Handout 3: Speech Breathing disorders

Question 1

parkinson’s disease

Answer 1

progressive neurological disease involving damage to the basal ganglia and loss of dopamine-related cells

Question 2

hypokinesia

Answer 2

reduced range of movement and reduced force of movements throughout the body
rigidity of muscles also contributes to hypokinesia

Question 3

hypophonia

Answer 3

speech intensity can be very low

Question 4

how is respiration affected in parkinson’s

Answer 4

• decreased rib cage movements (thought to be related to stiffness and rigidity in the rib cage muscles)
• increased abdomen movements (possibly an attempt to compensate for decreased RC)
• reduced vital capacity (also associated with reduced maximum phonation times)
• 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 5

how is speech affected in parkinson’s - 4 ways

Answer 5

reduced loudness
monotone speech
slurred consonants
fast speech

Question 6

to inc speech loudness in parkinsons the goal is to

Answer 6

increase range and force of respiratory movements

attempt to produce deeper inhalations during speech and focus on expanding the range of rib cage movements; could use respitrace for biofeedback related RC and ABD movements

Question 7

how could you inc expiratory effort during speech in parkinsons

Answer 7

longer and louder prolonged vowels and /s/s; use of oral pressure transducer or manometer for biofeedback about oral pressure

Question 8

is posture an issue in parkinson’s?

Answer 8

yes - stooped posture
reduce stooped posture using support devices or training

Question 9

cerebellar disease (what happens to walking and speech?)

Answer 9

cerebellum is important for the production of smooth, coordinated movements

• damage or disease in the cerebellum can cause most voluntary movements to become jerky and uncoordinated
• walking and arm/hand movements may become irregular, poorly controlled and jerky
• speech may show irregular changes in pitch, loudness and clarity on a moment-to-moment basis

Question 10

what are the resp parameters of cerebellar disease

Answer 10

RC and ABD movements show abrupt, irregular, jerky movements

• paradoxical respiratory movements - inhalation during exhalation (like a gasp)
• VC reduced
• speech initiated below normal lung volumes

Question 11

what are the treatment aims for cerebellar disease

Answer 11

• initiate speech at higher lung volumes and reduce the 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 12

damage above C3 causes

Answer 12

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

Question 13

c3-c5 innervates what muscle

Answer 13

diaphragm

Question 14

damage below C5 allows for what, what doesn’t it allow for?

Answer 14

damage below c5 allows for innervation of the diaphragm (rest breathing intact) but loss of innervation to other major muscles of inspiration (external intercostals) and expiration (internal intercostals and abdominals)

Question 15

damage for T2-12 causes issues w what

Answer 15

intercostals and abdominals

Question 16

what resp issue would be associated w T2-12 injury

Answer 16

• reduced vital capacity, inspiratory reserve volume, and expiratory reserve volume

related to reduction in muscle strength of intercostals and abdominals

• abdominal movements may be larger as patients attempt to use the diaphragm to

  take deeper inhalations 

• also rely on the elastic recoil of the lungs and diaphragm for exhalation (this passive mode is less powerful than the normal active mode of exhalation)

Question 17

treatment options for t2-12 damage?

Answer 17

attempt to build up strength of remaining respiratory muscles

• deeper and more forceful inspirations and exhalations
• Expiratory Muscle Strength Training (EMST) Device
• use of oral air pressure transducer as biofeedback device
• portable voice amplifier if speech loudness remains low
• expiratory paddle or abdominal band
• phrenic nerve pacing