Slide 1 ___________________________________

Harmonicas for Health ___________________________________

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Slide 2 ___________________________________
Thanks
• Thanks to Mary Jane Gormley for her passion
to not only make our harmonica class a reality ___________________________________
but also for being the catalyst in the writing of
the Harmonicas for Health book used in our
classes, and her proof reading.
• Thanks to Vicky Hicks for her technical advice
and proof reading.
• Thanks to my wife, Bonnie, for her editing, ___________________________________
proofreading and constant support.
• I would also like to extend thanks to Christine
Brock for putting the final editing touches on
this program.
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Slide 3 ___________________________________
Objectives & Goals
Objectives
1. Recognize the benefit of harmonica playing for ___________________________________
improvement of respiratory function.
2. Apply the use of harmonicas in respiratory populations
to further improve their medical condition and well being.
Goals
a) Identify the benefit that playing the harmonica will bring to the COPD, reactive
airway disease patient, and other respiratory patient populations by teaching
them better control of their breathing.
___________________________________
b) Teach patients to exercise the muscles that help them breathe more efficiently.
c) Help patients to strengthen their abdominal muscles for a more effective cough,
as well as to help mobilize secretions.
d) Demonstrate and teach back the basics of simple harmonica playing.
e) Apply new skills to your everyday clinical practice. ___________________________________

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Slide 4 ___________________________________
Three Hidden Goals
•
•
You will NOT become a harmonica virtuoso in one lesson.
You may still not like the harmonica;
___________________________________
however, you should have a “healthy”
respect for it.
• You should have at least one ounce
of fun during this class (your choice!).
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Slide 5 ___________________________________
COPD Data
•
•
Third highest mortality rate in U.S., not including other respiratory illnesses.
Most other major illness mortality rates decreasing or stable, COPD mortality rates ___________________________________
increasing.
• 134,676 COPD deaths reported in 2010.
• In 2011, over 12.7 million U.S. adults diagnosed with COPD.
• Over 24 million Americans have impaired lung function, indicating under-diagnosis

•
of COPD.
Around 80% of COPD is caused by smoking; one study indicates nearly 20% could ___________________________________
be linked to industrial pollutants. The figure is 31.1% for workers who never
smoked.
• Mayo Clinic has estimated that about 1% of COPD is caused by Alpha-1-antitrypsin
deficiency.
• Worldwide, more than 3,000,000 people died of COPD in 2005. Ninety percent of
those deaths take place in low or middle income regions. ___________________________________

___________________________________

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Slide 6 ___________________________________
COPD Data, 2011
• 10.1 million Americans diagnosed with chronic bronchitis
(affects all ages).
___________________________________
• 4.7 million Americans diagnosed with emphysema;
92% are older than 45.
• 1.4m ER visits and 3.2m admissions annually for COPD.
• 10.8% of assisted living residents have COPD.
___________________________________
• Lowest rates of COPD: Washington and Minnesota
• Highest rates: Alabama and Kentucky
___________________________________

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Slide 7 ___________________________________
Women and COPD
• Approximately 7 million women in the U.S. live with COPD.
Millions more have the disease but are undiagnosed.
___________________________________
• The number of COPD deaths among women COPD has quadrupled
over the past 30 years.
• 2014 was the 11th consecutive year in which women have exceeded
men in COPD deaths.
___________________________________
• In 2010, 70,000 women died from COPD vs. 64,000 men.
• Research has shown that women diagnosed with COPD experience
higher rates of anxiety, depression and report lower quality of life.
___________________________________

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Slide 8 ___________________________________
Increased Mortality Among Women vs.
Men
Possible reasons may be: ___________________________________
• The tobacco industry targeted women in the late 1960s, which
resulted in a huge increase in women smoking. The numbers
continue to increase as new cases of smoking-related disease are
diagnosed, including COPD, as women age.
• Women are more vulnerable than men to lung damage. Their lungs
___________________________________
are smaller and estrogen plays a role in worsening lung disease.
• Women are often misdiagnosed because COPD has long been
diagnosed as a man’s disease.
___________________________________

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Slide 9 ___________________________________
Prolonging Life: Two Absolutes
1. Patients who need oxygen must wear it! ___________________________________
(Minimum 15 hours daily recommended.)
2. If patient hasn’t quit smoking, he/she needs to
quit!
___________________________________
Respiratory medications will improve breathing and
allow improvement of activities of daily living (ADL)
but not necessarily prolong life. ___________________________________

