The main function of the respiratory system is to deliver oxygen to the cells of the body and remove carbon dioxide, a by-product of cellular metabolism. The lungs are responsible for pulmonary ventilation, and like bellows on an accordion, expand and relax in response to air pressure changes. The diaphragm is a primary inspiratory respiratory muscle and it is also active during speech, allowing for fine pressure adjustments during connected speech when lung volume requirements change. The chest wall maintains appropriate levels of muscle pressure, and if the abdominal muscles are held taut or disengaged, the rib cage becomes responsible for generating sufficient pressure for phonation (voice production), and this creates a potential for a loss of fine-tuning abilities, and a substantial increase in thoracic effort that may be difficult to maintain for extended communication.
Inspiratory muscle weakness has been reported in persons with Parkinson’s[i] but chest wall compliance may also be impacted by dyskinesia or dystonia of trunk muscles compromising the ability to attain and maintain lung volumes necessary for phonation. In addition, bowing of the vocal folds, which is also common in PD and contributes to voice quality changes, may interact with weak or stiff respiratory muscles and result in poor laryngeal-respiratory coordination.
Use of higher lung volumes at the onset of speech production allows speakers to generate higher recoil pressures and subglottal pressure for speech, with less reliance on muscle effort (think of a balloon fully expanded and ready to spring back). (Subglottic pressure is pressure generated beneath the vocal folds, and is important not only for speech production, but also cough effort, and timing of breathing and swallowing, a topic for another time).
A high lung volume at the onset of phonation is required for some speech tasks and the chest wall muscles must accommodate that task. (eg: vocalize an “ah” in a loud voice for 10 seconds). If you attempt that same voice task beginning at a low lung volume (eg: exhale completely and then attempt you’re “ah” task) greater expiratory muscle effort will be required, and some laryngeal straining may also be a result.
We know from speech research that activation of both inspiratory and expiratory muscles together allows for the most efficient control of the chest-wall system for voicing.[i]
Breathing Exercises You CAN Do at Home!
Because of the necessary ongoing co-ordination between inspiratory-expiratory muscles during speech production, establishment of optimal breathing patterns is a component of some voice treatment. In fact, Part 1 of the Voice Aerobics® program, Breathwork, focuses on posture, breathing, and voice production, and can be a great tool for helping to improve perception of how efficiently you are using the muscles for speech.
Patients who use The Breather®, a flow resistance respiratory muscle training device, tell me that they feel more rib cage expansion and “open” following its use, and that it feels “easier” to use the breathing muscles for speech.
In a recent LOUD Crowd® class several members demonstrated use of The Breather, and discussed some of their observations. One class participant, who I will call Rick is able to inhale and exhale to a fairly high volume, and sustain an “ah” for greater than 20 seconds, and yet, has difficulty maintaining adequate volume for connected speech. Another observant class member pointed out that when Rick took a large inhale prior to speaking, he was able to maintain loudness longer. Rick, than, took a big inspiratory breath through The Breather, feeling his rib cage expand, and on exhalation proceeded to speak with adequate volume. Using his device this way, may help Rick better co-ordinate breathing patterns and better judge breath support when completing speech practice at home.
Mastering breath support during reading tasks where phrase length is known is most likely going to be easier for most people, and a good place to begin home practice. More challenging for most people with Parkinson’s is maintaining adequate loudness during conversational speech when speech production competes with the increased cognitive demand required to process language and formulate a novel thought.
If your spouse or significant other complains that they only hear the first few words of what you say, you may be speaking at a low lung volume, and respiratory muscle training, which typically takes less than 15 minutes, added to your speech practice may help improve muscle strength and use.
[1] Baille G, Perez T, Devos D, Deken V, Defebvre L, Moreau C (2018) Early occurrence of inspiratory muscle weakness in Parkinson’s disease. PLoS ONE 13(1): e0190400.
[11] Hixon, T. J., & Hoit, J. D. (2005). Evaluation and management of speech breathing disorders: Principles and methods. Tucson, AZ: Reddington Brown.
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My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor Voice Aerobics® A Whole Body Approach to Voice Practice
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Hello, Katherine, thank you for your email. Sometimes when we read something it resonates with us and it sounds like this post did for you.If you have some breathing problems which affect you at various times with exertion, you should discuss this with your physician, who may want to order a pulmonary function test. If you feel that you lose your breath only when speaking, then, you might want to schedule an appointment with a speech-language pathologist who works with adults with speech and voice problems. You do not need a doctor’s order to see a speech pathologist, but if you wish to bill a visit to your health insurance, a physician order may be required.
I read this article and this sounds exactly like what I’ve been dealing with the past ten years. I have been trying to get dr. To diagnose my speech issue with no results or feedback on what is wrong.
Hi, Julian, hopefully you are on the road to recovery. The RMT kit are back in stock, so, if you feel the Breather would be of benefit to assist with your recovery, I am here when you are ready. Muscle atrophy occurs relatively quickly when hospitalized and immobile, so, re-strengthening those muscles for your sports specific saxaphone playing is important.
I’M A SAX PLAYER. RECENTLY I’VE BEEN HOSPITALIZED AND BED RIDDEN FOR QUITE SOME TIME AND HAVE NOT BEEN ABLE TO PLAY MY INSTRUMENT.
I THINK THE MUSCLES I USE IN PLAYING IT HAVE GOTTEN WEAK.
SO BEFORE I BUY YOUR PRODUCT I’M GOING TO RESUME PLAYING THE SAX (ALBIET WITH A CANULA UP MY NOSE) AND SEE IF THAT WORKS. I’LL USE A HARDER THAN NORMAL REED THAT WILL REDQUIRE MORE AND HARDER BREATHING OUT.
BUT THANKS FOR THIS GREATE INFO. IF THIS DOESN’;T WORK I’LL BUY YOUR PRODUCT WHEN IT BECOMES AVAILABLE AGAIN.
Hi, Joseph, from time to time, a patient will report to me that they feel as if they are “running out of breath” when speaking. Unless you have an underlying lung disease like COPD, the problem may not be adequate ariflow, the problem may be at the level of your vocal folds. Weakness or stiffness of one or both vocal folds can cause what could be describes as leaking or wasteage of airflow and give a perception of running out of breath. I would recommend that you discuss your concerns with your physician who may want to order pulmonary function tests. If you only have the perception of running out of breath when speaking, referral to a speech-language pathologist would also be recommended.
When I speak I run out of breathe and my words faint. What diaphragm exercises can I do so my speaking doesn’t faint?’