Older patients I see for voice treatment as well as patients with motor speech problems associated with Parkinson’s disease (PD) often report that they are “running out of breath” when they speak. Are they truly running out of breath or are they not managing breath support efficiently?
The main function of the respiratory system is to deliver oxygen to the cells of the body and remove carbon dioxide. The lungs are responsible for pulmonary ventilation, and like bellows on an accordion, expand and relax in response to air pressure changes. The respiratory muscles are active during speech production, and the chest wall maintains appropriate levels of muscle pressure. If the respiratory muscles are weak or stiff from aging or disease or the lungs have lost their elasticity from disease such as COPD, an individual may speak at a low lung volume, which is effortful and eventually can lead to vocal strain.
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.
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 maintaining 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.
Age-related reductions in pulmonary elastic recoil and respiratory muscle strength can also affect how
older adults generate subglottal pressure required for speech production[ii].
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.
Speech therapy and voice treatments approaches used to address vocal weakness due to age related changes such as Phorte (Phonation Resistance Exercise Training) or the Lee Silverman Voice Treatment (LSVT LOUD) for Parkinson’s use high effort vocalizing as a core exercise and a way of loading the muscles and thereby making them work harder to get stronger.
[i] 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. [ii] Huber, Jessica, Effects of Utterance Length and Vocal Loudness on Speech Breathing in Older Adults. Respir Physiol Neurobiol. 2008 December 31; 164(3): 323–330. doi:10.1016/j.resp.2008.08.007.
Breathing Exercises You CAN Do at Home!
Because of the necessary ongoing co-ordination between inspiratory-expiratory muscles during speech production, and timing of breathing and swallowing, establishment of optimal breathing patterns is often a component of some voice and swallowing 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.
Voice Aerobics Breathwork Video
Respiratory muscle training devices (RMT) are handheld devices, that like weights in the gym, create resistance for the breathing muscles and thereby provide a strengthening effect.
Patient using a Breather with a manometer for feedback
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. Expiratory muscle strength training using a threshold device like the EMST-150 has been shown to improve swallowing function and safety in individuals with Parkinson’s disease.
Any shortness of breath when speaking or moving should always be reported to your physician to rule out any pulmonary disease or other heart-lung related problems. If your voice problem is related to age or Parkinson’s, ASK FOR A REFERRAL to a Speech-language pathologist and start strengthening your voice!
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My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * Voice Aerobics® A Whole Body Approach to Voice Practice* Certified End of Life Specialist Training (CEOLS) * FiTOUR® Group Exercise Instructor
Voice Aerobics the heART and Science of Voice Practice
[i] 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. [ii] Huber, Jessica, Effects of Utterance Length and Vocal Loudness on Speech Breathing in Older Adults. Respir Physiol Neurobiol. 2008 December 31; 164(3): 323–330. doi:10.1016/j.resp.2008.08.007.