___________________________________

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Slide 10 ___________________________________
Ongoing Effects of COPD
• COPD can severely limit ADLs and quality of life (QOL), causing
increased SOB as patient tries to increase activities.
___________________________________
• COPD symptoms can also:
– Decrease psychosocial functioning in home and community,
creating less independence.
– Become worse with stress.
___________________________________
– Limit immune system’s ability to fight exacerbations, infections.
– Bring on negative psychological changes, i.e. chronic anxiety,
depression.
___________________________________

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Slide 11 ___________________________________
Limiting Effects of COPD
A recent American Lung Association survey reports that ___________________________________
COPD patients experience limitations in their ability to:
• Participate in family activities (46%)
• Sleep (50%)
• Work (51%) ___________________________________
• Socialize (53%)
• Do household chores (56%)
• Physically exert themselves (70%) ___________________________________

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Slide 12 ___________________________________
The Harmonica as Exercise
Exercise keeps us in shape to function more efficiently: playing a
harmonica is exercise!
___________________________________
• As the patient exercises breathing muscles, they breathe better with
less effort by engaging their:
– Diaphragm (primary breathing muscle)
– Intercostal muscles
___________________________________
– Accessory and shoulder muscles

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Slide 13 ___________________________________
How the Harmonica Helps
• Maintains good lung function, helping to reduce COPD
(and asthma) symptoms, and possible future exacerbations
___________________________________
• Facilitates deep breathing and helps us use more of our
lung capacity
• Improves ability to keep our lungs clear
___________________________________

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Slide 14 ___________________________________
It’s Not Just for COPD Patients
Patients with other health issues who have benefited ___________________________________
from learning harmonica include those with:
• Cardiovascular disease • ALS
• Asthma • Chronic pain
• Pulmonary fibrosis • Depression, Anxiety and ___________________________________
• Sleep apnea Stress
• Parkinson’s disease • Tobacco use
• Muscular dystrophy • Memory loss
• Learning disabilities ___________________________________

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Slide 15 ___________________________________
The Evidence is Clear
• 1970s -1990s: “Standards of Clinical Practice per American Music Therapy Association have found
improvement in motor, cognitive, language, social skills and emotional, spiritual components.”
—UW-Eau Claire: Harmonicas in Music Therapy: Research and Clinical Programming, Lee Anna Rasar
___________________________________
• 2004: “Playing harmonica…is certainly superior to the traditional methods of inhalational therapy.”
—Amarillo Globe News: Playing Harmonica Leads to Health Benefits
• 2011: “Playing harmonica shows you how to breathe right and leads to an increase in lungs capacity and
oxygen storing capacity.”
—The Times of India: “Play Harmonica, live a healthy life.”, Madhavi Dharia Shah
• 2013: After his second lung-transplant procedure in 2008, Larry Rawdon, Broadway cellist, began to
supplement pulmonary rehab exercises with the harmonica and showed significant positive results. “I am
convinced that for lung transplant patients, playing the harmonica can be considered [as] a piece of
___________________________________
legitimate breathing exercise equipment.”
—Mayo Clinic: Harmonica Helps Pulmonary and Lung-Transplant Patients Breathe Easier, @LaurenVenoy

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Slide 16 ___________________________________
Additional OTC Tools & Exercises
___________________________________
• Other tools: balloons, pinwheels,
soap bubbles, etc.
• Other techniques: singing or playing a Training your bubble
wind instrument functions basically on
exhaling; however, does require deep, abdominal breathing
___________________________________
• Cheap and proven breathing exercises that RTs teach:
– Pursed-lip breathing
– Abdominal breathing ___________________________________

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Slide 17 ___________________________________
Da Harmonica
• Inexpensive ___________________________________
• Small
• Goes everywhere
• Universally accessible ___________________________________
• Simple
• Especially pleasing to most dogs
• Works effectively on inhale and exhale ___________________________________

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Slide 18 ___________________________________
Four Points for Improved Breathing
1. COPD causes air trapping ___________________________________
2. COPD causes a loss of proper diaphragmatic ability
3. COPD makes it difficult to eliminate CO2 and to effectively clear the
lungs through coughing
4. COPD interferes with quality of life ___________________________________

