Respiration Flashcards
________ is the foundation of speech production, changing it changes everything upstream
breathing
Describe Tidal Breathing:
Breathing for life. Muscles are used for inhalation but exhalation is passive. Regular pace and on the slower side. There is a strict reciprical relationship b/w volume and pressure
What is Boyle’s law?
In a closed volume PxV = constant
Boyle’s law is PxV = constant this means: As ______ increases _________ decreases
volume increases
pressure decreases
Tidal Breathing:
Expanding lungs generates a zone of ________ pressure, air flows in, lungs fill with air, pressure inside the lungs is _____ , due to ________ forces air flows out.
zone of negative pressure
positive
due to elastic recoil forces
______ muscles are associated with generating negative pressure. When involved, _______ muscles are associated with generating positive pressure
inspiratory
expiratory
_________ is exhaling beyond the tidal volume
expiratory reserve volume
_________ is inhaling beyond the tidal volume
inspiratory reserve volume
What is vital capacity?
The combination of inspiratory reserve volumes, tidal volume and expiratory reserve volumes
What is inspiratory capacity?
Combination of tidal volume and inspiratory reserve volume
What is total lung capacity?
Combination of inspiratory reserve volume, tidal volume, expiratory reserve volume and residual volume
The ___________ represents the pressure measured inside the lungs at a given volume.
Relaxation Pressure Curve
T or F: The relaxation pressure curve involves only passive forces
True
T or F: Lungs are always generating the passive force of compression
True -lung recoil
T or F: Both passive and muscular forces are involved in breathing
True
Breathing is the power supply for speech. The goal of the respiration system during speech is to maintain constant _________
pressure at 5-10 cm H20
How is pressure maintained for speech?
Interplay between passive and muscular forces. The amount of muscular forces required depends on the pressure needs and the relaxation pressure available at that lung volume.
T or F: We use checking action during normal speech
False- checking action is using inspiratory muscles to decrease pressure in the lungs and slow the exhale. If used in speech it is an impairment.
Describe Speech Breathing:
- Quick inhalations and long exhalations
- High level of control
- Finely graded activity of inspiratory and expiratory muscles
- Expiratory muscles maintain appropriate pressure
AT what lung volumes do we use muscular forces to maintain pressure?
35 to 60% vital capacity
According to Hixon’s Clinical Framework what 4 questions should we ask?
1) Power- Is pressure maintained during speech?
2) Lung Volume - Does the lung volume seem appropriate at initiation?
3) Air flow - What is the airflow like during speaking?
4) Chest Wall Shape - What is the shape of the system during speech breathing?
List 4 possible types of respiratory impairments?
1) Difficulty with generating or maintaining pressure due to weak respiratory muscles
2) Inappropriate use (inhaling more than necessary)
3) “Unpredictable” activity resulting in interrupted flow (hyperkinetic disorders)
4) Fatigue, dyspnea with speaking
Speech breathing impairments are common in all types of dysarthria but are most notable in:
PD, MS, ataxia, ALS, CP, TBI, muscular dystrophy
During what tasks could you assess respiration perceptually?
Assess at rest and during phonation & reading sentences of different length and during a passage.
List 5 things to listen for when assessing respiration perceptually:
1) Loudness (soft, variable)
2) Breath group duration (short phrases)
3) Pause duration, placement and frequency
4) Prosody (stress)
5) Perception of effort during speaking
What are the 2 goals of perceptual evaluation?
- Describe the speech breathing abnormality
- Suggest physiologic reasons for these problems and its neuropathologic mechanism
4 things to look at in a Physiological Assessment?
1) Pressure
2) Vocal intensity
3) Breathgroups
4) Respiratory shapes
How do you PERCEPTUALLY assess adequacy of Subglottal Pressure?
Goal is 5-8 cmH20
- Sustained phonation for 15 seconds (if they can do it in non-speech they can do it in speech)
- Count to 20 on one breath
How do you Instrumentally assess adequacy of Subglottal Pressure?
Aerodynamic assessment
U-tube manometer
Water-bubble manometer
Hand-held spirometer
T or F: Every clinician should have a water bubble manometer
True- Cup with 10 cm of water above the end of the straw. Blow for 15 sec.
