Lecture 3 - 9/17 Flashcards
Freedome to Act - Energetic Rest
The body is ready without strain or stiffness. A state of being between the two extremes (lax and stiff).
We apply this concept to
- Respiration
- Phonation
- Resonation/Articulation
Tools to decrease the expiratory drive and medial compression of the VF’s
confidential voice
back pressure
resonant phonation
voiceless initiation of syllables
Clinician Answers: “Why Do I need to Do this?”
- Contributes to the partnership you hope to build during this process
- Clarifies the purpose of procedures
- Facilitates adherence to practice & other recommendations
Neurological control of respiration
respiratory center in reticular activating system regulates concentration of Co2 and oxygen
Active part of respiration
- Inhalatory to expand and elevate the chest wall
-Diaphragm and External Intercostals - Exhalatory to collapse the chest wall during forced exhalation
Abdominal musculature, transversus abdominis, external
& internal obliques, & rectus abdominis - Checking action to control speed of exhalation
External intercostal muscles
Passive non muscular forces in respiration
- Elasticity
- Gravity
- Pleural linkage
Oppositional relationship between lungs (to shrink &
collapse) & chest wall (to expand)
INNERVATION
Innervation for inhalation:
T1-T12 – Spinal intercostal muscles
C2-3, C5-8, CN XI – Posterior neck muscles
C3-5 Phrenic nerve – Diaphragm
Innervation for exhalation:
T1-T12 – Spinal intercostal muscles
Newborn Respiration Stages
Newborn Stage 1 – Lasts a few minutes following birth
Establishment of postnatal respiration
Newborn Stage 2 - Lasts several hours to a day or more
All parts of chest & abdomen expand & contract
together (synchronous)
Newborn Stage 3 - Lasts several days or weeks
Rapidly fluctuating rates, variable rhythms, and a wide
variety of respiratory patterns
Newborn Stage 4 - Begins several weeks after birth
Stable rhythms & respiratory patterns as chest &
abdomen expand & contract
Newborn Stage 5 - Around 8 months -
Rhythmic diaphragmatic & thoracic movements are
established
Childhood Respiration
Age 7
Thoracic breathing predominates
Adult Respiration
Age 20-21
Adult vital capacity has developed
Aging Of Lungs - 80+ years
-May have increased compliance in lungs & increased
stiffness of chest wall
-Decreased vital capacity
-Reduced voice loudness
-Limited pitch range
Passive
Non-muscular Forces
Active
Muscular Forces
Pleural Linkage
- Thin, airtight membrane (visceral pleura) envelopes lungs, & a similar membrane (parietal pleura) lines inside of chest
- Intrapleural fluid binds chest wall to lungs via negative pressure
- Midrange of vital capacity where freedom to act is greatest
- The pull from elastic recoil of pulmonary-chestwall unit reduces need for muscular activity during quiet breathing
Vital Capacities: Speech Range
During speech, we stay within the middle portion of this range where the passive respiratory forces are minimal (freedom to act).
Breathing when you yell is like….
Vary the size & speed of your inhalation
Observing Respiratory Systems (7)
- Adequacy of breath (SOB)
- Changes in movements of thorax
- Coordination between respiration & phonation
- Control for different voice tasks
- Changes in loudness
- Smoothness of loudness during speech & maximum phonation task
- “Sometimes when I talk it feels like I don’t have enough air.” (What patient feels/says)
Respirations and Capacities:
Total Lung Volume (TLC) – All air in lungs ~6,000 mL
Vital Capacity (VC) – Total amount of air that can be expired ~4000 mL
Tidal Volume (TV) – Midrange of vital capacity (35-60% VC) ~500mL
Inspiratory Reserve (IR) – Air forcibly inhaled after quiet inspiration (60-100% VC) 2500+ mL
Expiratory Reserve (ER)– Air forcibly exhaled after quiet expiration (0-34% VC) 900+ mL
(FROM GILL'S CLASS) mL MALE FEMALE
Tidal(TV) 660 590
TLC 6600 4600
IRV 3100 1900
ERV 1400 950
RV 2100 1500
Breathing for Speech
Usually stays in 38%-60% VC Range
-Middle of range of motion
-Greatest degrees of freedom & freedom to act
-Least amount of work
-Feels easy
-Range is similar to quiet tidal breathing
-Allows for vocal adjustments – To speak past your
customary breath groups, take a bigger breath
—–
Passive expiratory forces become insufficient to sustain phonation as you approach & go below resting expiratory level (38% vital capacity)
—-
Use inspiratory checking to maintain phonation (activation of the inspiratory muscles to resist the passive elastic forces)
Problems w/ Respiratory Functions Can Lead to…
- Shortened phrase length
- Reduced loudness
- Changes in phrasing
- Increased vocal effort
- Decreased desire to speak
Pulmonary Function Testing (7 types)
- Manometer
- Catheter in mouth & nose
- Whole body plethysmograph
- Pneumotachometer
- Rothenberg mask with air chamber
- Spirometer (SpiroPet)
- Stopwatch (Maximum Phonation Time)
SpiroPet
- Measures vital capacity in cubic centimeters (cc) of air
- Compares to normative data based on age & sex
- Refer to pulmonologist when mean vital capacity is below 70% of expected value
Max Phonation Time Norms: (neutral vowel /a/ maybe)
Maximum Phonation Time Norms: Children ~ 10 seconds Adults ~ 20 seconds Females ~ 25.7 seconds Males ~ 34.6 seconds
Duration too short suggests… Respiratory problem Lack of checking action Glottal insufficiency Velopharyngeal insufficiency Errors in data collection
Duration excessively long suggests… Singer Pressed phonation Hyperadduction of VFs Errors in data collection
Calculate Phonation Quotient Equation and Norms
Phonation quotient = Vital Capacity ÷ Maximum Phonation Time ----- Phonation Quotient Norms Range 100-200 cc/sec
Phonation quotient too low suggests… Lack of checking action Glottal insufficiency Velopharyngeal insufficiency Errors in data collection
Phonation quotient excessively high suggests… Singer Pressed phonation Hyperadduction of VFs Errors in data collection
Objective Measurement of Sustained /s/ & /z/
Norms for sustained /s/ & /z/ Normal /s/ for child is 9 sec Normal /z/ for child is 11 sec Normal /s/ for adult is 16 seconds Normal /z/ for adult is 19 seconds (why longer?)
Short duration for both (s & z) suggests…
Respiratory problems
Lack of checking action
Errors in data collection
Excessively long duration for both (s & z) suggests…
Singer
Errors in data collection
Objective Measurement of s/z
Norms for s/z ratio
Normal range is slightly less than 1 (between .7 & .99)
Less than .7 suggests… Increased medial compression Excessive stiffness of VFs Constriction in vocal tract (e.g., ventricular VFs, epilarynx) Inappropriately loud voice Pressed phonation Errors in data collection
Greater than 1 suggests… VF involvement (the /s/ is normal & /z/ is leaky) Glottal insufficiency Velopharyngeal insufficiency Errors in data collection