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Slide 19 ___________________________________
1. Trapped Air
• Loss of elasticity ___________________________________
• Airway collapse
• Inflammation and irritation of airways that causes narrowing

Common solutions:
• Pursed-lip breathing (PLB)
___________________________________
• Harmonica: Exhaling through harmonica creates a back
pressure that mimics PLB as you generate sound. Playing
more traditional wind instruments (trumpet, saxophone,
vocal, etc.) may also help. ___________________________________

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Slide 20 ___________________________________
2. Loss of Proper Diaphragmatic Ability
• When SOB, people often breathe from upper chest and/or
shoulders, in tripod position with elbows on table. ___________________________________
• Diaphragmatic breathing should do 80% of the work of breathing.
• Incorrect breathing wears some people out more quickly,
increases O2 demand causing more SOB: downward spiral toward
possible exacerbation.
___________________________________
Common solutions:
• Incentive spirometry • Playing wind instrument
• Inspiratory muscle trainer • Swimming
• General exercise • Yoga ___________________________________
• Singing • Harmonica

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Slide 21 ___________________________________
3. Eliminating CO2 and Effectively Clearing
Lungs
• Loss of elasticity in lungs
• Rigidity of the entire rib cage especially lower rib cage
___________________________________
• Ineffective overuse of intercostal and accessory muscles
causing fatigue, increased O2 demand, increased calorie
consumption.
Common solutions:
___________________________________
• Strengthening of diaphragmatic and abdominal muscles
• Incentive spirometry
• Inspiratory muscle trainer
• Core exercises
___________________________________

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Slide 22 ___________________________________
3. Eliminating CO2 and Effectively Clearing
Lungs
Devices and modalities to help clear lungs:
• Flutter valve ___________________________________
• “A Cappella”
• Mechanical vest
• Chest physical therapy
• “Lung flute” (see picture)
• Bi-level devices
• Harmonica:
___________________________________
– Promotes efficient diaphragmatic control
– Strengthens abdominal muscles
– Promotes a more effective cough mechanism
– Less reliance on intercostal and accessory muscle use
– Vibration caused by sound transmits throughout chest and lungs helping facilitate
airway clearance
___________________________________

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Slide 23 ___________________________________
4. Quality of Life
People with breathing problems have: ___________________________________
• Loss of well being
• Increase frustration
• Loss of independence ___________________________________
• Possible emotional problems such as depression,
anxiety, etc.
___________________________________

___________________________________

___________________________________

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Slide 24 ___________________________________
4. Quality of Life
Common solutions:
• Enlisting in an exercise regimen such as OPPR
___________________________________
• Joining community organizations
• Hobbies, volunteering, learning a new skill, etc.
• Harmonica:
– Enhances health
– Learning a new skill increases self-esteem, sense of accomplishment and well-
being
___________________________________
– Better control over symptoms
– Possibly decreases exacerbations, hospitalizations
– Increase mental involvement and focus
– Skill development
– Increase quality of life
___________________________________
– Possible new religious experience

___________________________________

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Slide 25 ___________________________________
What Stops Us?
What stops us from learning and teaching harmonica? ___________________________________
• If I stink at playing the harmonica, I will
have a major loss of self-esteem!
• What will my family, friends, peers say ___________________________________
if they find out I play harmonica?
– It may decrease my credit rating.
– It could make me grow grey faster.
– I may find myself friendless, homeless and/or penniless. ___________________________________

___________________________________

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Slide 26 ___________________________________
It’s About the Exercise!
• The benefits are not from how you sound! ___________________________________
• The benefits are from the blowing and drawing action
through the harmonica in a repetitive regimen.
• You really can’t make a bad sound.
• Your technique will improve with practice. ___________________________________
• It’s easy to start.
• Who cares what you look like as long as you are
helping
yourself (and others) to breathe better?!?! ___________________________________

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Slide 27 ___________________________________
Playing Harmonica Engages…
• Mouth • Hands
• Lips • Joints ___________________________________
• Tongue • Bones
• Cheeks • Ribs
• Jaw • Throat
•
•
Teeth
Neck
•
•
Lungs
Heart
___________________________________
• Eyes • Diaphragm
• Ears • Legs and Feet
• Muscles (if it makes you dance)
•
•
Arms
Brain
• More ___________________________________

