The harmonica, a…therapeutic instrument
The origins of the program

Like a lot of people, I have played the harmonica for many years and have made a lot of friends along the way. That's the magic of the harmonica; all you need to do is take one out of your pocket and watch the reactions around you, all smiles. I expect you too have had similar experiences

One of the most worthwhile encounters I have had thanks to the harmonica was with Michel Fedrizzi, a French guitarist and composer, unfortunately little known to the public. It was in fact as a result of this meeting that I first made contact with l’Association “Planète clé de Sol” who organise and finance the work of musicians in the hospitals in and around the Nancy area of France. At that time, about two years ago, I told Michel that I had been very interested by the work of Jean-Jacques Milteau and Greg Szlapczynski in Paris and from there he suggested quite simply that I spoke to the people in charge of the association, who were immediately enthusiastic about the idea.

I didn't know exactly how Jean-Jacques and Greg had worked in Paris but to me somehow it seemed logical to try to mix pleasure and practicality by using the harmonica to help children suffering from respiratory difficulties, particularly asthma. I therefore contacted the people from the Association "Planète clé de Sol", the administrators of the Nancy-Brabois children's hospital and the professors Monin and Vidailhet, with a proposition to use the harmonica as a means of therapy.

Having very little knowledge of the illness, I had no real ideas about what kind of exercises to give to the children and to what extent the harmonica could prove to be useful. It was in fact by working with Brigitte Recroix, a paediatric nurse, that these children's exercises were developed. Brigitte undertook to teach me a little about asthma while I helped her with the technical aspects of the harmonica. With her wide experience of the illness, Brigitte immediately pinpointed the potential of the harmonica as an aid to teaching children how to take their medical treatment correctly.

In Nancy, the harmonica was soon to become one of the best-adapted tools in helping children suffering from respiratory difficulties. It is in fact a great teaching aid as it helps children to understand about breathing ,because the harmonica is the only musical instrument that is played by both breathing in and out.

What happened next?

Once a week I visited children suffering from asthma and cystic fibrosis in the Atelier du souffle (the breath workshop) a building recently completed with the help of private donations. Supervised by Brigitte Recroix and myself, the children were to learn how to breathe more efficiently and how to actually control their breathing

Musically, with the harmonica, I taught them

"Breathe in….and hold the note for a long time, stop breathing for 5 seconds

Breathe out for a long time through your nose to empty your lungs"

The intensity of the harmonica's sound enabled the children to actually HEAR the length of breathing in. This apprenticeship with the harmonica helped them enormously with their inhalers, the most important single item that can help them to Improve their condition.

"Asthma remains today the most frequent of chronic children's diseases. The last few years have seen an increase in asthma related disease and mortality throughout the world. At the same time however, our understanding of the disease has improved and we know now that asthma in children is above all an inflammatory illness." (Barnes 1989)

PRINCIPAL TRIGGERS OF ASTHMA ATTACKS

In the home
- Allergies : domestic pets, house-dust mites etc...
- Smoking; active and passive
- Certain types of heating
- Humidity.

Outside the home
- Exposure to allergenic substances (friend's pets pollen etc.)
- Respiratory infections
- Physical exercise, cold air
.. Passive smoking.

Others
-Low aspirin tolerance
- Food additives (sulphites, monosodium glutamate, etc...)
- Emotional upset and stress
- Gastro-esophageal returns.

Improving the quality of lives

"Asthma can be controlled, providing that the sufferer has access to appropriate medical treatment and that he or she can be properly educated both in the administration of these treatments and in the prevention of asthma attacks. The main purpose of the education of asthmatics is to improve their quality of life firstly by teaching them how relieve the symptoms by correct medication and secondly by encouraging the adoption of a lifestyle and environment with a lower risk of provoking asthmatic attacks." (Boutin and Boulet;1993)

There is no magic potion or foolproof trick that can work in all situations, but there are certain basic theoretical principles which can be applied to the creation of educational programs for asthmatics, which can help to improve the efficiency of both the medicine and the preventative measures.

