Swallowing and Phonation may be improved with Inspiratory and Expiratory Resistive Training (RBT) with the Breather.

Many diseases and or conditions affect upper airway function. (Neuromuscular Diseases: CVA (including stroke), Parkinson's disease, MS/ALS; Vocal Fold Pathology: nodules, polyps vocal fold paralysis, tracheostomy; Head/Neck Surgery/Tx: laryngectomee, glossectomy, pharyngectomy, supraglottic laryngectomy). Because of these diseases and or conditions, airways can be altered creating such symptoms as difficulty in swallowing (dysphagia) which can lead to aspiration and imperfect articulation (dysarthria) or no phonation at all. As therapists, we share team goals for our patients and while we're doing our therapy we can reinforce other therapies as well. Resistive breathing training (RBT) can strengthen respiratory muscles. Speech and voice production is an overlaid function of respiration. So if respiration is improved, that is better airflow in and out of the lungs, could articulation, voice, and swallow functions be enhanced?

The following is a review of the respiratory muscles and how they affect swallowing and phonation, preliminary data, case studies, and testimonials. It is not the intention of PN Medical to prescribe therapy. . . it is to allow speech pathologists to share their ideas and forms of therapy for speech pathology. Please contact us via phone or fax, or emaill us your own comments. Thank you.

Respiratory muscles strengthened and toned via inspiratory resistance are the diaphragm, external intercostals which help to elevate the ribs, and the accessory muscles which are primarily skeletal muscles of the neck.

Muscles strengthened and toned via expiratory resistance are the internal intercostals and abdominal muscles. In pulmonary disease or if there is significant resistance to exhalation, the elastic recoil of the thorax does not have adequate force to remove enough air in the allotted time, hence air trapping. Effective use of the abdominals is often lost, and without this powerful generator of force to push the diaphragm into expiratory action, the patient is at a great disadvantage. Since it is the expiratory phase of respiration that generates air flow out through the vocal chords, it is most important to have adequate air flow for phonation. In addition, these muscles are most important for an effective cough, helping to prevent aspiration

 

 

Muscles strengthened and toned via inspiratory resistance are the diaphragm, external intercostals which help to elevate the ribs, and the accessory muscles which are primarily skeletal muscles of the neck.
Muscles strengthened and toned via expiratory resistance are the internal intercostals and abdominal muscles.
Laryngeal muscles constrict the pharynx, raise and draw back the soft palate which lifts up the uvula, closing off the nasopharynx as food passes from the mouth through the lower parts of the pharynx. And, most importantly contraction of the aryepiglottic muscles (those muscles that connect the arytenoid cartilages with the epiglottis) prevents "swallowing down the wrong pipe," and two other pairs of intrinsic laryngeal muscles function to open and close the glottis. Improper or incomplete glottic closure is often not realized until the patient develops congestion or pneumonia
One may think a patient may have to first choke or at least gag before aspiration occurs, but research literature offers no evidence that the gag response / reflex is an indicator of normal swallowing function. Approximately 40% of adult males and 10% of females in the average population have no gag reflex. Aspiration may or may not elicit a cough reflex, for example, "sillent aspiration."