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Slide 28 ___________________________________
Let’s Get Started!
Rule #1: Keep things separate and clean!
• Use hand sanitizer
___________________________________
• Provide napkins for harmonicas when not in use.
• Remember, those things are going in our mouths!
• Keep them warm and dry before playing.
• Don’t store in plastic containers until completely dry.
___________________________________
• No sharing!
• Don’t eat or drink anything except water.
• Don’t let the dogs lick harmonicas.
• Lap whap often.
Whap whap whap!
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Slide 29 ___________________________________
Warm-Up Exercises
Look at the harmonica and find the row of numbers from 1
to 10 above the holes. ___________________________________
1. Keep your shoulders relaxed.
2. Put a hand on your diaphragm and feel it move in and
out as you practice the exercises.
3. Draw in/blow out on holes 1 - 4, each exercise
counting to 4, @ same volume.
4. In/out x 4, change volume, soft - loud - soft. ___________________________________
5. In/out x 4, change volume, loud – soft - loud.
6. In/out x 4, separate notes, generated by diaphragm,
counting 1-2-3-4.
7. In/out x 4, changing the shape and position of your
mouth and tongue, making the sound “ooo- wee-
ooo…”
8. Practice #7 faster causing a tremolo effect.
___________________________________
9. Lap whap

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Slide 30 ___________________________________
Hand Positioning
The “Alligator The “Open
Clam”
Jaw”
• Touch both
1 • Make “alligator
jaw” with left hand.
2
. heels of ___________________________________
. • Place harmonica in
alligator’s “mouth.”
hands
together
(“clam
The “Closed Clam”
shell”). ___________________________________
3 • Cup right hand over back end of
harmonica.
. • Open and close right hand over
harmonica quickly to make a different
tremolo effect. ___________________________________

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Slide 31 ___________________________________
Variations
Replicating the Flutter Valve Effect
• Creates vibrations in the chest similar to flutter valve of
___________________________________
respiratory therapists, with similar results.
• Make the sound “tah-tah-tah-tah” or “ka-ka-ka-ka” blowing out.
• Make the sound “hut-hut-hut-hut” or “hah-hah-hah-hah” when
drawing in.
• In x 4, Out x 4, using the above sounds.
___________________________________
• Practice for 3-5 minutes daily.

Have you lap whapped lately!???!?

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Slide 32 ___________________________________
Variations
• Making the Train Sound
– Make the train whistle @ beginning and end, over holes 5-6-7, drawing in forcefully twice
(try to bend the reeds a little).
– Play holes 1-2 on the left side of the harmonica, in/out twice, each time slowly.
___________________________________
– Move harmonica from L>R after each repetition as you play faster.
– Once you are to the far right, playing fast, start to move back to the left, playing more slowly as you
move, until you are back to holes 1-2, drawing in and blowing out very slowly.
– End with the train whistle.
• Slide up or down to the notes, which is an easy way to find starting notes

•
(or correct mistakes – what mistakes!??!?!).
Blues “chugging”- inhaling/exhaling back and forth in a “shuffle-type” rhythm.
___________________________________
– The goal is to be able to do this repeatedly without getting short of breath with out stopping.
– The sound you make on inhale is “hah-HAH” and exhale is “tah-TAH.”
– “Hah-HAH – tah-TAH – hah-HAH – tah-TAH – hah-HAH – tah-TAH…”

___________________________________
Have you lap whapped lately!???!?

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Slide 33 ___________________________________
Playing One Note at a Time: Positioning
• Pursed Lip technique
• Tilted Harmonica– ideal method (you
___________________________________
may do a mix of both pursed lip and tilted
harmonica).
– For now, hold with both hands on each side.
– Put up to lips and blow out.
– Tilt back of harmonica upward almost
___________________________________
touching tip of nose.
– Using this technique, you’ll play fewer notes
due to bowl of lower lip.
– This takes practice!
Note the ___________________________________
tilted
harmonica

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Slide 34 ___________________________________
10-Hole Diatonic Harmonica
• Diatonic means you play your basic Do-Re-Mi-Fa-Sol-La-Ti-Do
scale (think “Sound of Music”). Low Do to high Do is called
___________________________________
an octave.
• The most common diatonic harmonica has 3 octaves.
• Middle octave is from holes 4-7 and is where you play most
melodies. ___________________________________
• Lower octave (holes 1-3) mostly for chording and
accompaniment (previous exercises)
• Upper octave (holes 8-10) for extending the melody higher.
• Neither lower octave nor upper octave is a full octave.
___________________________________

