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Free Downloads Support Material   Harmonica For Fun & Health Classes
Provided below is free download material written by David Barrett for instructors and organizations to use to help implement a Harmonica for Fun & Health program in their area. Feel free to use this material without prior consent from us.  If you are prompted to enter a password, select cancel.   The book/CD Harmonica For Fun & Health is now available by authors David Barrett and Dennis Bucko M.D.  Support material for this book and classes are at left.  Below is information on the disease process and how the harmonica can help.  David Barrett continues to work with El Camino Hospital in Mountain View, California.  David also helps to support his students that donate their time at other local hospitals.  If you have taught a program and have a success story you would like to share with us, please email to us at pulm@harmonicamasterclass.com

In May of 2004 David Barrett and volunteer staff at El Camino Hospital provided a harmonica program for people with COPD (Chronic Obstructive Pulmonary Disease) and related airway diseases. Findings from this helped David (and Co Author Dennis Bucko M.D.) complete their harmonica book/CD on the same subject. Below are pictures and the opening text to the book to be released in 2005.
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For many years I have been hearing success stories about harmonica programs taught to people with pulmonary disease and the benefits to the lives of the students that participated. When teaching a Harmonica Masterclass Workshop in Long Beach California a lunchtime conversation with student Dr. Dennis Bucko turned into what you see before you. Until the publication of this book, there had been no harmonica methods specifically written for people with pulmonary disease. It just made sense that there needed to be a methodical approach to teaching these students with special needs. This learning material fills that void.

The first step for me was to learn as much about all of the associated pulmonary diseases. After much research it was clear that our focus was to be towards persons with Chronic Obstructive Pulmonary Disease (COPD). Commonly this includes persons with Emphysema, Chronic Bronchitis and Chronic Asthma. Below is some basic information about these diseases.

Most people think of expansion and contraction of the rib cage as "breathing;" however, movement of the diaphragm plays the major part in air movement. The diaphragm (the thin muscle that separates the chest from the abdomen) moves up and down like a trampoline and creates changes in pressure within the lungs. When the diaphragm moves down and/or the rib cage expands (as in inspiration) and the lungs expand, the pressure inside the lungs becomes negative and air rushes into the lungs. This expands the air sacs (alveoli) of the lungs and fills them with air (the walls of the air sacs are about as thick as a soap bubble just before it pops). The fresh inspired air makes contact with the small blood vessels in the vessel walls (known as arterial capillaries which surround the alveoli) and oxygen crosses over into the blood where it attaches to red blood cells. At the same time carbon dioxide (metabolic waste product) crosses from venous capillaries into the air sacs. When the diaphragm relaxes and moves upward and the ribs contract, air and carbon dioxide are expelled from the lungs.

Emphysema is a disease that destroys the walls of the air sacs by an unknown mechanism. As more and more air sacs rupture, they open up into enlarged air sacs, which have lost much of their elasticity. This creates the problem most often seen in patients with emphysema: they can get air in, but they cannot get all the air out. The lungs work like a balloon—you blow the balloon up (lungs inflate) and when you stop, the balloon recoils and expels all of the air (lungs deflate). With emphysema, the natural process of expelling air is changed because the air sacs have ruptured and become non-elastic. The small airways in the lung collapse due to the increased effort of pulling a breath into the lungs. In addition, the loss of air sac surface area decreases the efficiency of oxygen/carbon dioxide exchange leading to low blood oxygen and/or high blood carbon dioxide levels.

Chronic Bronchitis
The bronchi are tubes, which supply all parts of the lung with air by splitting again and again into smaller bronchi, which run through all five lobes of the lungs. The bronchi divide into even smaller air tubes (bronchioles) and finally into 300 million tiny, elastic air sacs (alveoli).  Small muscles on the outside can contract or relax the tubes, i.e. asthma causes constriction of the muscles and decreased airflow.

All breathing tubes are lined with cells which have tiny hairs (cilia). Other cells in the airway make mucus which lies on top of the cilia. There are millions of cilia, all sweeping mucus towards the mouth. Inhaled foreign matter is trapped in the mucus and is pushed up towards the windpipe to be swallowed or coughed out. With chronic bronchitis the lining of the airways become inflamed, swells and produces excessive amounts of mucus. The swelling of the airways narrows the amount of air space, increases resistance and makes breathing difficult. Some airways may even be blocked by excess mucus. Mucus can't be coughed out due to the collapsed airways and this increases the chance of lung infection causing lasting damage to the lungs.

It was amazing to find that most of the benefits of harmonica play are areas of focus in pulmonary rehabilitation programs.

Issue #1 - COPD causes air to be trapped in the air sacs. In emphysema, because of the loss of elasticity, or in bronchitis because of irritation and swelling, airways have a tendency to become very narrow or collapse as you exhale. This causes difficulty exhaling and traps air.

