If You Can’t Breathe, You Can’t Function - Integrating Cardiopulmonary and Postural Control Strategies in the Pediatric and Adult Populations

June 23-25, 2017
Course is Closed

This course will challenge the practitioner to make a paradigm shift: connecting breathing mechanics and postural control with management of trunk pressures. Through her model of postural control (Soda Pop Can Model), the speaker will link breathing mechanics with motor and physiologic behaviors (a multi-system perspective).  She will present novel research demonstrating the role of vocal folds as postural stabilizers, extending the concept of “core stability” from the vocal folds on the top of the trunk to the pelvic floor on the bottom.  Numerous interventions will be presented that use positioning and ventilatory strategies to optimize motor performance.  Neuromotor breathing retraining techniques and manual assistive cough techniques will be the focus of treatment labs.  Multiple patient cases will be presented throughout the course.  The emphasis of the course will be on developing practical, quick clinical solutions for pediatric and adult patients in all practice settings. 

At the conclusion of Day 1, participants should be able to:

  • Describe how trunk pressures link breathing and postural control using the Soda Pop Can Model.
  • Describe the multiple, simultaneous roles of the diaphragm as related to breathing, postural control, gastroesophageal reflux, constipation, and venous return.
  • Demonstrate the role of the vocal folds in normal postural stability responses (balance) and make the case for using speaking valves for patients with tracheostomies.
  • Contrast normal infant chest wall development to those with impaired breathing mechanics.
  • Position patients for optimal physiological and biomechanical support of breathing with simple equipment (towels, pillows, etc.).
  • Use a ventilatory strategy algorithm presented in class to optimally match breathing with movements from bed mobility to athletic endeavors.

At the conclusion of Days 2- 3, participants should be able to:

  • Perform a multi-system (physical and physiologic) evaluation of motor impairments.
  • Identify the variations of “normal” breathing patterns and discuss the efficiencies/inefficiencies for individual patient conditions.
  • Evaluate need for, and demonstrate, appropriate neuromotor retraining techniques for patients with ineffective breathing/postural control strategies (health or participation deficits).
  • Participate in a live patient demonstration (if a patient is available) and suggest possible evaluation and treatment ideas based on the course material.
  • Design a targeted airway clearance program using the principles of mobilization, expectoration and oral management.
  • Demonstrate airway clearance techniques, with a heavy emphasis on manual assistive cough techniques, and apply an airway clearance algorithm to specific patients.
  • Identify thoracic cage/spine restrictions as they pertain to breathing mechanics and postural control (a very brief introduction musculoskeletal issues). 
  • Evaluate need for, and demonstrate, neuromotor retraining techniques to improve breath support for voicing. 
  • Suggest means for incorporating the course material into therapy activities in your clinical setting immediately.

Texas Children's Hospital
Feigin Center
1102 Bates, 1st floor conference room
Houston, Texas 77030

Cost -  


Earned credits -  

20.5 contact hours or CCU’s through TPTA and TOTA


Mary Massery, PT, DPT

Dr. Massery received her BS in Physical Therapy from Northwestern University in 1977, her DPT from the University of the Pacific in 2004 and her DSc from Rocky Mountain University in 2011. Her publications and interests focus on linking motor behaviors to breathing and/or postural mechanics in both pediatric and adult patient populations. 

Dr. Massery has been invited to give over 800 professional presentations in 49 US states, 9 Canadian provinces, and 15 countries worldwide, including more than 100 presentations for the American Physical Therapy Association, and a full-day post-conference program at the World Congress of Physical Therapy in Singapore.  Mary has delivered keynote and major addresses on topics such as cystic fibrosis and posture, neuropulmonary deficits, pectus excavatum (chest deformities), and connections between posture & breathing. 

Mary has received national awards from the APTA, including its highest clinical award, The Florence Kendall Practice Award, honoring “one’s outstanding and enduring contributions to the practice of physical therapy." She has been honored as Outstanding Alumnus of the Year by each of her 3 alma maters. And in 2016, she was awarded Northwestern University’s Alumnae Research Achievement Award.  Mary continues to maintain a private practice in Chicago, specializing in breathing and postural dysfunction. 


Day One

8:00 - 8:30


8:30 - 10:30

Lecture:  Breathing and posture: Part 1 - Pressure control (Soda pop model)

10:30 - 10:45


10:45 - 12:00

Lecture:  Breathing and posture: Part 2 - The diaphragm

12:00 - 1:00


1:00 - 2:00

Lecture:  Breathing and posture: Part 3 - The vocal folds

2:00 - 2:30

Lecture:  Normal and abnormal chest wall development and function

2:30 - 2:45


2:45 - 4:00

Mini-lab: Positioning strategies: What can you do in 90 Seconds or less that has a profound and lasting effect? 

4:00 - 5:30

Mini-lab: Ventilatory strategies:  Integrating breathing strategies with movement for optimal motor performance

Day Two

8:00 - 8:30

Coffee and ...

8:30 - 10:00

Lecture/Demonstration:  Chest assessment:  Focus on musculoskeletal alignment and breathing patterns

10:15 - 10:30


10:30 - 12:00

Lab:  Assessing breathing patterns and postural implications

12:00 - 1:00


1:30 - 2:30

Lab:  Facilitating efficient breathing patterns and endurance training: Neuromotor techniques for diaphragm, chest and other breathing patterns

2:30 - 2:45


2:45 - 4:45

Lab:  Facilitating breathing patterns (continued)

4:45 - 5:30

Patient demonstration (if possible)

Day Three

8:00 - 8:30

Coffee and ..

8:30 – 9:30

Lecture/Discussion:  recap patient demo using “Find the Problem” Chart

9:30 – 10:15

Lecture: Airway clearance: From Sherlock to solution

10:15 - 10:30


10:30 – 12:00

Lab:  Airway clearance: Focus on manual assistive cough techniques

12:00 - 12:45


12:45 – 1:30

Mini-lab:  Brief introduction to musculoskeletal restrictions of thoracic spine / rib cage that impair breathing mechanics (or vice versa)

1:30 – 2:30

Lab:  Enhancing breath support for phonation

2:30 - 3:00

Lab:  Group problem solving:  Putting it all together 


Wyndham Medical Center
6800 Main
Houston, Texas 77030


Angela Dumas