Why is respiratory function so important for SLP involvement?
● Successful phonation is dependent upon effective respiration.
● Uncoordinated breathing patterns or open vocal folds increase risk for aspiration. Compromised breath support limits cough strength and effectiveness to remove any substances that pass the vocal folds.
Low oxygen levels can affect:
● The heart due to the need for it to pump harder
● The brain, resulting in mood changes, reasoning and memory deficits (i.e. decreased cognitive function; increased safety risk)
● Physical abilities due to decreased sensory or motor planning (i.e., increased risk for falls)
The focus of SLP respiratory intervention is to improve the patient’s quality of breathing patterns for improved communication, swallow, and patient performance during ADLs or other physical activities. The goal of Respiratory Muscle Strength Training (RMST) is to increase the “force-generating capacity” of the muscles of inspiration and expiration; RMST can be used to target inspiratory or expiratory muscles, depending on patient needs (Sapienza, Troche, Pitts, Davenport, 2011).
Always measure the patient’s oxygen level and respiratory rate pre-, during and post-therapy activities. If oxygen falls below 90%, cue for deep nasal inhalation and/or other breathing techniques such as pursed lip breathing until levels resume. If levels are unable to resume, notify Nursing immediately. Additionally, assess and document the patient’s demeanor/anxiety levels during intervention.
Respiratory treatment interventions need to address:
● Proper breath control/breathing patterns
● Pursed lip/diaphragmatic breathing
● Sustained phonation
● Phrase production
● Respiration with swallow when issues are identified
● Airway protection
Create a Breath Support Tool Kit
● Straws, whistles, cotton balls, pinwheels, party horns, bubbles, etc.
● Professional tools, i.e., The Breathertm; EMST 150/75
Resistive Device Training Videos:
The Breather
https://www.pnmedical.com/lessons/in-service-video/
EMST 1500
https://emst150.com/how-to-train/
Sustained Airflow/Phrasing
● Have patient draw circles or other items while sustaining “ah”
● Blow bubbles at a target, blow cotton balls across a table/into a cup, blow pinwheels, whistles, etc. Add a straw for resistance.
● Utilize pre-made phrases already established in the number of syllables needed.
● Dual task: have patient read phrases while on exercise bike
Refer to SLP Respiratory Rehab POSTette for additional information