04 - Respiratory Disorders

Question 1

Name 2 speech breathing disorders

Answer 1

Parkinson’s Disease
Cerebellar Disease
Spinal Cord Injury

Question 2

What is Parkinson’s Disease (PD)?

Answer 2

A progressive neurological disease involving damage to the basal ganglia

Question 3

How does PD affect speech?

Answer 3

Speech intensity can be very low
Related to breathy voice (laryngeal) and decreased respiratory support
General reduction in the range and force of speech movement and breathing

Question 4

Which disease results in reduced stride length and reduced facial movements?

Answer 4

Parkinson’s Disease

Question 5

How does PD affect rib cage movements and abdomen movements?

Answer 5

Decreased RC movements (thought to be related to stiffness and rigidity in the RC muscles)
Increased ABD movements (possibly to compensate for decreased RC movements)

Question 6

How does PD affect vital capacity?

Answer 6

Vital capacity is reduced (which is associated with reduced maximum phonation times)

Question 7

How does PD affect Intraoral Pressure?

Answer 7

Reduced Intraoral Pressure
- limited respiratory muscle force and failure to completely close the lips, tongue, & velopharynx, so inadequate build-up of oral air pressure

Question 8

How can we use respitrace to help treat PD speech problems?

Answer 8

Use respitrace for biofeedback related RC and ABD movements while attempting to produce deeper inhalations during speech and focus on expanding the RC movement range

Question 9

Treatment of PD patients involves increasing the range and force of the respiratory movements to produce _________

Answer 9

Increased speech loudness

Question 10

Which pieces of equipment could we use for biofeedback about oral pressure in PD patients?

Answer 10

Oral Pressure Transducer

Manometer

Question 11

What are 2 ways we might try to help treat PD speech symptoms?

Answer 11

Increase range and force of respiratory movements

Focus on expanding the range of RC movement to produce deeper inhalations during speech

Attempt to produce more expiratory effort during speech (longer and louder prolonged vowels and /s/ sounds

Reduce stooped posture using support devices or training

Question 12

How does the cerebellum related to movement?

Answer 12

The cerebellum is important for the production of smooth, coordinated movements, so damage or disease to the cerebellum can cause most voluntary movements to become jerky and uncoordinated

Question 13

If you saw someone with irregular, poorly controlled, and jerky walking and arm/hand movements, which speech breathing disorder would you think they had?

Answer 13

Cerebellar Disease

Question 14

If you saw someone with irregular changes in pitch, loudness, and clarity on a moment-to-moment basis, which speech breathing disorder would you think they had?

Answer 14

Cerebellar Disease

Question 15

What do RC and ABD movements typically look like in a patient with Cerebellar Disease?

Answer 15

Abrupt, irregular, and jerky

***Paradoxical respiratory movements may also be observed

Question 16

What do paradoxical respiratory movements produce?

Answer 16

Can produce undesirable inhalatory movements during exhalation (may be perceived as ‘inhalatory gasps’)

Question 17

What are some respiratory parameters you might see with a patient with Cerebellar Disease?

Answer 17

Jerky RC and ABD movements
Paradoxical Respiratory Movements
Inhalatory gasps during exhalation
Reduced Vital Capacity
Speech initiated below normal lung volumes

Question 18

What are some things we might try to do to treat Cerebellar Disease speech problems?

Answer 18

• Initiate speech at higher lung volumes and reduce severity of irregular respiratory movements
• Deeper inhalations, start speech at start of exhalation
• Spirometric or respitrace feedback for increased inspiratory volumes
• Respitrace as feedback for monitoring and attempting to reduce paradoxical movements

Question 19

How might we use respitrace feedback to help treat Cerebellar Disease?

Answer 19

Use it to increase inspiratory volumes

Use it to monitor and attempt to reduce paradoxical movements

Question 20

Why can Spinal Cord Injuries cause a speech breathing disorder?

Answer 20

Can prevent brainstem from sending signals to respiratory nerves, to the diaphragm, and to major muscles of inspiration and expiration (internal and external intercostals, and abdominals)

Question 21

How could spinal cord damage above c3 influence breathing?

Answer 21

Respiratory paralysis - brainstem cannot send signals to respiratory nerves at c3 or below

Question 22

What part of the spinal cord is related to innervation of the diaphragm?

Answer 22

c3-c5

Question 23

What would damage below c5 results in?

Answer 23

Innervation of the diaphragm intact (rest breathing)
Loss of innervation to other major muscles of inspiration (external intercostals) and expiration (internal intercostals and abdominals)

Question 24

Which vertebrae are related to intercostals and abdominals?

Answer 24

T2-T12

Question 25

What respiratory parameters might we see with a Spinal Cord Injury between T2 and T12?

Answer 25

Reduced intercostal and abdominal muscle strength
-> reduced vital capacity, inspiratory reserve volume, and expiratory reserve volume

Diaphragm used to compensate
-> larger abdominal movements

Passive, less powerful exhalation
-> need to rely on elastic recoil of the lungs and diaphragm

Question 26

Why would a Spinal Cord Injury somewhere from T2 to T12 cause larger abdominal movements?

Answer 26

Patients have lost innervation to major inspiratory and exhalatory muscles, but not the diaphragm, and so are attempting to use the diaphragm to take deeper inhalations

Question 27

What location would a Spinal Cord Injury be at to result in passive exhalation, relying on the elastic recoil of the lungs and diaphragm?

Answer 27

T2-T12

Question 28

Why would a patient with damage to T2-T12 have reduced vital capacity, inspiratory reserve volume, and expiratory reserve volume?

Answer 28

Because of the loss of innervation to major muscles of inspiration and expiration, resulting in decreased strength of the intercostals and abdominals

Question 29

Name 1 thing we could do to try to treat someone with a spinal cord injury to T2-T12

Answer 29

• Attempt to build up strength of remaining respiratory muscles
• Deeper and more forceful inspirations and exhalations
• Expiratory Muscle Strength Training (EMST) Device
• Use an oral air pressure transducer for biofeedback
• Arrange the use of a portable voice amplifier if speech loudness remains low
• Phrenic nerve pacing