COMPONENT 2. 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. 

Research: 

Adams (1980) - states that teaching breathstream management within a
linguistic complexity hierarchy maximizes the patients chances of 
competently executing intricate laryngeal behaviors. 

Conture (1990) - stresses the importance of the client understanding 
how respiration, phonation, and articulation work together to produce
speech.  He provides excellent analogies for use with school-age 
clients. 
 
Costello (1983) - agrees that breathstream regulation may facilitate 
the reduction of hard contacts, glottal stops, and "bombastic"
initiation of phonation that characterize the dysfluent speech of 
some children. 

Riley and Riley (1983) - recommend that the building of the speech 
support process, as airflow management, is an elementary goal in
any fluency program. 


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:”

      a. Passive breathing
      b. 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.
      c. Proceed to single word production.
      d. Proceed to carrier phrase.  (e.g., "I see a ______")
      e. 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.
      
      a. 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.
   b. 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.