Learning Objectives

By the end of the course the participant should have:

• Evidence as to the etiology, nature and implications of Breathing Pattern Disorders (BPD) (dysfunctional breathing) – which are abnormal respiratory patterns ranging from simple upper chest breathing patterns to the extreme of BPD, hyperventilation.
• The ability to recognize signs and symptoms of functional breathing pattern disorders, and the difference between these and pathological respiratory conditions, that lie outside the scope of this course.
• The understanding that because BPDs may sometimes mimic cardiac, neurological and gastrointestinal conditions – these should be ruled out if present. BPD is not a disease process, simply abnormal breathing patterns that are amenable to rehabilitation, and which interfere with normal respiratory function.
• An understanding of the widespread influences of BPD on physical and emotional health in general, and the musculoskeletal system in particular, based on current clinical and research evidence.
• An understanding of the connection between BPD and symptoms involving circulatory, neurological, psychological and metabolic processes, based on clinical and current research evidence.
• An awareness of the connection between BPD and pelvic floor, low back  (and sacro-iliac) dysfunction.
• Awareness of – and the ability to utilise, standard assessment methods including capnography and validated instruments such as the Nijmegen Questionnaire, and Rowley Breathing Self-efficacy Scale (RoBE) – in assessment of BPD – as well as a range of observational and palpatory tests and methods.
• The ability to assess and evaluate associated biomechanical changes involving the thoracic cage, rib and clavicular dysfunction, together with the use of evidence-based, clinically useful and appropriate soft tissue and articular mobilization methods.
• An increased ability to explain to clients the value of regularly applied – evidence informed – rehabilitation (breathing exercises and mobilization methods) in the management of breathing pattern disorders – and to instruct clients in their use.
• Greater awareness of various complementary approaches to rehabilitation of respiratory function – including sleep hygiene, relaxation methods, and optimal nutrition.

Evidence suggests that the key elements in rehabilitation of chronic BPD require that the client:

1. Understands the background and implications of breathing dysfunction (educational component)
2. Biomechanical mobilisation of the structures involved in respiration, via self-applied exercise and, where necessary, appropriate manual treatment (biomechanical component)
3. Dedicated application of breathing exercises (rehabilitation component)
4. Time for these ingredients to achieve changes. – which varies depending on chronicity.

Resources/References

• http://www.physio-pedia.com/Breathing_Pattern_Disorders 8/8.
• Barker NJ, Jones M, O’Connell NE, Everard ML.  Breathing exercises for dysfunctional breathing/hyperventilation syndrome in children. Cochrane Database Syst Rev. 2013 Dec 18;12:CD010376.
• Bradley H, Dr Esformes J.Breathing pattern disorders and functional movement.  Int J Sports Phys Ther. 2014 Feb;9(1):28-39.
• Chaitow, L., Bradley, D. and Gilbert, C. Recognizing and Treating Breathing Disorders. Elsevier, 2014.
• Courtney R  van Dixhoorn, J  Evaluation of Breathing Pattern: Comparison of a Manual Assessment of Respiratory Motion(MARM) and Respiratory Induction Plethysmography. Appl Psychophysiol Biofeedback (2008) 33:91–100Bradley H, Dr Esformes J.  Breathing pattern disorders and functional movement. Int J Sports Phys Ther. 2014 Feb;9(1):28-39.
• Jones M, Harvey A, Marston L, O’Connell NE Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev. 2013 May 31;5:CD009041.
• van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199-206.

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