R.P.T., director of rehabilitation services and a physical therapist with Northridge Medical Center in Fort Lauderdale, Fla. "It becomes more of a challenge to take a deep breath because the muscles don't want to move as easily."
The normal rate of breathing when at rest is 12 to 18 breaths per minute. Because of rigidity, it is not uncommon for Parkinson's patients to breathe at a rate of more than 20 breaths per minute.
"As a result, they exert more energy, fatigue easier and can't tolerate activities well. They often are short of breath," says Maritza.
Shortness of breath also can occur from the stooped posture some PD patients experience. The compromised posture leaves less space for the muscles to expand.
Better Breathing, Better Voice Control
If the muscles in the chest wall are rigid, breathing is affected which, in turn, affects speech. Exhaled air is the power behind voice. So rigid muscles lead to a decreased ability to speak at an acceptable level of loudness because the muscles are not elastic and cannot move with variable force and speed.At least 75 percent of those with Parkinson's experience changes in speech and voice at some point in their journey with the disease. For some, a change in the quality of the voice-often a "hoarse" or "breathy" quality-is the first symptom of the disease. These symptoms are called dysarthria. To the listener, dysarthria sounds like weak, slow or uncoordinated speech.
"The vocal cords are weak and so there is a low voice and breathiness," says Holly Shill, M.D., of the Muhammad Ali Parkinson Research Center in Phoenix. "Parkinson's patients should not rely completely on their medications to improve this condition. You need speech therapy and voice therapy interventions to improve it."
For Marjorie Johnson, M.A., C.C.C., S.L.P., a speech pathologist at the Struthers Parkinson's Center in Minneapolis, focusing on breathing is an integral part of improving her patients' speech. "Breathing techniques are among the first activities I concentrate on. If you can improve your breath support and respiratory energy, you can get better voice volume and projection."
Barriers to Breathing
Those with PD, like anyone else, can be anxious. And, to be sure, Parkinson's does not lessen anxiety, it increases it.Anxiety can aggravate many conditions, Parkinson's included. The heart beats faster, blood pressure rises and hands shake more than usual. When you are experiencing anxiety, you breathe faster and the levels of carbon dioxide in the blood drop. This increases your rate of breathing as it shifts from the abdomen to the chest. With chest breathing-or hyperventilation-each breath is faster, shallower and less efficient. You spend more energy on breathing.
"When people are in a highly anxious state, it becomes more difficult to take a deep breath and control your air," says Marjorie Johnson. "Reduced air exchange also can put the person with Parkinson's at risk for developing aspiration pneumonia if food or liquid enters the lung."
Better breathing and a strong respiratory system can help generate the productive coughs that ward off aspiration pneumonia.
"Pneumonia is the leading cause of death for people with Parkinson's," says Dr. Shill. "Those with PD generally have a normal life span, but pulmonary issues are frequently a problem, especially as the disease progresses. Proper breathing may be able to combat this, although it has never been studied."
Dr. Shill is quick to point out that the side effects of medications also can contribute to respiratory problems in PD.
"Medications can be helpful in treating the changes in breathing patterns that result from PD, including chest wall restriction, upper airway obstruction and motor fluctuations. However, ergot derivatives may cause pleuropulmonary fibrosis. I always counsel my patients who are on those dopamine agonists that are ergot derivatives, such as Pergolide and Bromocriptine, that these meds can cause pulmonary fibrosis."
Can You Change Your Breathing?
You know you can control breathing based on your physical and mental state. But can you consciously change the way you breathe for the better, so that it becomes involuntary?"My patients tell me that with Parkinson's, things they never had to think about, like annunciating, swallowing, walking, they now have to concentrate on," says Dr. Shill. "That means you have more control over them than you realize and you can change them, often with therapy. It's like when you were younger and your mother told you time and again to stand up straight. It's the same idea of practicing something over and over again until it becomes automatic."
There are specific exercises that are designed to help breathing. You'll get the best results when you work with a trained physical therapist and/or speech pathologist. These professionals may suggest traditional respiratory exercises, or other approaches.
Using Music and Yoga to Improve Respiration
For over 25 years, Connie Tomaino, D.A., M.T.-B.C., has observed significant improvement in respiratory function through music therapy. She is vice president of music therapy at Beth Abraham Family of Health Services in New York. She uses music to stimulate unconscious activity, including a change in breathing patterns."With Parkinson's, the patient sometimes cannot initiate certain motor responses. It's as if the thought to move or act in a specific way is there, but the brain doesn't convey the message so that the action takes place," says Connie. "The music acts as a stimulus to connect the thought process with the action."
Connie recently completed a study of breath support and articulation in patients with dysarthria, including patients with PD. At the beginning of the study, the patients spoke very slowly and quietly because of breath support issues. Using rhythmic patterns, Connie had the patients recite small sentences-such as "It's cold outside. I need a coat."-to the beat of a drum.
At the beginning of the study, the patients were able to speak only three to five syllables coherently. For two months, Connie and her team met with the patients for one hour, twice a week. Singing familiar songs with few words like "Amazing Grace" helped them gain a sense of breathing and holding breath long enough to carry a tune. By the time the study was completed, the patients were speaking sentences of between 14 and 19 syllables coherently.
"There is something about music and how the auditory system stimulates other motor pathways to excite those areas of the brain to allow an activity to take place," says Connie. "If an aspect of speech is lacking, it is possible it can be compensated for with singing. Singing can be a precursor to speech to make it more intelligible and, in the process, enhances breath support."
Another approach designed to aid in relaxation with side benefits of building better breathing is yoga. In recent years it has gained popularity as a treatment for Parkinson's because of its breathing techniques and postures that help loosen rigid muscles.
"While the effects of yoga or tai chi on PD haven't been studied, you have to imagine it can be helpful," says Dr. Shill, "especially in reducing anxiety and promoting proper respiration."
At Northridge Medical Center, yoga that is modified for the Parkinson's patient is offered as part of their bi-weekly exercise program. Cushions and other props are used to help PD patients achieve better posture and facilitate balance.
"We use chairs and cushions quite a bit because we need to emphasize the opening of the chest and the posture," explains Maritza Nogueras. "Posture, flexibility, stretching, breathing and relaxation are emphasized."
One of Maritza's greatest success stories is a patient who was hardly able to speak when he began the class. When he did speak, his voice was so weak it was barely audible. After working with the speech therapist and attending yoga for six weeks, his speech is back, to the delight of his wife, doctor and the staff at Northridge.
It is important to note that although there are many books and videos on yoga, almost none deal with the specific challenges of Parkinson's. It is important to find an instructor who understands the disease and practices a style of yoga that can be adapted accordingly.
One Breath at a Time
Taking the time to work with your breathing and training your body to do it properly can improve overall health, whether or not you have Parkinson's disease.Remember, breathing that comes from the abdomen is the most efficient respiration. Imagine a baby lying on its back in a crib. With every breath, the tummy rises and falls. That is normal, abdominal breathing. The goal of speech and physical therapy is to get you as close to that type of breathing as possible.
But just as there is not one way to restrict breathing, there is not one way to correct it. With the help of your doctor, you can find therapists in your area who can work with you to improve your respiration.. one breath at a time.
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