Respirations
Breath is the link between the body and mind." - Dan Brule
How we breathe can have a major impact on our:
- Brain - Mood - Attention - Body Awareness - VOICE!
Power Source Filter Theory
air supply from lungs-breathing
Power-Source-Filter Model
Power: BreathingSource: Vocal FoldsFilter: Resonance- in mask of face
Subglottal Pressure
Pressure that builds below the vocal foldsControls: - Airflow - Fundamental Frequency (pitch) - Intensity (volume)
Upper and Lower Airways
The conducting airways are divided into:Filter: Upper respiratorySource: Upper respiratoryPower: Lower respiratory
Passive & Active Forces of Respiration
Quiet inspiration: active • Quiet expiration: passive (recoil) • Inspiration with talking: active • Expiration with talking: active • Inspiration with high volume tasks: forced• Expiration with high volume tasks: forced
Muscles of Inspiration
Muscles of quiet/active inspiration: - Diaphragm - External Intercostals - Scalene (sometimes) • Muscles of forced inspiration: - 17! - A few include sternocleidomastoid, scalene, trapezius
Muscles of quiet/active inspiration
- Diaphragm - External Intercostals - Scalene (sometimes)
Muscles of forced inspiration
- 17! - A few include sternocleidomastoid, scalene, trapezius
The Diaphragm
As the diaphragm moves downward, force is transferred to the lower ribs, moving them outward. • Intra-abdominal pressure rises, and the lower rib cage expands.
Muscle Contraction in Quiet Expiration
• None!! • Passive relaxation decreases the volume of thoracic cavity due to elastic recoil of the lungs.
Muscles of Forced Expiration
Forced expiration further decreases lung volume and involved: - Internal intercostals - Internal oblique abdominus - External oblique abdominus - Rectus abdominus
Structures of Respiration
lots
The Alveoli
Center of Air Exchangetiny sacs of lung tissue specialized for the movement of gases between air and blood
For the lungs to inflate
alveolar pressure must be less than atmospheric pressure.
For the lungs to deflate
alveolar pressure must greater than atmospheric pressure.
Boyle's Law
Inverse relationship between pressure and volume.- Volume of lungs increase during inspiration. - Pressure of lungs decrease during inspiration. - This causes air to rush in and fill the lungs.Pressure wants to equalize- pressure in lungs wants to match pressure outside of lungs.
innervation of diaphragm
C3,4,5 (keeps the diaphragm alive) - phrenic nerve
Inspiration Overview
• Resting Inhalation: - Always active and may be forced - Diaphragm contracts - Thoracic cavity expands - Air rushes in • Inhalation for Phonation: - Always active and may be forced - Diaphragm contracts - Intercoastal and neck muscles help expand chest cavity - Air rushes in
Expiration Overview
Resting Exhalation: - Passive - Diaphragm relaxes - Lungs get smaller - Air is released • Exhalation for Phonation: - Active and may be forced - Many muscles involved - Controlled release of air
Resting Respiration vs. Respiration for Phonation
Resting Respiration: - About equal in duration - Approximately 2 seconds each - Pause after exhalation - Ratio of 2:3 • Respiration for Phonation: - Quick inhalation - Exhalation can be extended to 15 sec or more - 20-50% of vital capacity needed for speech - Ratio of 1:9
Respiration Volumes
• Tidal capacity / tidal volume • Expiratory reserve volume • Inspiratory reserve volume • Residual volume • Vital capacity
• Tidal capacity / tidal volume
• Amount inhaled / exhaled in a typical cycle • Determined by oxygen needs • Breathing in and out at rest
Vital capacity
Total amount of air that can be exhaled after a maximum inhalation • Often assessed by using "ssss
Expiratory reserve volume
Maximum volume of air that can be exhaled beyond a tidal expiration • Supplemental air
Inspiratory reserve volume
Maximum volume of air that can be inhaled beyond a tidal inspiration
Residual volume
Amount of air that stays in the lungs all the time
Pulmonary Function Testing (PFT)
Test the flow/volume relationship to diagnose the presence and assess the effect of large (central) airway obstruction • Performed in Pulmonology or ENT to discern cause of dyspnea
What happens when there is a problem with the power source?
