Day 4 AM Flashcards
(195 cards)
1
Q
5 originally proposed layers of the vocal folds (Hirano)
A
Epithelium
Superficial Layer of the Lamina Propria –
Intermediate Layer of the Lamina Propria –
Deep Layer of the Lamina Propria
Thyrovocalis muscle
2
Q
Like in other parts of the body, the epithelium is a (thin, thick) covering (100−180μm) of the vocal folds,
protecting them from their intrinsic and extrinsic environment
A
thin
3
Q
Epithelium is composed of? Shape?
A
stratified squamous cells which are flat or plate-‐‐like in shape
4
Q
Define: superficial layer of the lamina propria
A
The main vibrating proportion of the vocal folds
5
Q
Superficial layer of lamina propria also referred to as
A
Reinke’s space
6
Q
The ________ and ________ are often referred to as the C_______
A
epithelium, SLOLP, cover
7
Q
Intermediate layer of the lamina propria: composition? Movement?
A
Composed mainly of elastic fibers which run parallel to the vibrating edge of the vocal fold, allowing this layer to only stretch in an antero-‐‐ posterior direction
8
Q
Deep layer of the lamina propria: compositon?
A
Composed mainly of collagenous fibers which run parallel to the vibrating edge of the vocal fold
9
Q
Define: thyrovocalis muscle
A
The most medial portion of the thyroarytenoid muscle, makes up the bulk of the vocal fold structure
10
Q
Define: extracellular matrix (ECM)
A
“filler” substance that exists between cells in an organism
11
Q
Role of extracellular matrix (ECM)
A
The ECM plays an important role in cell function (particularly in protection against damage, and in recovery)
12
Q
In the vocal folds, the ________ is rich in ECM within (all, some) layers of the superficial, intermediate and deep layers
A
lamina propria, all
13
Q
Hyaluronic acid (HA)- define, function?
A
A chief component in the ECM, it helps cells proliferate and migrate while playing an important role in absorption and tissue viscosity
14
Q
Amount of HA seems to be (variable, consistent) between individuals. Why?
A
Variable, genetic factors
15
Q
The (abundant, scarce) amount of HA observed in the (female, male) vocal folds is thought to be (related, unrelated) to _______. Why?
A
abundant, female, related, impact absorption. Acting as a protective factor against the characteristic high vibration frequency of the female vocal folds
16
Q
3 primary functions of the larynx?
A
airway protection, speech, breathing
17
Q
3 ways structures of the larynx are used in speech production to modify the airflow from the respiratory system.
A
- Voicing: Adducting the vocal folds together so that they vibrate during the production of vowels and voiced consonants
- Voiceless: Abducting the vocal folds during the production of voiceless consonants.
- Intonation: Changing vocal fold vibration rate changes the perceived pitch of the speaker’s voice (higher rate = higher pitch)
– Ex: Statement vs. a question: “Gracie did not go to school.” (falling intonation)
“Gracie did not go to school?” (rising intonation)
18
Q
3 structures of the interior laryngeal system that move
A
Vocal folds, epiglottis, ventricular folds
19
Q
4 muscles that adduct the vocal folds
A
interarytenoid muscles, transverse interarytenoid muscle, oblique interarytenoid muscle, lateral cricoarytenoid (LCA)
20
Q
Interarytenoid muscles: function?
A
Brings the arytenoids together, causing them to slide toward the midline
• Squeezes the vocal process of the arytenoids
21
Q
transverse interarytenoid muscle: function?
A
Primarily responsible for medial compression
of vocal folds
– Used to vary intensity of vocal fold vibrations
22
Q
Oblique interarytenoid muscle: function?
A
Superficial to transverse arytenoid muscle
• Connects muscular process of one arytenoid to apex of opposite arytenoid
23
Q
Lateral cricoarytenoid muscle: function?