Inhalers

In child asthmatics, the efficiency of the inhaled medicine is directly related to the amount which reaches the bronchial tubes, this in turn depends on the number of particles produced and their characteristics, the type of inhalation (the rate of intake, length of pause etc.) and the anatomy of the upper air passages. In order to gain the greatest benefits from these anti-asthmatic medicines which are mainly administered by inhalation it is important to understand the different uses of the inhalers
For this reason, Brigitte Recroix always explains the exact workings of an inhaler to the children. Generally speaking children over the age of 11 use a "Ventodisk", or "Diskus" or perhaps a "TurboHaler",younger children use inhalation chambers".
Whichever device is chosen, the importance of knowing how to use it correctly remains the same.

A few different models of inhaler

An aérochambreMD for adults and children over five. It has a one-way valve which blocks off larger particles and reduces medicine loss.

An aérochambreMD for children from one to five (with mask). 5 to 10 successive respirations are recommended.

An aérochambreMD for infants(with mask).

A VentahalerMD Transparent 750ml conical chamber, with one-way valve. This valve serves to maintain the medicine in a spacer within the apparatus until the patient is ready to inhale.

Taking the medicine

The child must breathe in the medicine, deeply and for a certain length of time, the inhalation must then be stopped for 5 seconds to allow the total diffusion within the bronchial tubes after which the child has to breathe out long and hard through the nose. For children under five, several successive inhalations are recommended.
It was for this reason that I introduced the harmonica, to help the children understand exactly what they must do when using their inhalers

I ask them to play a long note, drawing on the harmonica, to then stop breathing for five seconds and lastly to breathe out through the nose for a long time without letting out a single note on their harmonica. During the exercise of course I played them a few catchy melodies

Charline and the giant

When six year old Charline has to take her treatment she must breathe in deeply to ensure that the medicine reaches fully into her lungs, but she can only manage a few short breaths and doesn't believe that she can breathe either harder or for a longer period. She is sure that breathing any harder will cause her pain.
I tried straightaway to take her mind off pain by teaching her how to draw and blow into a harmonica and by playing a short melody for her. This first contact with the harmonica went very well but her breathing in and out of the instrument were so feeble that if she had actually been taking her medicine at that time she could not possibly have absorbed it in sufficient quantity

So I told her that only a tiny little mouse would be able to hear her music if one happened to be passing by, but if a giant should be anywhere near with his ears so high in the sky he could not possibly hear and would certainly be very sad!! I asked her once more to play louder and longer so that the giant would be able to hear. Suddenly without a care for the pain which had troubled her so just a few seconds before, she breathed in much, much harder so as not to displease any lurking giants.

I could see in her eyes that she had understood just what she had done, she had realised that she could breathe in deeply without any sign of pain, and I explained that all that air she had taken in whilst playing the harmonica for a giant, could also be found every time she had to take her medicine. A few days later Charline returned home, harmonica in her pocket, as happy as could be, to show her mother the tune that I had taught her

Briefly…

Every week the harmonica goes to visit the children and little by little, it helps them with their treatment. Every week these children go home with a harmonica as a gift, once again thanks to private donations. If you would like to make a donation, however small please send it to "L'atelier du souffle", Hôpital d'enfants de Nancy-Brabois 54000 Nancy-France.

Every year about 600 asthmatic children are admitted at the Nancy-Brabois hospital. Some stay for just one day, others may stay a little longer following a more severe attack. For the time being I only visit the children once a week, so it is generally this kind of patient that I see the most frequently. The harmonica classes and the breathing practice sessions are by no means obligatory and of course we cannot insist on the participation of the children brought regularly by their parents for treatment. If however the word gets round, everyone must surely realise the real impact of the harmonica in teaching the children how to correctly take their medicine
.
Medical treatment is efficient provided it is taken under optimal conditions. The harmonica can genuinely help children to understand, which enables them to do for themselves exactly what is necessary to improve their condition.

If you have ever given a harmonica to a child you will surely have noticed that spark of wonderment in their eyes, if you haven't already done so, then it's never too late!

Paul Lassey, Nancy-France.
http://paul.lassey.free.fr