SUPPORTING TECHNIQUES

Frog breathing: a learned skill that can be used as a substitute (voluntary) method of breathing
The personal experience of Gary McPherson (see also people stories)
WHAT IS FROG BREATHING ?
Frog breathing, or technically speaking, glossopharyngeal breathing (GPB) is a learned skill that can be used as a substitute (voluntary) method of breathing. It can produce adequate ventilation for either short or long periods of time even when there is total paralysis of the respiratory muscles. Frog breathing uses the muscles of the tongue (the glossa) and the throat (pharyngeal muscles) to force air into the trachea and lungs through a repetitious process. This process involves using the tongue and throat muscles as a pumping mechanism to force air into the lungs. This pumping action is sometimes referred to as a stroke. It is important to remember not to swallow, or air will enter the stomach. The muscles of the tongue, soft palate, pharynx and larynx must be functional.

Frog breathing is used effectively by many respiratory impaired individuals (primarily those who had polio) for emergencies, transfers, chest expansion, coughing and to permit time away from the ventilator. In a few cases, individuals can remain off the respirator for extended periods of time, and in some situations all day if the individual’s skills are highly developed.

Most individuals need considerable instruction and encouragement to learn this technique, as well as hours of practice to master it. To learn frog breathing one could use the image of inflating a brand new balloon as a metaphor. When you first attempt to inflate a new balloon the first bit of air is the most difficult to instill. Each additional attempt at inflation becomes easier as the balloon becomes more expanded. This is similar to our lungs when using frog breathing. A proficient frog breather will average approximately 8 or 9 breaths per minute with each breath requiring 12 – 15 (strokes) involving the pump-like action mentioned earlier.

Any individual who utilizes glossopharyngeal breathing is continually expending energy through physical exertion. Therefore, it is natural to assume that like any other physical activity, conditioning of the muscles involved will affect an individual’s proficiency. Frog breathing has the potential to change the quality of life for any individual who has an upper respiratory condition including those with a spinal cord injury or muscular dystrophy.

EVERYDAY ACTIVITIES
Many daily activities can interfere with an individual’s ability to perform the frog breathing techniques and skills that provide adequate ventilation. The reason is because these daily activities involve the mouth and throat muscles thus causing interference. With a great deal of practice and confidence an individual can learn to master these daily requirements and still be able to effectively frog breathe. It is important for users and care givers to be aware of this in order to avoid creating unnecessary stress or crisis situations.

Following, are some brief explanations of some of the implications for people who frog breathe. Also, there is an additional list of implications for some extra curricular activities, medical situations and some of the benefits that can accrue to people who actively practice frog breathing on a regular basis.

• Drinking and eating – it is extremely difficult to swallow liquid or food, and at the same time, pump air into one’s lungs.

• Talking, quality, amplification – when a person who uses frog breathing, talks or speaks for any length of time, it can be extremely fatiguing after awhile. It takes a significant amount of air to sustain this activity and it is important to remember to breathe deeply, and more often than usual.

• Brushing teeth – when inserting a foreign object into the mouth of a frog breather, in this case a toothbrush, it is virtually impossible to frog breathe.

• Bowel movements – when sitting upright on the toilet an individual can create additional pressure on the abdomen and bowel, and consequently, assist in the elimination of bodily waste.

• Lying down – it is more difficult to frog breathe when lying down as opposed to sitting up. This is due to losing the advantage of gravitational pull on the respiratory system.

• Breaths per minute, volume – these are affected by the need of the individual and is often determined by the activity of moment.

• Relieving stress – frog breathing can be very effective in relieving stress. It allows an individual to deep breathe and regulate the expiration to assist with relaxation.

• Breathing through nose and/or mouth – breathing through the nose gives the individual the advantage of natural humidification, however, it is somewhat less effective than breathing through the mouth. Mouth breathing gives a person better proficiency because it is possible to get higher volumes per stroke of air. This advantage is somewhat negated because a person will experience ‘dry mouth’ through this process. Also, mouth breathing is aesthetically, less appealing to some people.

• Exercising frog breathing muscles – it is important to develop the strength and stamina of the muscles used in the process of frog breathing. The net effect is, the more you use them, the better they become at delivering the benefits of the skills involved. It is like any other set of muscles, it is important to keep them in good shape. The more you use them, the better the results.

• Laughing, sneezing, and yawning – these may seem insignificant but both of these affect the ability to take in air.

• Clothing (attire around neck) – it is important to remember to where loose fitting clothing around the neck and throat area. This will avoid causing interference with the pharyngeal muscles.

• Smell: a person’s ability to smell is somewhat impaired as a result of frog breathing. This is particularly noticeable when breathing through the mouth as opposed to nose breathing. Usually, this isn’t significant but it can be in case of fire or toxic fumes.
 
EXTRA-CURRICULAR ACTIVITIES
kissing/making love
exercising/ wheeling
reading out loud
public speaking
 
MEDICAL RELATED NEEDS
colds - congestion
dentist
x-rays - holding your breath
intubation and surgery
tracheostomy implications
panic - shortness of breath - staying calm
 
OTHERS
sobbing
changes of altitudes, i.e. mountains vs sea level
aesthetics
"breath taking" experience
 
BENEFITS
varied activities
it’s portable
work
play
entertainment
socializing
coughing and clearing the airway

 

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Presentation at the "7th International Conference – Noninvasive Ventilation – Across the Spectrum from Critical Care to Home Care" , March 14-17, 1999, Caribe Royale Resort Suites, Orlando Florida, USA – Permission Gary McPherson
 
Helpful References
  • John R. Bach, M.D., F.C.C.P., Mechanical Insufflation-Exsufflation – Comparison of Peak Expiratory Flows With Manually Assisted and Unassisted Coughing Techniques; CHEST, Vol. 104, p. 1553-1562, Nov. 1993 Issue
  • John R. Bach, M.D., F.C.C.P., Pulmonary Rehabilitation, The Obstructive and Paralytic Conditions; HANLEY 6 BELFUS INC., 1996
  • G. Carbone, A. Corrado, C. Gregoretti, Ventilazione non invasiva; ARCHIMEDICA, 1997
  • Susan Sortor Léger, RRT, Manually-Assisted Courgh, IVUN News, Spring 1998, Vol. 12, No. 1
  • George Emerson, The In-Exsufflator Cough Machine, IVUN News, Spring 1998, Vol. 12, No. 1