A
Pulls the muscular process of the arytenoids forward and medially
• Arytenoid moves in rocking motion, inward and downward
24
Q
Abduction vs. adduction
A
Abduction = pull away/apart, adduction = come together
25
1 muscle that abducts the vocal folds
PCA- posterior cricoarytenoid
26
Posterior cricoarytenoid- function?
Pulls the muscular process of the arytenoids posteriorly, rocking the arytenoids back to their axis
27
PCA muscle is antagonist to the ____ muscle
LCA
28
PCA is also active during (rest/exercise) to permit _______
exercise, movement of a greater
| volume of air
29
PCA is synergistically connected to the ______.
Diaphragm
30
1 muscle that stretches the vocal folds
Cricothyroid
31
Cricothyroid: function?
Rocks the thyroid cartilage towards cricoid cartilage
| – Elongates the vocal folds and places them under increased tension
32
Cricothyroid is the ONLY muscle in the larynx whose primary function is _______?
lengthening the vocal folds
33
Cricothyroid: more stretched = (more/less) tense
more
34
Thyrooarytenoid muscle- tensing function?
Isometric contractions of both TV and TM portions will tense
| medial and lateral aspects, respectively
35
Thyroarytenoid has (isometric. isotonic) contractions?
isometric
36
Thyroarytenoidmuscle- shortening (decreasing length) function
Contraction of longitudinally
oriented fibers
• Pulls anterior (thyroid) and posterior (arytenoid) portions closer together.
• Tilts the thyroid backward to relax the vocal folds and at the same time pulls
the muscular process forward to assist in medial compression
37
5 laryngeal position considerations
```
• UP and BACK
UP and FORWARD
DOWN • Decrease distance
between hyoid and thyroid
•Stabilize
```
38
What do laryngeal movements lead to?
Control variables- controlled sound production
39
Laryngeal opposing pressure (LOP)- 3 considerations
```
muscular pressure (Adductors),
surface tension (tendency of viscous liquid to stay cohesive/together in as little area as possible)
gravity
```
40
LOP
A measure of the opposition provided by the larynx to translaryngeal pressure (the air pressure difference between the trachea and the pharynx) when the larynx is closed air tight.
41
LAR
An airflow dependent property of the airway that indicates the opposition to flow provided by the larynx; it's a matter of the cross-sectional area and length of the airway.
42
Relationship between LOP And LAR
LOP --> LAR
43
LAR is (dependent on, independent of) effective and sufficient ____ AND ______.
LOP, expiratory airflow
44
Main construction site of LOP
vocal folds
45
Stiffness = _______.
rigidity
46
Stiffness is the opposite of ________
compliance
47
Stiffness of VF's varies by
location on the fold
48
How do we increase stiffness?
Can also manipulate stiffness actively by elongating/stretching them and/or tensing the muscular process of the thyroarytenoid muscle
49
Increased stiffness means vibration occurs at a (lower, higher) frequency
higher
50
What is the effect of mass on rate of vocal fold vibration?
More mass = lower pitch = lower vibrating frequency. Less mass = higher pitch = higher vibrating frequency
51
Reinke's edema: define and effect on VF mass?
swelling of the vocal folds due to fluid collected within Reinke's space. Increases VF mass.
52
Transgender voice considerations/treatment
Treatment more behavioral and hormonal, start hormone treatment early (before puberty), consistent behavioral treatments to change habitual pitch, a LOT of variability
53
4 primary functions of the larynx?
