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If You Can’t Breathe,You Can’t Function: Integrating Cardiopulmonary and Postural Control Strategies
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If You Can’t Breathe,You Can’t Function: Integrating Cardiopulmonary and Postural Control Strategies

7/7/2017 to 7/9/2017
When: July 7-9, 2017
Where: Saddleback Memorial Medical Center
24451 Health Center Drive
Laguna Hills, CA  92653
United States
Presenter: Mary Massery PT, DPT, DSc
Contact: Rita Pierson
(916) 929-2782 x105

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Course Description

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.


Course Objectives


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.



Friday (7.5 Contact Hours)                                          Open Enrollment (110 people)


8:00 - 8:30

Registration and coffee

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


Saturday (7.5 Contact Hours)                                      Limited Enrollment (50 people)


8:00 - 8:30


8:30 - 10:00

Lecture: Find the problem: Pulmonary assessment from a multi-system perspective

10:00 - 10:15


10:15 - 12:00

Lab: Chest assessment: Focus on musculoskeletal alignment and breathing patterns

12:00 - 1:00


1:00 - 1:30

Lab: Chest assessment (continued)

1:30 - 2:30

Lab: Facilitating efficient breathing patterns and building endurance: chest, diaphragm, and symmetry techniques (neuromotor techniques)

2:30 - 2:45


2:45 - 4:45

Lab: Facilitating breathing patterns (continued)

4:45 - 5:30

Patient demonstration (if possible)


Sunday (5.5 Contact Hours)                                        Limited Enrollment (50 people)


8:00 - 8:30


8:30 – 9:00

Discussion: recap patient demonstration

9:00 – 10:00

Lecture: Airway clearance: From Sherlock to solution

10:00 - 10:15


10:15 – 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



Mary Massery, PT, DPT, DSc 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.



20.5 contact hours or 2.5 CEUs

Instruction Level: Advance to Intermediate
Format: Lecture and lab
Target Audience: Physical Therapists.



Saddleback Memorial Medical Center
24451 Health Center Drive
Laguna Hills, CA 92653

Campus Map


Registration received by June 7, 2017

Lecture & Lab Fees (Limited Availability, Days 1-3)

$750 APTA  members
$1,000 Non-members


Lecture Only (Day 1 only)

$350 APTA members

$560 Non-members

Add $100 for late registration.


All cancellation requests must be received in writing – no exceptions. A full refund, less 20% service fee, if cancellation is received 14 days prior to the start of the course. No refunds after June 23, 2017.

Course Requirements

Required attire for labs: ladies - tank tops, sports bras, etc. Everyone - loose, comfortable pants such as yoga pants, sweat pants, etc. Participants not wearing lab clothes are invited to come and observe.

Anatomy books: Participants are encouraged to bring their favorite anatomy book to help visualize the presentations.

Suggested pre-readings for the course: A variety of pre-readings are available. See Mary’s publications on her website:

Long hair: Hair clips or pony tail bands are needed for long hair in labs.

Linens: All registrants are asked to bring a bath towel each day. Even the Friday group will be practicing techniques and will need a towel! Saturday and Sunday registrants need to bring a padded mat and a pillow as they will be laying on the floor during labs, practicing the techniques



Free surface parking


Courtyard by Marriott – 23175 Avenida da la Carlota, Laguna Hills, CA
Laguna Hills Lodge – 23932 Paseo de Valencia, Laguna Hills, CA
The Hills Hotel, An Ascend Collection Hotel – 25205 la Paz Road, Laguna Hills, CA

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