Academic journal article Journal of Medical Speech - Language Pathology

Speech Breathing Behavior in Normal and Moderately to Severely Dysphonic Subjects during Connected Speech

Academic journal article Journal of Medical Speech - Language Pathology

Speech Breathing Behavior in Normal and Moderately to Severely Dysphonic Subjects during Connected Speech

Article excerpt

A long-standing clinical assumption regarding dysphonia secondary to vocal abuse is the expectation that the speaker will demonstrate aberrant speech breathing patterns. To evaluate this assumption, the speech breathing behavior of 10 adult females with normal voices was compared with that of 10 adult females with moderate to severe abuse-related dysphonia under two speaking conditions: paragraphs consisting of 10 and 60 syllables per sentence. Between- and within-group comparisons were made of(a) lung volume change; (b) magnitude of rib cage and abdominal contributions to lung volume; and (c) initiation and termination of lung volume re: Resting Expiratory Level (REL); and (d) between-group measures of rib cage and abdominal circumferential chest wall movements. Lung volume estimates and rib cage and abdominal movements were monitored using inductive plethysmography, and the data was measured from strip chart recordings. Significant results indicated that the end-expiratory lung volume levels of the dysphoni c group were farther below REL than those of the control group in the 60-syllable paragraph. Furthermore, a significantly greater proportion of dysphonic group used paradoxical abdominal chest wall movements during speech expiration in comparison to the normal group. Implications for the evaluation and treatment of dysphonia are discussed.

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Dysphonia related to vocal abuse, or hyperfunctional dysphonia, has been associated with aberrant speech breathing (Hixon & Putnam, 1983; Koufman & Blalock, 1988; Sapienza & Stathopoulos, 1994; Schutte, 1986). Boone and McFarlane (1994) clinically define vocal hyperfunction as the use of excessive force or muscle tension during speech production that includes attempts to speak on inadequate expiration, insufficient inspiratory phase for the phonatory task, improper use of exhalation, and chest and abdominal muscles in competition with each other.

Synergistic activity of the respiratory and laryngeal mechanisms is required for efficient phonation (Tanaka & Gould, 1985), and clinical impressions suggest that individuals with abuse-related dysphonia (ARD) do not coordinate the respiratory and laryngeal mechanisms effectively for normal voice production. Aronson (1980) suggested that abnormal breathing patterns, presumably related to anxiety and tension, result in a failure to provide sufficient breath support for speech. According to Boone (1977), dysphonic clients exhale tidal volume before initiating phonation, produce deliberate and deep inhalations to overcome phonatory difficulties, and have difficulty sustaining phonation because of an insufficient breath supply for phonatory tasks.

A few studies have examined the ventilatory behavior of dysphonic subjects with ARD during continuous speech (Hixon & Putnam, 1983; Sapienza, Stathopoulos, & Brown, 1997; Sperry; Hillman, & Perkell, 1994). The majority of speech breathing research, however, has been performed with one to three subjects, under vowel or syllable conditions, and with mildly dysphonic subjects (Hillman, Holmberg, Perkell, Walsh, & Vaughn, 1989; Hixon & Putnam, 1983; Hunker, Bless, & Weismer, 1981; Koufman & Blalock, 1988; Netsell, Lotz, & Shaughnessy, 1984; Sapienza & Stathopoulos, 1994; Sapienza et al., 1997; Schutte, 1986; Sperry et al., 1994). There is a need to examine the speech breathing behavior of larger groups of subjects with varying degrees of dysphonia, under conditions more closely approximating spontaneous speech. The rationale for use of a continuous speech condition (an extended speech task) is that it is inherently nonstationary (Parsa & Jamieson, 2001) and a closer approximation of spontaneous speech than vowel or syllable conditions. Moreover, task providing minimal punctuation cues permits subjects to use their own internal reference regarding when to pause to replenish their air supplies, thus approximating spontaneous speech. …

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