How do you assess Vocal intensity?
- SPL meter - 70db, hold 6-12 cm from the mouth
- Test in quiet and noisy environment - look at variation across environment
- Can the person maintain phonation
Testing Vocal intensity in a noisy environment is especially important in ____
PD
Define Breathgroup:
A unit of connected speech sparated from another unit by a pause of 200ms or longer
How would you assess breathgroups?
- Record a reading passage.
- Identify pauses longer than 200msec in duration. -
- Count # of words/ breathgroup.
- Judge whether locations of pauses is appropriate.
- Measure pause duration b/w breathgroups and at sentence boundaries
How do you assess Respiratory Shapes?
Touch people while they perform the task to get kinesthetic info. Muscles contract during inhalation. You may or may not feel something after that.
List 6 goals of treatment of respiratory function?
- increase subglottal pressure
- increase speech intensity (maintain loudness)
- increase breath group duration (ability to maintain Ps)
- Use appropriate lung volume range (improve efficiency, prosody)
- Improve breathing, efficiency
- Reduce fatigue during speaking
Describe the timeline of treatment:
- address medical issue first
Either manage laryngeal, VP and artic first, breathing first or both at the same time.
What are 2 common non-speech treatment tasks
- tidal breathing (education about breathing)
- breathing through a water manometer; blowing - max inhale and exhale/ fast inhale and slow exhale
Do not expect generalization to speech
What are 4 common treatment tasks that involve speech:
- sustained phonation
- strings of words (automatic and word lists)
- Phrases of different duration
- Stress-varying exercise
What are some possible postural adjustments for breathing?
- appropriate upright position
- abdominal binder to support expiratory musculature
- Expiratory board/ paddle - teach them to use external object (ie. wheelchair), teach them when to lean
T or F: Supine breathing helps diaphragm but makes the abdominals work harder.
helps abdominals but makes the diaphragm work harder
List 3 treatment methods:
1) Augmented Feedback
2) Linguistic Approach
3) Strength Training
The purpose of augmented feedback is to work on awareness. Options include:
- U-tube or digital manometer for sub-pressure
- Respitrace or respiratory magnetometer for lung volume and respiratory shapes
- Acoustic feedback (Visipitch or SPL meter) to monitor loudness
Describe the linguistic approach:
- Teach breathgroup structure (simplify syntax)
- Teach about pausing in normal speech and reading
- not every pause = inhalation - Contrastive stress drills
What are the goals of strenght training:
- increase strenght
- increase endurance
- changes in muscle size and patterns of activation
How would you do strength training vs endurance training:
strength training - use heavy loads, small number of reps and lots of recovery
endurance training- light loads but lots of reps
T or F: We don’t use strength training in the oral motor system or the respiratory system
False - abdominal and intercostal muscles are skeletal muscles and skeletal muscles can benefit from strength training
T or F: For strength training we need to be challenged beyond threshold level to get improvements. The increase in load is more important than the increase in frequency to get muscle hypertrophy, recruitment of motor units and increased firing rates, improved synchronization in firing of motor units.
True
_________ increases inspiratory volume and therefore _____ improve breath group length and lounness.
Inspiratory muscle training
may
Describe inspiratory muscle training:
- increase inspiratory volume
- shorten inspiration
- improve ability to hold inspiratory effort
- may reduce speaking related dyspnea (shortness of breath) and fatigue
Describe expiratory muscle training:
- develop better control over the expiratory phase
- prolong expiratory flow
- may decrease speaking related dyspnea and fatigue
Inspiratory and expiratory muscle training are _________ exercises. Do not expect generalization to speach breathing without speech breathing intervention.
non-speech
How does loaded inspiration/ expiration work:
- breath against resistance
- determine patient’s max capacity (30 cmH20)
- determine target (70% of max)
- patient will inspire thru device for 2 min with 1 min recovery. Repeat 8-10 times.
- perform X# of weeks
- As max inspiratory pressure improves increase the target
What professionals should SLP consult/ work with for breathing?
Respiratory therapist
occupational therapist
physiotherapist
