Respiratory System

Respiratory System in Speech

• Key Structures:

  • Diaphragm: Major muscle for inspiration.

  • Lungs: Provide the air supply for phonation and speech.

  • Other associated muscles: intercostals, abdominals, and accessory respiratory muscles support controlled airflow during speech.

• Function in Speech:

  • Generates subglottic air pressure necessary for:

    • Phonation (voice production via vocal folds)

    • Speech intensity (volume)

    • Prosody and phrasing (breath groups)

  • Controls speech timing and fluency through regulated exhalation.

 

🧍‍♀ Relevance to Freda (Parkinson’s Disease)

• Parkinson’s impact on respiration may include:

  • Reduced respiratory drive (due to basal ganglia dysfunction)

  • Poor breath support for phonation (soft voice)

  • Monopitch and monoloudness

  • Short phrases due to limited air support

• This contributes to the hypokinetic dysarthria profile.

Types of Respiration Relevant to Assessment

Respiration Type	Description	Relevance to Speech/Assessment
Quiet Inspiration	Passive breathing in at rest, mostly via diaphragm	Baseline respiratory capacity
Quiet Expiration	Passive breath out, no muscle activity	Not sufficient for speech needs
Forced Inspiration	Active engagement of accessory muscles (e.g., sternocleidomastoid, scalene)	May signal respiratory weakness if relied on during speech
Forced Expiration	Active abdominal and intercostal contraction	Essential for adequate subglottic pressure in speech

 

 

🩺 Assessment Questions to Consider

• Is the client using only the diaphragm, or are accessory muscles (e.g., neck and shoulder movements) visibly overactive?

• Is speech breathy or weak? → May suggest insufficient subglottic pressure.

• Does the client fatigue quickly when speaking?

• Are there short utterances or irregular phrasing due to poor breath support?

 

🧑‍⚕ How Do We Detect Forced Inspiration?

• Observation: Watch for shoulder elevation, neck tension, clavicular breathing.

• Palpation: Assess upper chest versus abdominal breathing.

• Speech Tasks: Ask client to count aloud, read a passage, or sustain a vowel sound—look for early breath termination.

• s/z ratio and maximum phonation time can be used for baseline assessment.

Clinical Insight: Use of Accessory Respiratory Muscles

• Overuse of accessory muscles (e.g., sternocleidomastoid, scalenes, abdominal muscles) suggests that quiet inspiration and expiration are insufficient.

• This often indicates:

  • Increased work of breathing

  • Fatigue during speech

  • Compensatory strategies due to reduced respiratory efficiency

  • Underlying neuromuscular weakness or rigidity (common in Parkinson's)

 

👀 What to Look For

Muscle Group	Signs of Use	What It Might Indicate
Neck muscles(sternocleidomastoid, scalenes)	Elevated shoulders, neck strain, visible contraction during inhalation	Reliance on accessory inspiration
Abdominal muscles	Forceful abdominal movement during exhalation, visible tensing	Compensation for weak expiratory drive
Upper chest	Shallow, clavicular breathing pattern	Reduced diaphragmatic activity

 

 

🩺 Clinical Relevance in Parkinson's Disease

• Bradykinesia and rigidity can impair diaphragm movement.

• Patients may recruit accessory muscles more readily.

• Result: fatigued, breathy, and poorly projected speech.

 

✅ Assessment Tip

Ask the client to:

• Take a deep breath — observe where movement occurs (chest vs abdomen).

• Sustain a vowel — time it and listen for volume drop or vocal fatigue.

• Read a short passage — note phrasing and breath breaks

Respiratory Pathology and Speech: Key Considerations

🔄 Gas Exchange & Speech Production

Speech requires a consistent and controlled outflow of air. If gas exchange is compromised (as in asthma or COPD), the client may:

• Fatigue easily

• Speak in short phrases

• Exhibit reduced vocal intensity

• Pause frequently for breath

 

🩺 Common Respiratory Conditions & Speech Implications

Condition	Key Pathophysiology	Effect on Speech
Asthma	Bronchoconstriction + mucus production	Shortness of breath, cough, difficulty sustaining phonation
Chronic Bronchitis (COPD)	Chronic inflammation and mucus overproduction	Wet voice, frequent throat clearing, poor voice quality
Emphysema (COPD)	Alveolar destruction, air trapping, poor oxygen exchange	Reduced breath support, weak voice, effortful speech

 

 

❗ Clinical Red Flags to Observe

• Shortness of breath at rest or during speech

• Coughing during speech or phonation

• Audible wheezing or rattling

• Rapid respiratory rate

• Difficulty sustaining vowels or phrases

 

🧠 Integrating This in Clinical Reasoning

Ask yourself:

• Is reduced speech intelligibility due to linguistic/motor impairments?

• Or is it due to reduced respiratory support from an underlying pulmonary condition?

 Subglottic Pressure & Posture: Key Clinical Concepts

Subglottic Pressure: What It Does

• Required to initiate and maintain vocal fold vibration

• Needs to overcome laryngeal resistance to set vocal folds in motion

• Affects voice intensity, pitch, and sustained phonation

 

🧍‍♀ Postural Influence on Phonation

Postural Element	Impact on Subglottic Pressure
Spinal alignment	Poor alignment (e.g. kyphosis, slumping) restricts diaphragm efficiency and thoracic expansion
Neck tension	Increases tone in suprahyoid/infrahyoid muscles, altering laryngeal height and stability
Jaw and tongue posture	Can pull on the hyoid bone, indirectly affecting the larynx’s vertical position

 

 

🧠 Neuromuscular Considerations

• Suprahyoid muscles (e.g. mylohyoid, geniohyoid): Elevate larynx

• Infrahyoid muscles (e.g. sternohyoid, omohyoid): Depress larynx

• Laryngeal height affects tension in the conus elasticus (supporting the vocal ligaments from below) → influences subglottic pressure and efficiency of vibration

 

🔍 Clinical Application: What to Observe

• Is the client slouching or upright?

• Is there visible neck tension (e.g. clavicle/SCM activation at rest)?

• Is the larynx visibly elevated or depressed?

• Is speech effortful or accompanied by visible strain?