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 breath control is often shallow, with the child filling their lungs with oxygen by using the clavicles or thorax instead of the diaphragm like they are supposed to. Sure signs of unproductive breathing can be a bell-shaped torso, with the ribs bowing out to increase lung capacity and volume. The shoulders may also be moving up and down with each breath. Some patients will try to push air out of the lungs by sliding or leaning forward during exhalation, grabbing their seat and pulling, or jumping up and down in their seat. Oxygen is frequently expelled right away and with force, leaving no breath reserved for sustained exhalation. The patient’s speech is breathy, often with gasps or inhalations during a phrase. They may begin with high volume which rapidly decreases to a faint whisper and the need to inhale right away again. Abdominal grading is minimal. Fatigue will set in quickly because the shoulders, rib muscles, arms and back are not intended for breathing.
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 child will often be given a set of exercises by the speech and language pathologist after the SLP has assessed the support that the child will require to encourage good breath support, tongue mobility, and oral resonance. There will be greater support introduced initially and then will be gradually taken away so that the child learns to continue these skills on their own without realizing it. Exercises to improve abdominal grading and diaphragmatic breathing are introduced at the stage when the child is working on exhalation skills. The child may also need to learn directionality when blowing as part of his/her progress. The SLP will have a good variety of strategies and proven techniques that will work on all of these skills and will build a foundation for good speech.
When looking for strategies and tools to help teach diaphragmatic respiration, it is important to use evidence based practice. Will the tool help children with hypotonia improve their breath support similar to typically developing children? Can it help with controlled exhalation for up to 10 seconds for children and 20 seconds for adults? Does it prevent frequent puffs of air and encourage breath support for sentences? Is the progress measurable? Does the tool give feedback about the length of expiration and the accuracy? Is it readily available and reasonably priced? Toys, devices, and apps should be considered. With the allure and the number of available apps, it is important to choose a therapeutic app which truly works toward the goal of good diaphragmatic breath support and duration.
To download a copy of an SLP approved breath control app, visit the Hot Air App site to see how this particular app overcame common breath support training issues.
