04 - Respiratory Disorders Flashcards
Name 2 speech breathing disorders
Parkinson’s Disease
Cerebellar Disease
Spinal Cord Injury
What is Parkinson’s Disease (PD)?
A progressive neurological disease involving damage to the basal ganglia
How does PD affect speech?
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
Which disease results in reduced stride length and reduced facial movements?
Parkinson’s Disease
How does PD affect rib cage movements and abdomen movements?
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)
How does PD affect vital capacity?
Vital capacity is reduced (which is associated with reduced maximum phonation times)
How does PD affect Intraoral Pressure?
Reduced Intraoral Pressure
- limited respiratory muscle force and failure to completely close the lips, tongue, & velopharynx, so inadequate build-up of oral air pressure
How can we use respitrace to help treat PD speech problems?
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
Treatment of PD patients involves increasing the range and force of the respiratory movements to produce _________
Increased speech loudness
Which pieces of equipment could we use for biofeedback about oral pressure in PD patients?
Oral Pressure Transducer
Manometer
What are 2 ways we might try to help treat PD speech symptoms?
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
How does the cerebellum related to movement?
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
If you saw someone with irregular, poorly controlled, and jerky walking and arm/hand movements, which speech breathing disorder would you think they had?
Cerebellar Disease
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?
Cerebellar Disease
What do RC and ABD movements typically look like in a patient with Cerebellar Disease?
Abrupt, irregular, and jerky
***Paradoxical respiratory movements may also be observed
What do paradoxical respiratory movements produce?
Can produce undesirable inhalatory movements during exhalation (may be perceived as ‘inhalatory gasps’)
What are some respiratory parameters you might see with a patient with Cerebellar Disease?
Jerky RC and ABD movements Paradoxical Respiratory Movements Inhalatory gasps during exhalation Reduced Vital Capacity Speech initiated below normal lung volumes
What are some things we might try to do to treat Cerebellar Disease speech problems?
- 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
How might we use respitrace feedback to help treat Cerebellar Disease?
Use it to increase inspiratory volumes
Use it to monitor and attempt to reduce paradoxical movements
Why can Spinal Cord Injuries cause a speech breathing disorder?
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)
How could spinal cord damage above c3 influence breathing?
Respiratory paralysis - brainstem cannot send signals to respiratory nerves at c3 or below
What part of the spinal cord is related to innervation of the diaphragm?
c3-c5
What would damage below c5 results in?
Innervation of the diaphragm intact (rest breathing)
Loss of innervation to other major muscles of inspiration (external intercostals) and expiration (internal intercostals and abdominals)
Which vertebrae are related to intercostals and abdominals?
T2-T12
What respiratory parameters might we see with a Spinal Cord Injury between T2 and T12?
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
Why would a Spinal Cord Injury somewhere from T2 to T12 cause larger abdominal movements?
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
What location would a Spinal Cord Injury be at to result in passive exhalation, relying on the elastic recoil of the lungs and diaphragm?
T2-T12
Why would a patient with damage to T2-T12 have reduced vital capacity, inspiratory reserve volume, and expiratory reserve volume?
Because of the loss of innervation to major muscles of inspiration and expiration, resulting in decreased strength of the intercostals and abdominals
Name 1 thing we could do to try to treat someone with a spinal cord injury to T2-T12
- 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
