1. Respiratory System Chapter 8
Perry C. Hanavan, AuD
Speech Science

2. Static Pressures – Oral/Nasal Manometer
Point estimate of pressure.
cm H2O
Not suitable for dynamic measurement (speech)

3. Dynamic Measure Oral pressures Pressure transducer
Oral pressures – tube place near mouth, fitted on mask (fairly non-invasive)

4. Subglottal & Alveolar Pressures
Direct measure
Invasive
Indirect measure
Oral pressure on stop consonant /p/
Direct measurement invasive – inserting a needle (with pressure transducer) in the trachea
Inter-Oral pressure on unvoiced, stop consonant – alveolar = tracheal = interoral pressure – open system

5. Airflow (Volume Velocity)
Related to supra- tracheal structures
Larynx
Glottis
Articulators
VP port
Tongue & Lips (plus)
Glottis
too much flow – breathy voice
to little flow – tense voice
VP Port
Too little resistance hypernasal (velar insufficiency, limited lateral pharyngeal wall movement (both)– hypernasal
Too much resistance hyponasal – enlarged adenoidal tissue
Tongue – position high/low for vowels varies airflow, airflow is also varied by contact made at various stricture points – alveolar ridge, velum, posterior pharyngeal wall
Lips contact each other, and teeth
LARGER THE OPENING – THE GREATER THE AIRFLOW
Children – LOWER Peak airflow
1. smaller vocal tract
2. greater vocal tract resistance
3. lower elastic recoil of lungs (organs more elastic – less pressure generated due to elastic recoil)
/s/ versus /z/ ? /z/ less airflow – equal articulatory restriction, but /z/ is voiced (restriction at glottis
initial /p/ (900 ml/s adult) aspiration greater than /s/ (500 ml/s - /p/ large buildup of air pressure and sudden release.
Pneumotachograph

6. Lung Volume – Chest Wall Shape
Measured directly spirometer.
Measured indirectly - Respiratory Kinematic Analysis.
rib cage & abdominal movement.
Volume – amount of air in the the lungs (liters, milliliters, cc, % VC)
Spirometer – static measure – not suitable for speech
Plethysmography
elastic band around chest and abdomen
Plethysmography

7. Chest Wall Shape - Speech
Speech configuration (relative to resting position)
Rib cage larger
Abdomen smaller
IN RELATION TO THEIR RESTING POSITIONS
Rib cage larger
Most lung movement accomplished by Rib cage adjustment
rib cage wall contacts 3/4th surface of the lungs
Abdomen smaller – (abdomen moves inward PUSHES DIAPHRAGM UP & expands LOWER RIBCAGE)
quick small contractions of the diaphragm for quick SPEECH inhalation

8. Lifespan Changes in Speech - Children.
Smaller lungs & thorax.
increase to about years.
Use higher percentage of VC.
Breathing less efficient (use more effort).
Less fluent (more pauses, repetitions, verbal mazes, etc.)

9. Lifespan Changes in Speech - Older Adults
Chest wall changes
Lung
Less efficient than young adults
Intelligibility good, however
use more air per syllable
inhale more frequently
Ossification of costal cartilages, change in thorax shape, reduced muscular tone – less quick adaptation of breathing apparatus.
Loss of alveolar surface tension – cappilarry blood volume lung size – reduced recoil of lung (less efficient gass exchange – deecrease in
1. vital capacity
2. expiratory reserve volume
3. inspiratory reserve volume
INCREASE in RESIDUAL VOLUME – amount of air REMAINING AFTER MAXIMUM EXPIRARION (remaining CO2)

10. Exhalation passive forces for life breathing
Gravity
Muscular relaxation
External intercostals
Diaphragm
Elasticity
Alveolar
NOT Rib torque
Exhalation passive forces for life breathing
Gravity – downward pull on rib cage
Muscular relaxation (external intercostals) – rib cage returns to resting shape (diaphragm returns to dome shape) – decreases vertical dimension thorax
elasticity – respiratory tissue and lungs return to resting shape
rib torque – (tendency of a force to produce rotation) assists INHALATION

11. Inhalation-Exhalation

12. Measurement Devices Pneumatochograph used to measure airflow
Plethysmograph suit monitors the movements of both the abdomen and ribcage
Magnetometer is two coils of wire which generate an electromagnetic field

13. Electromyography (EMG)

14. Pneumotachograph Mask
Illustration of oral-nasal circumferentially-vented pneumotachograph mask (Glottal Enterprises, Syracuse, NY ). The mask is partitioned into nasal and oral chambers. Each chamber has fine mesh, wire screens that serve as flow-resistive pneumotachographs. Catheters (not visible in photograph) are inserted into each chamber to detect pressure variations associated with airflow. A microphone (also not visible in photograph) is positioned outside of the mask to record the audio signal. Integration of the airflow signals is done to determine lung volumes associated with speech utterances (see graphic #2). An additional catheter (visible in the photograph) is inserted through the oral chamber and positioned in the mouth to detect oral air pressure (see graphic #1). PERCI-SARS software ( Microtronics, Chapel Hill, NC ) is used to display and analyze the aerodynamic and acoustic data.

