Respiratory efficiency is frequently a obstacle for children with low muscle tone, also known as hypotonia. A speech therapist will use a child's ability to inhale and exhale as a building block to efficient speech production. Vocal volume, quality and pitch are dependent on good breath support and exhalation that can be sustained. If a patient has inefficient breath control, he is unable to exhibit a strong exhalation and may end up unable to complete a word or sentence. He/she may also tire quickly because he/she is using muscles that were not intended to be used for breath control. We want patients to be able to communicate effectively, and that entails looking at how they are breathing. Can we improve respiration for speech therapy?
Inefficient breathing is often shallow, with the child "filling" the lungs with air by using the thorax or clavicles instead of the diaphragm. Tell tale signs of inefficient breathing can be a bell shaped torso, with the floating ribs flaring out to increase lung capacity and volume. The shoulders may be moving up and down with respirations. Some children will try to push air out of their lungs by rocking forward during exhalation, grabbing their chair seat and pulling, or bouncing up and down. Air is frequently expelled immediately and with force, leaving no breath left for sustained exhalation. The child's speech is breathy, with frequent gasps or inhalations during a sentence. He may start out with a loud voice which rapidly decreases to a whisper and the need to inhale quickly. Abdominal grading is minimal. Because the shoulders, rib muscles, arms and back are not intended for breathing, fatigue can set in quickly.
A child with hypotonia may need to use one or both hands to stabilize himself due to weak abdominal and core muscles and endurance. The child may need assistance by the use of a chair with back support or even pillows to help stay stabilized during speech. If the speech is still difficult to understand, this is likely because the tongue is being used for stabilization purposes involuntarily. If this is the observation then abdominal weakness is suspect.
When collaborating with occupational therapists, respiratory therapists, physical therapists, and developmental therapists, it is often the case that the speech and language pathologist will address these breath control patterns with "good speech" as the main goal to reach. Speech that is easily understood because the tongue is not occupied, has good oral resonance and voicing, is ample in volume, and has mostly correct pitch is all very closely related to efficient breath control.
The speech and language pathologist will assess the support the child needs initially to work on good breath support, tongue mobility, and oral resonance. That support is provided and gradually withdrawn as expiratory volume, duration, and efficiency improves. Exercises to improve abdominal grading and diaphragmatic breathing are introduced while working on exhalation skills. Additionally, the child may need to learn how to blow with directionality, or with rounded lips. The speech and language pathologist will have a variety of strategies and techniques to work on these skills as the foundation to good speech.
In addition to traditional strategies and techniques to help improve diaphragmatic respiration, one can also acquire apps, toys and devices to assist in the learning process. This can also help keep the child engaged in the therapeutic activities. There are several questions you need to ask about the app or toy before you buy though. Will the app or toy help the child improve their breath support in comparison to a typically developing child? Will it help with controlled exhalation for extended periods of time (up to 20 seconds for adults)? Does the app or toy discourage frequent puffs of air as opposed to sustained, even exhalation? Does the app or toy give accurate feedback that can be used for improvement and analysis? Is the app or toy reasonably priced so that it is worth the cost? With the growing number of apps and toys that are becoming available for therapy, it is important to measure them against this set of questions so that you know that you are getting an app or toy that will actually help reach the child's goals of good diaphragmatic breath support and duration.
Inefficient breathing is often shallow, with the child "filling" the lungs with air by using the thorax or clavicles instead of the diaphragm. Tell tale signs of inefficient breathing can be a bell shaped torso, with the floating ribs flaring out to increase lung capacity and volume. The shoulders may be moving up and down with respirations. Some children will try to push air out of their lungs by rocking forward during exhalation, grabbing their chair seat and pulling, or bouncing up and down. Air is frequently expelled immediately and with force, leaving no breath left for sustained exhalation. The child's speech is breathy, with frequent gasps or inhalations during a sentence. He may start out with a loud voice which rapidly decreases to a whisper and the need to inhale quickly. Abdominal grading is minimal. Because the shoulders, rib muscles, arms and back are not intended for breathing, fatigue can set in quickly.
A child with hypotonia may need to use one or both hands to stabilize himself due to weak abdominal and core muscles and endurance. The child may need assistance by the use of a chair with back support or even pillows to help stay stabilized during speech. If the speech is still difficult to understand, this is likely because the tongue is being used for stabilization purposes involuntarily. If this is the observation then abdominal weakness is suspect.
When collaborating with occupational therapists, respiratory therapists, physical therapists, and developmental therapists, it is often the case that the speech and language pathologist will address these breath control patterns with "good speech" as the main goal to reach. Speech that is easily understood because the tongue is not occupied, has good oral resonance and voicing, is ample in volume, and has mostly correct pitch is all very closely related to efficient breath control.
The speech and language pathologist will assess the support the child needs initially to work on good breath support, tongue mobility, and oral resonance. That support is provided and gradually withdrawn as expiratory volume, duration, and efficiency improves. Exercises to improve abdominal grading and diaphragmatic breathing are introduced while working on exhalation skills. Additionally, the child may need to learn how to blow with directionality, or with rounded lips. The speech and language pathologist will have a variety of strategies and techniques to work on these skills as the foundation to good speech.
In addition to traditional strategies and techniques to help improve diaphragmatic respiration, one can also acquire apps, toys and devices to assist in the learning process. This can also help keep the child engaged in the therapeutic activities. There are several questions you need to ask about the app or toy before you buy though. Will the app or toy help the child improve their breath support in comparison to a typically developing child? Will it help with controlled exhalation for extended periods of time (up to 20 seconds for adults)? Does the app or toy discourage frequent puffs of air as opposed to sustained, even exhalation? Does the app or toy give accurate feedback that can be used for improvement and analysis? Is the app or toy reasonably priced so that it is worth the cost? With the growing number of apps and toys that are becoming available for therapy, it is important to measure them against this set of questions so that you know that you are getting an app or toy that will actually help reach the child's goals of good diaphragmatic breath support and duration.
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To learn more about breath control apps, visit the Hot Air App site to see how this particular app solved some common breath support training obstacles.
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