Parkinson's Voice and Swallowing: Why Train The Breathing Muscles?

One of the first things speech-language pathologists learn during their education is the concept that voice and swallowing are a part of a "shared system", referred to as the aerodigestive tract.  Like a cast of stage actors, muscles of respiration, the larynx ( voice box), and the oral-pharynx ( mouth and throat) participate in an exquisite performance of  breathing, speaking, and swallowing.

When speaking, the airstream from our lungs passes through the vocal folds and the vibration that occurs creates voice.  Our tongue, lips and  the shape of our mouth further modify the airstream into recognizable speech.We are always using the breath going out, exhalation, for speech. During swallowing, the demand changes so that when we  swallow, we  actually hold our breath,  so that food or liquid is prevented from entering into our airway. We have learned from the swallowing research that the momentary breath hold also happens during  the breath out , exhalation, creating an opportunity after the swallow  for the exhaled breath to sweep away any particles of food or liquid that may have become stalled in our mouth or throat.

                              

Upper aerodigestive tract - Image courtesy of Passy-Muir Inc.

               

All day long, without our instruction our bodies perform these shared functions. And, like many functions in our body, this performance goes on daily, seemingly effortlessly, until or unless the process is stressed by illness or disease.

 Respiration, in particular, always demands our attention. Most of us have had the experience of trying to talk while walking or climbing stairs. Not easy, and when our breathing is stressed this way, we always choose to "catch our breath" before completing our thought.  Similarly, when laughing and talking during a meal, we may mistime our swallow with a breath, and the result is a vigorous coughing episode as we proclaim "something went down the wrong pipe!"

 For individuals with a medical diagnosis of Parkinson's disease, COPD or other neurogenic or neuromuscular problems, reduced strength or efficiency of the respiratory muscles can result in reduced voice loudness and an increased number of  mistimed episodes of choking when eating or drinking, threatening the health of their lungs. Strategies for strengthening the respiratory muscles, therefore, should be incorporated into swallowing and voice therapy programs and should be considered when designing a home exercise program.

Respiratory muscle training can include:

Instruction in diaphragmatic breathing and purse lip breathing which can help you to take deeper and slower breaths.

 Expiratory muscle training using a device.

EMST 150 Expiratory muslce strength trainer

BREATHER Respiratory muscle trainer

                                                              

Strategies to improve your ability to "hold" your breath when swallowing.

A home program such as Voice Aerobics which can be performed independently and heightens awareness about the use of diaphragmatic breath support for voice.