15.                                                                                                           
Pneumotachograph
Illustration of adult speaker performing a vital capacity maneuver. A heated Fleisch #3 pneumotachograph is used to record expired respiratory airflow. Vital capacity volume is determined by integration of the airflow signal.
 Click here to view Vital Capacity graphic

16. Opto-electronic Plethysmography
OEP System measures the changes of the complex shape of the chest wall during breathing by modeling the thoraco-abdominal surface with a large number of points belonging to selected anatomical reference sites of the rib cage and abdomen. The automatic motion analyzer on which it is based uses passive markers composed of a thin film of retro-reflective paper on plastic hemispheres (5-10 mm diameter). The markers are placed on the skin by bi-adhesive hypoallergenic tape. Special video cameras (solid state CCDs) operate up to 120 frames per second synchronized with coaxial infrared flashing LED’s. A dedicated software computes with high accuracy the 3D coordinates of the different markers. No specific calibration is required besides the initial one, performed during the installation of the system

17. Handheld Pneumotachograph
A handheld pneumotachograph transducer employing the latest wireless blue tooth technology.
This cable-free connectivity allows the subject to be tested conveniently and comfortably anywhere within a 3 metre radius of the computer capturing the data. This freedom of movement without wires is a major benefit to measurements at the bedside or on domiciliary visits, made simple with the BlueSpiro software included within the package. BlueSpiro is also able to integrate directly with the powerful and user-friendly EXP'AIR software, so subject data can be automatically added to the full database and reported via the central reporting. The Medisoft-unique feature of working either locally or networked allows measurements to be made away from the network and then simply transferred up to the network when re-connected. This would make it possible to download a subject list for a ward visit, make the trip, perform the tests and then to reconnect and post the data on return to the department. The BlueSpiro is able to work with a simple portable computer with its own integrated Bluetooth or a USB port to which to connect the supplied blue tooth key. The system works with Windows 2000 and Windows XP Pro.

18. Respiratory Problems

19. Diseases Parkinson's disease Cerebellar disease Cerebral palsy
Spinal chord injury
Mechanical ventilation
Voice problems
Asthma
Paradoxical vocal fold motion (PVFM

20. Parkinson's disease Soft voice Slurred speech Mumbled or rapid speech
Speech sounds flat, like a monotone.
Breathy or hoarse voice quality.
Lack of facial expression and gestures
Difficulty finding words
Difficulty participating in fast-paced conversations

21. Cerebellar disease
Hoarse-breathy, coarse voice, tremor, monopitch, monoloudness
Normal resonance
Intermittent articulatory breakdowns
Explosive syllable stress, loudness and pitch outbursts, abnormal prolongations of phonemes & intervals between sounds & words
Shallow inhalations, reduced exhalation control, rapid breaths, irregular and sudden-forced patterns

22. Cervical spinal cord injury
Symptoms of a C3 Level Injury
Limited range of motion
Loss of diaphragm function
Requirement of ventilator for breathing
Symptoms of a C4 Level Injury
Potential requirement of ventilator for breathing
Symptoms of a C5 Level Injury
Ability to speak and breathe on own, but breathing will be weak

23. Cerebral Palsy
Generally demonstrate several abnormal breathing patterns including
Poor breath support and reduced vital capacities
Irregular breath groups and inappropriately rapid rates
Reverse breathing groups and asynchronous movements of the muscles involved in breathing
May speak at the end of exhalation portion of a breathing cycle resulting in in short, choppy speech
May have long pauses at inappropriate times
May have difficulties coordinating breathing with phonation

24. Neurological Disorders

25. Asthma
Narrowing of bronchial tree passageway

26. Mechanical Ventilation

27. Voice Disorders

28. Paradoxical Vocal Fold Motion (PVFM)
Disorder in which coordination between respiratory and laryngeal systems is disrupted by inappropriate spasmodic vocal fold adduction during inhalation phase

29. Changes in Aging Respiration
Decrease in breath support
resulting in weakened voice
attempt to compensate sphyncterically contracting larynx during phonation, producing a strained quality - muscular tension dysphonia

30. Physiologic Age-related Changes
Greater
Leakage airflow rates
Peak airflow rates
Lower
Lung pressures
Smaller
Vital capacities
Female
Male