REGULATING AND CONTROLLING BREATHSTREAM

Rationale: Respiratory management and adequate breath support are important variables to be worked on with children and adolescents who stutter. Often times, in response to their stuttering, children will develop aberrant breathing patterns in an effort to control their stuttering. Behaviors such as talking on exhausted breath, quick, shallow inhalations, and talking on an inhalatory cycle, are common behaviors observed in dysfluent children. For those children who exhibit difficulty in initiating and/or maintaining airflow and voicing for speech production, direct techniques may be necessary to provide the child with tools for reducing tension and easing out of laryngeal blocks

Activities/Techniques

1. Teach the client the concept of "easy voice." The clinician demonstrates a breathy initiation of phonation on a constant- vowel (CV) combination. Instruct the client to "feel" how easy his/her airflow lets his/her voice "turn on." The following hierarchy may be employed when teaching "easy voice:"
   1. Passive breathing
   2. Passive breathing with phonation. (Have client let out a small breath of air while beginning to move his/her articulators and then begin phonation on this breathstream.
   3. Proceed to single word production.
   4. Proceed to carrier phrase. (e.g., "I see a ______")
   5. Proceed to phrase and sentence level.

2. In language appropriate to the child's conceptual level, explain the anatomy and physiology involved in voice production and what "happens" during stuttering.
   1. Conture's (1982) water hose analogy may be appropriate depending on the age of the child. Conture draws an analogy between a garden hose and the speech production system, comparing areas where the water and air are turned off and, what happens as a result.
   2. Use models and pictures of the larynx.

3. Instruct the client to feel the clinician's larynx during the production of tense vs. hard voice onset (vowels or CV combinations are appropriate). Then have the child feel his own larynx during tense and relaxed productions.

4. The concept of "speaking on an /h/" can also facilitate adequate regulation of breathstream. The client begins with /h/ plus a variety of vowels with the clinician cueing the client to feel this "easy voice." Then, contrast with pairs such as "hold/old", "hat/at" to facilitate awareness of easy onset of voice.

5. Identification of abnormal breathing patterns may be necessary if these behaviors have developed in response to the stuttering moment. Help the child become aware to quick, shallow breathing and talking on exhausted breath. (e.g., "Did you breathe deep enough?", Are you talking with no air?")

6. Some children may exhibit poor timing of the respiratory cycle. The clinician should model appropriate "chunking" of words into phrases to facilitate adequate inhalatory and exhalatory cycles. Pre-marking breath groupings on reading material is a good activity to aid in increasing the child's awareness of appropriate breathing. (This pre-marking should indicate where the pauses and inhalations for speech should come.)

7. For the child who forces words out using levels of their expiratory reserve volume, assist him/her in slowing down their rate of speech, prevent the rush of words, and encourage appropriate pauses in an utterance. Cueing the child to "pause for a second" may also facilitate more appropriate breathing.

8. Caution is advised in using breathing exercises for children. For older children, clavicular breathing, which creates tension in the upper chest and laryngeal area, can be modified to a more thoracic/abdominal pattern through breathing exercises.

9. Modeling and instructing the client to use easy voluntary prolongations at the beginning of phrases, facilitates easy onset of voice, continuous voice production, and reduces laryngeal tension as well as allows for a reduction of subglottal air pressure prior to voice production.

10. To teach and visually reinforce easy onset, the clinician may use blowing bubbles at the initiation of air flow in the production of single words. Words should be chosen where the initial phonemes require intra-oral air pressure. (e.g., p----ull, p----at, p----our). Instruct the child to begin saying a word using easy speech. As he/she builds up air in the oral cavity, they should exhale slowly into the bubble wand and then initiate phonation.

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