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.
 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.
 Hixon, T. J., & Hoit, J. D. (2005). Evaluation and management of speech breathing disorders: Principles and methods. Tucson, AZ: Reddington Brown.
Start Your New Year with some FUN Speech Practice!
Happy New Year
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
Voice Aerobics the heART and Science of Voice Practice