Chest wall kinematics during speech breathing in tracheoesophageal speakers.

OBJECTIVES: The purpose of the present study was to determine how tracheoesophageal (TE) speakers manipulate the chest wall (rib cage and abdomen) to speak and how respiratory compromise (chronic obstructive pulmonary disease; COPD) and task variables influence those behaviors. METHODS: The chest wall movements of 11 male TE speakers (5 with COPD and 6 without COPD) were measured during tidal breathing, spontaneous speech, and reading. Repeated-measures multivariate analyses were used to compare breathing behaviors across speech tasks and by respiratory health. Additional repeated-measures multivariate analyses and 1-way analyses of variance were conducted on temporal, aerodynamic, and linguistic measures. RESULTS: There was a significant main effect of task and a significant interaction effect of COPD and task on chest wall movements. Rib cage movements varied by task, whereas abdominal movements were as predicted. There was a significant difference in utterance length by task. There were no main effects of COPD on the chest wall and no significant group differences in utterance length, aerodynamic measures, or intelligibility. The TE speakers were generally accurate in inspiring at appropriate linguistic boundaries. CONCLUSIONS: The results suggest that there is robust control for speech breathing following laryngectomy, but that there is also increased effort within the chest wall. Implications for future research considerations are discussed.

Lung volumes used during speech breathing in tracheoesophageal speakers.

OBJECTIVES: The purpose of this study was to determine how tracheoesophageal (TE) speakers manipulate lung volumes to meet speech demands and how respiratory compromise (chronic obstructive pulmonary disease [COPD]) and task variables influence these behaviors. METHODS: The lung volumes of 9 male TE speakers (4 with COPD, 5 without) during tidal breathing, spontaneous speech, and reading were investigated. Repeated-measures multivariate analyses of variance were used to compare lung volumes and utterance length across speech tasks and by respiratory health. A one-way analysis of variance was used to compare aerodynamic measures and intelligibility by COPD diagnosis. RESULTS: There was a significant main effect of task and a significant interaction effect of COPD and task on lung volumes at initiation and termination of speech. The TE speakers terminated speech exclusively below the resting expiratory level (REL) in both speech tasks because of elevated RELs, which are often present after laryngectomy. There were no main effects of COPD on any lung volume measures and no significant group differences in utterance length, aerodynamic measures, or intelligibility. CONCLUSIONS: Intelligibility and aerodynamic measures were not influenced by lung volumes and were comparable to findings of previous research. Speaking past the REL might be a compensation to optimize expiratory control for speech in a compromised system and a marker for the increased effort often anecdotally described by TE speakers.

Establishing validity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

PURPOSE: The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to provide a protocol and form for clinicians to use when assessing the voice quality of adults with voice disorders (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kramer, & Hillman, 2009). This study examined the reliability and the empirical validity of the CAPE-V when used by experienced voice clinicians judging normal and disordered voices. METHOD: The validity of the CAPE-V was examined in 2 ways. First, we compared judgments made by 21 raters of 22 normal and 37 disordered voices using the CAPE-V and the GRBAS (grade, roughness, breathiness, asthenia, strain; see Hirano, 1981) scales. Second, we compared our raters' judgments of overall severity to a priori consensus judgments of severity for the 59 voices. RESULTS: Intrarater reliability coefficients for the CAPE-V ranged from .82 for breathiness to .35 for strain; interrater reliability ranged from .76 for overall severity to .28 for pitch. CONCLUSIONS: Although both CAPE-V and GRBAS reliability coefficients varied across raters and parameters, this study reports slightly improved rater reliability using the CAPE-V to make perceptual judgments of voice quality in comparison to the GRBAS scale. The results provide evidence for the empirical (concurrent) validity of the CAPE-V.

Paradoxical Vocal-Cord Dysfunction: Management in Athletes.

OBJECTIVE: To describe a treatment strategy for paradoxical vocal-cord dysfunction (PVCD) as it applies to an athletic population. BACKGROUND: Paradoxical vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of PVCD is an inappropriate closure of the vocal cords during respiration, resulting in airway obstruction. This condition is familiar to speech-language pathologists and otolaryngologists yet remains poorly understood in the sports medicine community. Treatment strategies are even less understood. A therapeutic exercise program designed to promote diaphragmatic breathing may allow an athlete to gain control during episodes of dyspnea. Elimination of contributing or concomitant conditions is critical to resolution of the condition. DESCRIPTION: The treatment of PVCD requires an understanding of the pathoanatomy of the condition. The focus of the exercise program is on relaxation of the larynx and conscious activation of the diaphragm and abdominal muscles during respiration. The athlete must have a sense of laryngeal control while performing the exercises. In addition, the patient and practitioner must realize the amount of neuromuscular reeducation required to change breathing patterns. CLINICAL ADVANTAGES: This therapy may allow the athlete to gain control over episodic dyspnea, participate in athletic activities with fewer complications, and, perhaps, reduce or eliminate medications prescribed to treat suspected bronchospasm.