Common Solution - “Pursed Lip Breathing” can reduce collapse by increasing the resistance to the flow of air. This keeps pressure high inside the airway by holding the airway and air sacs open as the diaphragm and abdominal muscles squeeze more air out of the lungs. Pursed Lip Breathing is done by breathing in through your nose, keeping your mouth closed. Pucker your lips in a whistling or kissing position and breathe out slowly, gently tightening your abdominal muscles to push the air out through your lips. Be sure to use enough pressure to make a sound, but do not force exhalation. Stay relaxed and exhale at least twice as long as you inhale. As you inhale count one to two. As you exhale count one to four. Always breathe out twice as long as you breathe in.

How Harmonica is Similar - Notes are performed on the harmonica on both the inhale and the exhale and air is forced through the reeds creating some resistance. This means that there is always positive pressure on the airways reducing collapse, mimicking pursed lip breathing.

Issue #2 - Loss of diaphragmatic muscle efficiency
The diaphragm is the major muscle of breathing. It is a large dome-shaped muscle, located just below the lungs, dividing the chest from the abdomen. The diaphragm is responsible for up to 80% of breathing effort. Thoracic or Rib Breathing is the other mechanism of respiration. The DHD Healthcare website (www.dhd.com) states "costal breathing lifts the rib cage up and out via the external intercostal muscles, enlarging the thoracic cavity producing a partial vacuum. The lungs are expanded by negative pressure, but not enough to ventilate the lower lobes, reducing pulmonary ventilation since the lower lobes receive a greater share of blood due to gravity. Respiration is shallow, with not much movement of the abdomen." Patients often recruit ”respiratory accessory muscles" (neck, chest, arms, and shoulders).  Because of hyperinflation of the lungs, people with emphysema and bronchitis develop flattened diaphragms, which do not work as efficiently to get air into and out of the lungs. These people use the accessory muscles to compensate for their disease.

Common Solution - The diaphragm is a muscle that can be reconditioned with exercise. To do Diaphragmatic Breathing, place one hand over your upper chest area, and the other over your abdominal area. Breathe out, first feeling your lower hand being pushed inward. As you breathe in, the hand over the diaphragm rises as air fills the bases in your lungs. The hand over your upper chest should feel no movement.

How Harmonica is Similar - Playing the harmonica requires support from the diaphragm for both short and long breath patterns. Training prior to playing the harmonica on Diaphragmatic Breathing and coaching during classes will provide a fun context in which to strengthen the diaphragm.

Issue #3
- Patients with COPD must work to get air out of as well as into their lungs. This is commonly due to the loss of elasticity of the lungs and to the rigidity of the lower rib cage (includes cartilage, tendons, muscles, and skin). The mobility of the lower part of the rib cage is especially decreased due to shallow breathing.

Common Solution - Strong abdominal muscles help push air out by compressing the rib cage and pulling the lower ribs downward. They are also needed to achieve a forceful cough.

How Harmonica is Similar - Playing the harmonica requires use of the lower lobes of the lungs, diaphragm and costal muscles. The harmonica is a low impact exercise for all of this. As a player's endurance increases, more rigorous playtime can be done to move the exercise level up as needed.

Issue #4 - Loss of well-being, loss of independence and depression. Many patients with chronic disease find that they become depressed and suffer a lessening of their quality of life.

Common Solution - Many of the pulmonary rehabilitation efforts are aimed at lifting the patient's spirits and increasing independence and fostering creativity.  This improves “Health Related Quality of Life,” an important measure of the success of pulmonary rehabilitation. 

How Harmonica is Similar - Learning to make music is uplifting to all. Learning to play the harmonica requires focus, practice, and skill development. When the student progresses and hears his or her own music, depression can lift and a sense of accomplishment improves well-being and quality of life. 

As I read more, I was amazed to learn that the activities that a harmonica player goes through are very similar to pulmonary rehabilitation exercises. The next step was to find out what could be done to help ease a COPD patient into harmonica play and if the music needed to be rewritten to accommodate their level of breath control. The "Starting Exercises" in Section 2 will help to ease the new player into the act of breathing through the harmonica. The music examples are similar to those presented to any new harmonica player, with specific markings that show where to breathe.

Our goals for this book are to help people with COPD achieve increased mobility and stamina, increased respiratory muscle endurance, increased energy, deeper breathing, a better outlook on exercise and better quality of life through making music using the harmonica.

The key is improving quality of life. The advantages of a well-rounded exercise program are clear. Some of the devices used in pulmonary rehabilitation (such as the Inspiratory Spirometer and PFLEX®) do not offer much enjoyment of achievement. Harmonica offers an amazing thing—the creation of music. To think that the making of music can be so helpful in other areas of our lives is amazing. Not only do we have physical benefit through exercise, but mental benefit that comes with the calming effect music has on our mind, body and spirit.

Playing the harmonica is not the only tool you will use in your journey to modifying the disease process, but is one tool of many for living a healthy, vibrant life. Don't use this as an excuse not to exercise as recommended by your doctor; use the harmonica as an additional tool. There is no clinical evidence (through a documented study) that shows that COPD can be drastically helped by playing the harmonica, but it's obvious to me observing people learning this wonderful instrument that the benefits are boundless.

     Our volunteers Steve and Karen. Thanks!
   From right to left Thanks to: Missy Von Luehrte, RN; Vivian Low, RN, MPH; and Jodi Howe, RN  

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