FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Coordinating Gentle Lower-Rib Breathing

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Original entry 5: Lower-rib or diaphragmatic coordination. This page expands the original list rather than adding a new intervention. [Professional consensus; individual assessment required]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For the Person With FND

You do not have to make your belly move a certain amount or fill your lungs to capacity. When lower-rib coordination is part of your treatment, the purpose is to reduce unnecessary effort and find an easier rhythm. It is worth learning with someone who can see whether it actually helps your pattern.

Trying it with your care team

Begin in the position your respiratory physiotherapist or speech and language therapist recommends. If comfortable, use a light hand at the lower ribs as a temporary cue. Allow a modest breath in and an unforced breath out, following the demonstration rather than chasing a particular depth or count. Let the hand cue go once it has served its purpose. Progress to a relevant activity only when your clinician agrees.

Making room for difficult days

Pain, posture, fatigue and other respiratory conditions can change what is comfortable. You can ask for different positioning or a different cue. Avoid rigid timed breathing, forceful abdominal pushing or long breath holds. Stop if practice brings on dizziness, air hunger or increasing effort.

For a familiar, mild bout, use your agreed plan and reduce the activity demand if needed. Once comfortable, return gradually to something ordinary. You do not need to make up missed practice. If the approach repeatedly makes things harder or offers little help, ask for review; continuing support should not depend on quick improvement.

When this page is not the right response

Do not use cough suppression to manage choking, serious breathlessness or a new unexplained breathing pattern. Seek emergency help for severe difficulty breathing, blue or grey colour, inability to speak because of breathlessness, collapse or suspected airway obstruction. Chest pain or coughing blood needs urgent medical assessment. New noisy breathing, fever, weight loss, repeated chest infections or a changed persistent cough warrants reassessment. Follow prescribed respiratory treatment and your individual emergency plan.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Help arrange comfortable support if asked. Do not press on the person’s abdomen or judge progress by visible movement. A shorter, easier practice can be more useful than a longer session that leaves them exhausted.

Agree beforehand how the person wants help during a familiar bout. A changed or severe episode calls for the medical plan rather than more coaching. Coughing can be exhausting even after the visible bout has ended; leave room for recovery and practical help.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Use this option only when assessment identifies a coordination target. Establish whether tactile feedback helps or increases monitoring. Adapt for respiratory comorbidity, pain, mobility and fatigue; fade cues toward ordinary activity. Lower-rib movement is not a diagnostic test for FND, and this component has not been established as an independently effective FND treatment.

These pages concern assessed presentations. Chronic cough, cough hypersensitivity, tic cough, somatic cough syndrome and inducible laryngeal obstruction are not interchangeable diagnoses, and upper-airway symptoms are not automatically FND. Use the paired diagnostic page and coordinate an individualized plan. Agree a review point, meaningful participation goals and access adaptations rather than prescribing an arbitrary exercise dose.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

The practical explanation adapts professional consensus into everyday language. It is not a tested standalone protocol. Evidence from broader cough-management programmes or other airway diagnoses does not establish the efficacy of this single component in FND. Illustrative situations are teaching examples, not patient quotations or outcome claims.

  • FND-CIT-0025: Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. JNNP. 2021;92(10):1112–1125. DOI. FND-related speech and language therapy consensus; component-specific evidence is limited.

  • FND-CIT-0147: Haines J, Esposito K, Slinger C, et al. UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID-19 pandemic. Clinical & Experimental Allergy. 2020;50(12):1287–1293. DOI. Supports specialist diagnostic assessment; pandemic access arrangements are historical, not a general reason to omit laryngoscopy.

Source review: September 20, 2026 · Human review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —