Aerodynamic measurements

in dysarthria
Dr. Swapna
 Normal patterns
• Rest breathing: Outward movt. of rib cage &
abdomen during inspiration and inward movt. of
both parts of the chest wall during expiration.
• Speech breathing: Inward displacement of the
abdominal wall & an outward displacement of
the rib cage from their resting position. Usually,
but not necessarily, both parts move inward
during sp. utterance.
• Timing of breathing for sp involves a quick
inspiration followed by a slow expiration
• In dysarthria, respiratory, phonatory &
resonatory mechanisms are affected
differently & to a different degree
depending on the type of dysarthria.
• LMN- resonatory affected more
• UMN- phonatory + resonatory affected
Physiological deficits arise due to a lack of
integration & coordination of these
systems.
• The foll. aerodynamic considerations are
important in dysarthric sp. assessment: 3
approaches for msmt:
1) Aerodynamic valving for the following: Used in
pts with structural deficits like VPI. Measures
ability to perform certain activities that are
essential for the proper production of consonant
sounds.
a)Oral/nasal coupling (ability to separate nose
from mouth during velopharyngeal closure)
b)Tongue-alveolar approximation for fricatives
(ability to bring the tongue, alveolar ridge & teeth
into correct approximation for frication)
c) Adduction/abduction vocal folds for voicing &
devoicing
2) Aerodynamic motor ability: principally
tested for ability of structures to perform
tasks in ltd. pd. of time associated with
normal speech motor activities.
a) Time taken for velopharyngeal closure
b) Build up & sustain intra oral pressure
c) Build up & sustain subglottal pressure
(difficult for dysarthrics, i.e. maintenance
of time & volume)
3) Aerodynamic sensory ability: tests for
ability to monitor variables that are
associated with generation of sp. e.g. poor
control of force dynamics (velocity,
direction, point of contact, strength etc.),
poor feedback & poor control & coordn.
(records volume & rate of airflow)
 Aerodynamic measures
1. Non speech tasks to assess respiratory system:
(Respiratory)
• Max. expiratory capacity
• Tidal volume TV (volume of air inspired or expired with
each normal breath)
• Expiratory reserve volume (amount of additional air that
can be breathed out after the end expiratory level of
normal breathing)
• Inspiratory reserve volume IRV (extra volume of air that
can be inspired above the tidal volume)
• Vital capacity (equals the inspiratory reserve volume plus
the tidal volume plus the expiratory reserve volume)
• Max. inspiratory capacity (volume that can be inhaled
after a tidal breathe-out: (TV+IRV)
• Residual volume (volume of air remaining in the
lungs after the most powerful expiration).
• Total lung capacity (volume of air in the lung at
the end of maximal inspiration (IRV + Tidal Vol.
+ ERV + RV (residual volume)
• Forced expiratory volume1(FEV1): volume of air
that a person can expire in 1 sec when asked to
inspire maximally & expire as quickly as possible
• Flow volume loop
• Resting breathing rate
• Tracheal/subglottal pressure
All except the last one measured using
‘spirometer’
2. Evaluation of breathing for speech includes
assessment of – (Phonatory)
• Glottal pressure
• lung volume (quantity of air used to speak,
judged perceptually by duration of sp. phrases
produced on 1 breath (if air flow is normal)
• Air flow
• Chest wall shape
• MAFR
• Phonation quotient (VC/MPD)
• Phonatory airflow rate (avg. airflow at a
particular rate)
• Vocal velocity index (MAFR/VC)
• Glottal resistance (pr. across glottis/flow)
• Max. flow volume
3) Resonatory:
Oral nasal airflow
Oral/nasal pressure
4) Articulatory
Intra oral pressure
Tongue alveolar approximation for fricatives
Tongue & lip approximations for stops &
labiodentals
 Assessing aerodynamic
performance
• Tools range from simple sensing devices
to elaborate combinations of pressure
transducers & airflow meters.
 Sensing devices-capable of gross
determination of function
 Pressure transducers & airflow meters-
provide acceptable estimates of the
performance of discrete activities.
 Instrumentation
• Sensing devices not used because of the
foll. disadv:
• Msmts are related more to respiratory
effort than to palatal function
• Response times were extremely slow
• Errors in measurement occurred
• Measurements were usually made during
non speech activities like blowing
 Instrumentation
1. Pressure transducers for air pressure msmt.
(e.g. nasometer)
 The electronic principle involve measures of
variable R, capacitance & inductance (when
pressure varies, either of these vary)
 It records airway pressure in VT (e.g. oral
pressure, nasal pressure or both)
 It helps in gross determination of the airway
function (e.g. nasalence measures)
2) Airflow (amount of lung vol. expended
over time) meters (e.g.
pneumotachographs, spirometers)
 Helps in obtaining discrete measures (e.g.
VC in cc)
 Records volume & rate of airflow
I. Air pressure msmt (pressure transducers)
1. Msmt. of tracheal/subglottal pressure
using non speech tasks:
Pr. delivered to the lx by the lungs
necessary for phonation to occur (air pr.
generated below VF).
Estimated by the foll. method:
• Place one end of a small tube in the mouth
and connect the other end to a pr.
transducer
• Use U-tube manometer with a leak tube (Netsell
& Hixon, 1978): inexpensive & non invasive.
Instruct the client to blow with as much force as
possible & to maintain a target level of water
pressure. A velopharyngeal & lip seal is
assumed when using a mouthpiece. Nose clip
should be used to prevent nasal air escape. If
these are inadequate (facial weakness/
paralysis) a full face mask that captures both
oral & nasal airflow may be used.
Rule of thumb: An individual who can generate &
sustain 5cm H2O for 5 sec with the ‘leak’ tube
has sufficient pressure capability to meet most
speech requirements.
Used to measure static oral & nasal pressure
• Hixon, Hawley & Wilson, 1982 –suggested an
even simple home made device for determining
respiratory driving pressures using drinking
glass & straw. Instruct the client to blow through
a straw into a glass of water. Fix the straw so
that the tip is 5cm below the surface of the
water, have the client blow just until bubbles
come out. This indicates that client can generate
5cm H2O pressure. If he can sustain that pr. for
5 sec, the pr. is adequate for sp. purposes. (if
client weak, insert straw only 3 cm into the
water, for bubbles to emerge, he would need to
produce 3cm H2O)
• Msmt. of tracheal/subglottal pressure
using speech tasks:
• Prolonging phonation with adequate &
steady loudness indicates good generation
& control of tracheal pressure.
2. Intra oral pressure:
 Recorded by placing a catheter in the mouth &
attaching it to a pr. transducer & recorder.
 Oral cavity pr.= 3-8 cmH2O for non nasal
consonants in normal conversational speech.
 But even in palatal dysfunction-pr. is above 3cm
H2O.
 They are also able to maintain because of the
nasal airway resistance.
 So msmt. of intra oral pr. does not provide an
estimate of palatal function.
3. Nasal pressure:
 Used as an index of velopharyngeal function.
 Place a nasal olive against the more patent
nostril while having the subject to produce non
nasal consonants within sounds/phrases.
 Nasal pressure should be negligible or ‘zero’ for
adequate closure.
 1-6 cmH2O – inadequate pr.
4. Simultaneous measurement of oral & nasal pr.
(Warren, 1979):
 Msmt of pr. difference across the velopharyngeal
port for rating palatal competency.
 Closure of velopharyngeal orifice creates a pr.
difference between nose & mouth.
 When complete closure occurs (/p/), pr. in mouth
is determined by respiratory effort & will vary
from 3-8 cmH2O. Pr. in nose will be
atmospheric/zero since no air leaks into the
nose.
 But if there is velopharyngeal opening, the
difference in pressure will vary with the size of
the opening. Since a difference in oral & nasal
pr. is used, effect of respiratory effort is
cancelled out when the velopharyngeal
mechanism is not completely closed.
• Speech sample- /papa/ & /hamper/ (nasal-
plosive combination which stresses on the
palatal mechanism)
• In palatal dysfunction clients,
velopharyngeal closure is usually
adequate when the differential pr. is
greater than 3 cmH2O
• If the differential pr. is between 1 & 2.9
cmH2O-closure is borderline
• If the differential pr. is below 1 cmH2O-
closure is inadequate for normal speech
• Other pressure transducers:
I. Resistance based pressure transducers
1. Bourden tube oral manometer:
• It is a pressure transducer which is elastic.
The tube is thin walled, the cross section
of which is a flattened circle. Increased
pressure in the tube makes it bend
outwards. The stress force moves the free
end of the tube moves a dial pointer & the
pressure can be read directly.
2. Strain gauge pressure transducer:
• Used for dynamic speech pressure
measurement.
• Strain gauge is a device that exhibit a change of
electrical property (esp. resistance) when they
are deformed by external force (stress).
• Pressure sensing tube is connected to a
chamber whose floor is a relatively flexible
diaphragm which deforms with pressure.
• So primary transducer-diaphragm, secondary
transducer - strain gauges (4 no.) mounted on
the diaphragm
• Uses electrical bridge circuits that require
excitation voltage. Amplifier required to track
output.
• Two types of strain gauge transducer:
a) Unbonded:
Pressure gauge is clamped to a solid support.
Open end of the sensing tube is positioned in
the region of the vocal tract where pressure is
evaluated. Pressure will displace diaphragm
within the transducer  amount of stretch on
the gauge changes  resistance in the wire
changes which is sensed.
-Good sensitivity & reliability
-Damaged by severe physical shock
b) Bonded: The elements that sense
diaphragm movement are either bonded
directly to the diaphragm or are special
semiconductor elements that are actually
part of it. E.g. microswitch.
-More sensitive
-Small & stiff diaphragm assures a good
frequency response
-Low cost
II. Reactance based pressure transducers
Pressure sensed by causing it to alter
the reactance of a capacitor or inductor.
1.Variable capacitance transducers used in
condensor microphones for recording air-
borne signals. Capacitative pressure
transducers are used for the msmt. of
dynamic VT pressures, but are not
popular.
2. Variable inductance transducer:
a. Variable reluctance pressure gauge:
Reluctance is the magnetic equivalent of
impedance.
 Two inductors kept in series.
 Diaphragm (made of stainless steel) is
positioned so as to divide a small cavity
into 2 equal & separate spaces, each of
which serve as a pressure chamber.
 On the wall of each is a toroidal inductive
coil.
As pressure in one chamber rises,
diaphragm is deflected, moving away from
the coil on the high pressure side and
towards the coil in the low pressure
chamber. Because the diaphragm has
high magnetic permeability, the inductance
of one coil increases as the diaphragm
moves closer to it, while the inductance of
the other decreases as the diaphragm
moves away.
• Adv:
 Withstands mechanical shock
 Highly sensitive
 Good frequency response
• Disadv:
 Requires AC excitation & thus a carrier
amplifier system.
III. Specialized pressure transducers: Adapted for
specific use. These are ultra-miniaturized
pressure transducers which can be placed in the
esophagus & stomach for determination of
transdiaphragmatic pressure. Pressure gauges
small enough to fit in oral cavity/glottis (4cm
above/below vocal folds)
Disadv:
 Calibration is difficult
 Sensitive to the temperature difference of the
egressive & ingressive tidal airflow.
• Air flow msmt:
1. Pneumotachographs /pneumotachometers:
Available in different sizes. Those intended for measuring
low rates of flow use higher impedance
Patient is fitted with a mask with a pneumotachograph
attached to its outlet.
The patient is asked to blow forcefully generating a large
positive pressure inside the mask, before the leakage
occurs.
Principle: A pressure drop occurs across any resistance
introduced in an air stream.
The resistance to air flow is created using fine wire-mesh
screen or a series of narrow tubes.
Pressure sensing ports are placed on either side of the
resistive element.
Pneumotachograph’s output is the pressure drop across its
resistive element. This is sensed by the differential
pressure transducer. The output is the electrical analog
of the airflow.
Masks without leak  pneumotachograph
(wiremesh/narrow tubes) differential pressure
transducer carrier amplifier flow signal

2. Warm-wire anemometer:
The basis for measurement of airflow – change
of electrical resistance with temperature.
When a ventilatory or speech airflow passes
over it, an electrically heated wire will be cooled
significantly. Consequently, wire’s resistance
changes that can be measured with serves an
index of the magnitude of the flow.
• Resistance of the wire should mirror the airflow.
Resistance can be tracked by monitoring the
voltage drop across the wire.
• Disadv: Limited frequency response

Frequency response of the anemometer can be

improved by using a fine wire that is kept at a
near constant temperature by a feedback circuit.
Phonatory function analyzer & phonation analyzer
use modified anemometer system to measure
airflow.
Adv: Simple set up
3. Body plethysmograph: (Hixon, 1972, Warren,
1976) measure airflow in 2 ways.
First method:
Patient’s body is enclosed within the
plethysmograph.
A special collar forms an air tight seal around the
neck.
During inspiration & expiration, the volume of the
body increases & decreases, compressing &
rarefying the air within the box.
The pressure change causes air to flow through a
screen in the wall of the box that serves as a
resistance.
The screen functions like a resistive element, so
the pressure difference across it is proportional
to the flow of air in & out of the lungs.
Inspiration causes air to flow out of the
plethysmograph (as lungs enlarge, taking up
more space in the box), while expiring results in
an airflow into the box. So transducer flow is an
inverse of the lung volume change.
Plethysmograph is actually measuring change in
lung volume which is different from flow.
Second method: Measure flow alone. Box remains
open, but patient’s head is enclosed in
plethysmograph dome. Collar is again used to
form an airtight seal around the neck. As the
case when the body box is used, a screen (this
time in the dome) serves as the resistance
across which a pressure proportional to the flow
is measured. This eliminates the influence of
lung pressure. The patient is placed inside the
flow transducer.
4. Electro-aerometer: Smith, 1960; Van den berg,
1962)
Primary transducer is a rubber flap valve through
which the air stream must pass.
Resistance of valve is between 1.25 & 3 cm H2O
that produces a pressure drop in the air flowing
through it.
This pressure causes the valve’s 2 rubber flaps to
separate.
A light beam is directed through the valve to be
sensed by a photo diode (secondary
transducer).
.
The amount of light transmitted is
proportional to the area of the valve
opening, which is inturn proportional to the
pressure drop and therefore to the airflow.
The output of the photodiode is an analog to
the flow rate.
Each flap valve is a one-way device-one for
ingressive air and the other for egressive
air.
Oral & nasal airflow can be measured
simultaneously
• Objective msmt of respiratory shape using
Respiratory inductive plethysmography (RIP) or
respitrace.
• It is a transduction system designed to monitor
circumferential size changes in the rib cage &
abdomen. Shape & motion of the chest wall
provides insight into the muscular mechanism
used for sp.
• Two coils of insulated wire glued to cotton mesh
bands that fit snuggly around the speaker’s
torso.
• This unit electronically sums the rib cage &
abdominal contributions to obtain a calibrated
index of total lung volume change.
• Results displayed in movement by time or
movement by movement (ribcage by abdomen
displays).
• Practical considerations w.r.t. dysarthria during
aerodynamic measures
1) Posture/respiratory effort
a) Observe for trunk muscle control (reduced
upright position)
b) Allow for extra time for the assessment of
dysarthric patients to ensure adequate, valid &
reliable data because they may have difficulty
in making adjustments on command, e.g.
swallow, adjust head & neck position, hold
transducers in place etc.
c) Repeated trials may be required by repositoning
the intra oral catheter & coaching subjects to
alter their tongue positions.
2) Bilabial incompetance/closure could be due to
a) Reduced labial closure
b) Mandibular weakness
Provide digital assist to the mandible for lip closure
for papa/hamper. If closure not possible, then
change the sample utterance to tata/hunter &
place the intraoral pressure sensor farther into
the mouth to sample pressure behind the
lingua-alveolar place of occlusion for /t/ or /n/.
3) Drooling: Clogging of catheter occurs in
pressure-flow measurement during speech.
When this occurs there is a baseline shift in the
signal. Then clear the catheter & reset the
instrument. Instruct the subjects to swallow just
prior to placement of catheter.
4) Performance variability (e.g. in flaccid,
weakness sets in from trial to trial, variations in
medication, arousal levels etc.). So multiple
baseline recordings are recommended across
several recording opportunities.
5) Fluctuating tone condition (e.g. hyperkinetic)
Effective coupling of aerodynamic abilities
with speech: check for
Expiratory control of speech
Quick expiration
Expiratory breath control (50-60 cc/syllable)
Expiratory breath control at initiation &
termination
Effective handling of residual respiratory
capacity