SPAUD 212 - Chapter 3

pulmonary function testing (PFT)

direct measurement of lung volumes & airflow using spirometer

lung volume and how fast air is flowing through different parts of respiratory system

use of spirometer varies depending on assessment and treatment

respiratory kinematic analysis

method to visualize and quantify chest wall movement, assessing respiratory function by tracking motion signals in the chest and abdomen

spirometers

cannot be used to measure lung volumes during speaking

speaking tasks

respiratory kinematic analysis, lung volumes estimated from rib cage & abdominal movement

pressures needed for speech

P_alv

oral pressure: P_oral

tracheal pressure: P_trach

Subglottal pressure: P_s

manometer

what is used to measure pressures needed for speech?

airflow

volume velocity

measure of volume of air moving in a certain direction at a particular location per unit time

measured in milliliters/second (ml/s)

pneumotachometer

what device is used to measure airflow?

symptoms of respiratory disorders

patient recorded, what they’re experiencing, as a clinician may not be able to document that (ex: chest pain, headache, chest tightness)

signs of respiratory disorders

objective observation, as a clinician you can observe and document (ex: wheezing, coughing)

dyspnea

means difficulty in breathing

subjectively perceived discomfort in breathing

varies from mild to extreme

shortness of breath, chest tightness, need to work hard to breath

may occur during speech

stridor

audible sound during inhalation/exhalation

high or low pitched

due to turbulent air flow as air passes through narrow or obstructed segment in the airway → forces air to go through a more narrow place causing the sound

caused by infections, foreign objects, cardiovascular problems, etc.

principles of clinical management for respiratory disorders

measure patient’s respiratory function in both nonspeech and speech tasks

tailor treatment to the patient’s specific respiratory difficulty

sequence clinical activities in order of pressure variables, volume variables, and chest-wall shape variables

practice respiratory exercises in speech contexts

parkinson’s disease

• Progressive neurological disorder 

• Characterized by rigidity of muscles: Affects range of movement (ROM)

  • Impacts all muscles of the body

• Speech Characteristics: monotonous speech (prosody impacted), imprecise articulation, breathy (more air) & weak voice (loudness impacted)

  • Goes back to laryngeal and respiratory system

  • Sounds are distorted/not as clear

substantia niagra

dopamine

basal ganglia

subcortical structure

cerebral palsy

• Non-progressive neurological disorder

• In children & adults → congenital 

• Different forms of CP affect respiratory function for speech in different ways:

  • Spastic CP: hypertonicity (stiffness) of muscles, weakness; shallow inhalations and forced & uncontrolled exhalation 

  • Athetoid CP: involuntary movements (like tremors, can’t be controlled) that interfere with normal voluntary movements; irregular & uncontrolled breathing

  • Ataxic CP: (cerebellum is affected) timing and incoordination of movement of breathing affected; irregular rate, rhythm, & depth of tidal breathing 

voice disorders

• Some voice disorders may be associated with respiratory dysfunction: voice nodules, polyps, etc

  • Higher or lower than normal lung volume initiations for speech

  • Speech initiated at volumes below REL

  • Higher percentage of VC per second in speaking tasks

  • Lower lung terminations for speech

  • Decreased lung volumes at higher intensities

  • Higher than normal P_trach

stuttering

• Characterized by disruptions (dysfluencies) in flow of speech 

  • Difficulty starting a word or sentence

  • Repetitions of words or parts of words

  • Prolongations of speech sounds

  • Excess (muscle) tension in face and/or upper body 

paradoxical vocal fold motion

• PVFM (also called VCD → vocal cord disfunction)

• Vocal folds adduct during inhalation (come together instead of being open)

• Coordination between respiration & laryngeal systems affected

• Major symptoms: tightness in chest, difficulty breathing, shallow breathing, stridor, cough, dyspnea

• Misdiagnosed as asthma (overlap in symptoms)

  • Stridor on inhalation

  • Normal to mildly abnormal blood oxygen levels during attack

  • Reduction in FEV/FVC ratio

  • FEF/FIF greater than 1

  • Flattened inspiratory limb on flow-volume curve