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Slide 35 ___________________________________

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Slide 36 ___________________________________

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Slide 37 ___________________________________
Your first
song on
harmonic
a! ___________________________________
Mother will
be so
proud!!! ___________________________________

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Slide 38 ___________________________________
Let’s Play
Some
Rounds! ___________________________________

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Slide 39 ___________________________________
Monitoring Progress Monthly
PFT screening ___________________________________
• FVC/predicted %
• FEV1/pred. %
• Peak flow/pred. % ___________________________________
• SpO2 (+ HR)
• Inhale one note (hole 4) as long as possible.
• Exhale one note (hole 4) as long as possible. ___________________________________

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Slide 40 ___________________________________
Smiles and
Better
Breathing All
Around ___________________________________
Thanks! Now
get
practicing!! ___________________________________
Start a class!!!

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Slide 41 ___________________________________
References
•
•
American Lung Association
NHLBI Data fact sheet, COPD, NIH publication No. 03-5229, March 2003. ___________________________________
• From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for
Chronic Obstructive Lung Disease (GOLD) 2008.
• National Heart, Lung, and Blood Institute fact sheet 2003.
• Keeping You in Harmony, Katrina Riggin, RRT, Pulmonary Rehab, Ball Memorial Hospital.
•
___________________________________
Harmonicas for Health—A Guide to Breathing Better, Gormley and Vesely, Cardiopulmonary Rehab,
Bloomington Hospital.
• UMHS press release: When breathing needs a tune up, harmonica class hits all the tight notes, Sep. 28th
2005, Katie Gazella.
• Jerry Reynolds RT, Ohio State University in Columbus, Sing Out – The secret weapon for respiratory
health, MDA Publications, Vol. 12, #3, May/June 2005 (muscular dystrophy).
• Harmonicas for Fun & Health, www.harmonicamasterclass.com, David Barrett
• www.sciencedaily.com music for your lungs: pulmonologists treat breath shortness with harmonica
classes. ___________________________________

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Slide 42 ___________________________________
References (cont.)
•
•
www.azcentral.com/news/arizona republic/local/articles/1228phx breath 12268.html (John C. Lincoln hospital, Phoenix).
http://www.stltoday.com/news/multimedia/videos/harmonicas-for-health/html_0310bb02-8f35-5a1d-bad5-
50c60504db47.html
___________________________________
• https://www.youtube.com/watch?feature=player_detailpage&v=xedc5Be-ZnI
• http://www.youtube.com/watch?v=PmHy2FevTuE
• http://www.youtube.com/watch?v=yeTTs5bc_P4&feature=relmfu
• Amarillo Globe News, Playing harmonica leads to health benefits, Wednesday, March 17th, 2004
• Elisabeth Olson, Easy Breathers Project Manager, Air Education and Communication Specialist, Wisconsin Department of
Natural Resources, CE/6 Box 7921, 101 S. Webster St., Madison, WI 53707-7921. You can also go online at
www.easybreathers.org.
___________________________________
• University of Wisconsin-Eau Claire, Lee Anna Rasar, September 28th 2010, [email protected]
• The Times of India, [email protected]
• Zen and the art of harmonica, David Harp, Kripalu Online, 2007
• Mayo Clinic, Harmonica Helps pulmonary and lung-transplant patients breathe easier, Lauren Venoy, July 19th, 2013
• COPD Digest, Harmonicas 4 Health, Vol. 12, #3, October 15th 2016, pg. 22-23

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Slide 43 ___________________________________
My Thanks to…
Introduction music:
• “Walkin’ Blues” by Joe Peters; performed by
___________________________________
Joedai Warriors, “Red, Black, & Blue” CD.
• “What’s On Your Mind” by Joe Peters;
performed by Joedai Warriors,
“Edge of Disaster” CD.
• “Feeling Blue” by Phil Hipskind; performed by
Kari Johnson & the Impasse Band, “Time Marches On” CD, 2014
___________________________________
All photography used with permission:
• Steve Fletcher, slide 2
• Louise Michaelis, 36,38
• F.D. Gormley, all remaining patient/class photos ___________________________________

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