Impacts phonation
Dyspnea
• The conscious awareness of labored breathing or air hunger • Causes: - Movement - Exercise - Speaking - Environmental triggers • Origin: - Lower respiratory conditions - Certain laryngeal conditions
Origin of Dyspnea
• Lower airway disorders - Pneumonia - Asthma - Exercise Induced Asthma - COPD - Low tone • Upper airway disorders: - Ventricular fold compression - Webbing - Subglottic stenosis - Bilateral TVF paralysis - Arytenoid joint dislocation - Paradoxical Vocal Fold Motion - Muscle Tension Dysphonia
Pneumonia
• An infection of the lung (one or both) primarily affecting the alveoli • Causes: - Bacteria - Viruses - Fungi • Symptoms: - Cough - Trouble breathing - Chest pain - Fever
Asthma
• A chronic condition that intermittently swells and narrows the airways in the lungs • Types: - Allergen-triggered - Nonallergic - Exercise-induced - Cough variant - Occupational - Aspirin-induced • Symptoms: - Chronic cough - Wheezing - Shortness of breath (SOB) - Frequent respiratory infections - Throat irritation - Anxiety
Chronic Obstructive Pulmonary Disease (COPD)
• A group of progressive lung diseases, causing chronic inflammation that leads to obstruction of airflow from the lungs • Most common are: - Emphysema - Chronic bronchitis • Cause: - Tobacco smoking • Symptoms: - Shortness Of Breath - Wheezing - Chest tightness - Chronic cough - Frequent respiratory infections - Lack of energy
Low Tone
Spinal cord injury • Neurodegenerative disorders: - Cerebral Palsy (CP) - Muscular Dystrophy - Myasthenia Gravis - Down's Syndrome - Prader-Willi Syndrome - Multiple Sclerosis (MS)
Laryngeal Resistance Disorders
• Ventricular fold compression • Webbing • Glottic stenosis • Bilateral TVF paralysis
Fully Abducted vocal folds
should be open when breathing
Ventricular Fold Compression
May be short of breath because ventricular folds are squeezing and creating tension
Subglottic Stenosis
narrowing of space below glottis• Causes: - Congenital - Acquired • Infection • Trauma • Intubation - Idiopathic • Symptoms: - Stridor - Breathing difficulty - Poor weight gain (children)
Laryngeal Web
Membrane that grows across the anterior portion of the glottis.• Causes: - Congenital - Long-term intubation • Symptoms:- Wheezing - Shortness Of Breath - Coughing - Respiratory infections - Voice changes
True Vocal Fold Paralysis
one or both sides of vocal folds are paralyzed
Paradoxical Vocal Fold Movement (PVFM)
upper airway obstruction due to atypical adduction of vocal folds
Respiration Overview
• Respiration is the power source for voice production • Lower and upper respiratory conditions impact phonation • Respiratory conditions often co-occur with voice disorders (and other areas of SLP)
Larynx
voice box; passageway for air moving from pharynx to trachea; contains vocal cords
The Larynx Major Functions
Major functions - Breathing - Airway protection - Valving - Voice production
The Cartilages of the Larynx
• Hyoid bone (suspended above) • Epiglottis • Thyroid cartilage • Cricoid cartilage • Arytenoid cartilages (2) • Corniculate cartilages (2) • Cuneiform cartilages (2)
Levels of the Larynx
1. Supraglottic Space2. Transglottic space3. Subglottic space
thyroid cartilage
A firm prominence of cartilage that forms the upper part of the larynx; the Adam's apple.
cricoid cartilage
the ring-shaped structure that forms the lower portion of the larynx
Arytenoid cartilage
Two small cartilages in the larynx, the movements of which abduct and adduct the vocal folds.
Rocking of the Thyroid cartilage
Stretch and shorten vocal folds which changes the pitch.
Structures of the Larynx Overview
• Organ of voice production (but also has other important functions) • 9 cartilages • 1 bone
Laryngeal Development
• True Vocal Folds are complete by 12 weeks and babies can silently cry in utero • Length of True Vocal Folds: - Birth: 2.5 mm - 16 months: 8 mm - Adult female: 11-17 mm - Adult male: 12-22 mm • Cartilages: - Infant: soft - Adult: hard
Lamina Propria
• Infant: 1 layer • Age 4+: Identifiable layers
Vocal Ligament
• No ligamentous structure in newborns • Emerges between 1-4 years old • Continues in immaturity until after puberty, typically 10-16 years old
Pubertal Changes in the Male Larynx
• Anatomical changes: - Increase in testosterone - Thickening of laryngeal cartilages - Larynx descends - Vocal folds lengthen • Impact on voice: - Pitch lowers - Voice cracks
Pubertal Changes in Female Larynx
• Anatomical changes: - Larynx descends - Vocal folds lengthen • Impact on voice: - Pitch lowers (not as much as males)
Effects of Aging
• Anatomical changes: - Sarcopenia: muscle wasting • Vocal fold atrophy - Vocal fold edema - Reduction in vagus nerve (X) fibers - The aging larynx: presbylaryngis • Impact on voice: - Breathiness - Hoarseness - Roughness - Tremor
Larynx through the Lifespan Overview
• Marked differences from infancy to geriatrics • Differences in anatomy related to age and gender • Impact on voice quality and function