* Respiration: “coupling” between pharynx and trachea
* Airway protection
* Thoracic fixation (“containment” of pulmonary air supply)
* Sound generation
54
Transient sound; define, examples
unvoiced stop sounds, /p,t,k/
55
Phases of transient sound
pressurization phase --> release phase
56
3 processes of transient sounds
Glottal configuration change (add-‐abd) – burst of transient airflow that vibrates
supralaryngeal structures
Glottal configuration change (add-‐abd)
LOP --> LAR: subglottal pressure
57
Speech/voice is observed in ______ waves
quasiperiodic
58
Sustained utterances (noise): define and example
turbulent flow that is noisy and inconsistent; /h/
59
Sustained utterances (noise) result from ______.
turbulent airflow
60
Glottal configuration adjustment leads to _______
turbulent airflow
61
Sustained utterances (voice): define and example
quasi-periodic sound; all voiced sounds
62
3 theories of quasi-periodic sound
Sustained airflow (VF opening/closing
Glottal configuration: adduction (posturing)
LOP --> LAR : subglottal pressure
63
3 theories of phonation
Myoelastic-‐‐Aerodynamic theory (Van den Berg, 1958) • Hirano’s body-‐‐cover theory • Titze’s self-‐‐oscillation theory
64
Myo-elastic aerodynamic theory (MEAT): definition
explains vocal fold vibration “Myo” & “elastic” = properties of the muscle and tissues
65
3 Aerodynamic aspects of MEAT - opening and closing
– Opening -‐‐ Positive pressure (PTP)
– Closing -‐‐ Bernoulli effect and elasticity
– PTP
66
Bernoulli effect: definition, example, (constriction of air through a tube causes (faster, slower) airflow around the obstruction
At a point of constriction there will be a decrease in air pressure perpendicular to the flow and an increase in velocity of the flow.
• Constriction of air through a tube causes faster airflow around the obstruction.
• Examples include a curve ball in baseball
67
the vocal folds (do, do not) open and close during phonation because there (is, is not) a separate muscle contraction for each opening/closing movement
do not, is
68
he vocal folds open and close (manually, automatically)
automatically
69
2 requirements for VF's to open and close automatically
the folds are in the appropriate positions, and there is sufficient buildup of pressure below them
70
Hirano cover-body theory
The contrasting masses and
physical properties of the vocal fold cover and the body causes them to move at different rates as air passes
between the vocal folds.
71
2 models of the Hirano cover-body theory
one mass model, 3 mass model; largest most prominent mass = thyroarytenoid muscle, cover= 2 smaller masses between CA muscle and VF's
72
Self-oscillating theory
Pressure and flow provided by pulmonary air at
| 3 sites helps maintain vocal fold vibration
73
Vocal fold closure is _____ in form, and is both ____ and ___ in direction.
wave-like, horizontal and vertical
74
3 phases of vocal fold closure manipulated by subglottal pressue
opening, closing, closed
75
More specific process: 4 phases of vocal fold closure
Open posterior -‐‐> open anterior -‐‐> close anterior -‐‐> close posterior
76
3 implications of VF parameters
• Vertical and horizontal components to VF vibration
• Mass of the vocal folds themselves
– Length – Thickness
• Role of tension
77
How do changes in VF parameters affect vocal pitch, loudness, and quality?
Damage or changes to properties decrease habitual
pitch
Higher F0 perceived as higher pitch
Quality- shape of rest of resonating cavities of upper airway (pharynx, nasal cavity, oral cavity)
78
Define fundamental frequency (F0), correlate of?
Pitch- Reflects the vibratory rate of the vocal folds. How many vibrations (open and close) during
one sec.
79
Define intensity, correlate of?
“loudness” – Power from respiratory system, shape of glottis, shape of vocal tract, lip opening
80
3 qualities of voice that can be regulated
F0, intensity, quality
81
Vocal fold abduction = (periodic/aperiodic) sound
aperiodic (noisy)
82
Vocal fold adduction = (periodic/aperiodic) sound
periodic (normal vibration)
83
Period sound- 3 characteristics
intense, clear, involve resonance
84
Vibrating vocal folds affect the _________ of the resulting sound wave
F0
85
The higher the rate of vibration, the (lower, higher) the f0 of the sound, which we perceive as a (lower, higher) pitch
higher, higher
86
Vocal fold vibration creates _____ waveforms
cyclical
87
Rate is defined as
cycles/second (Hertz)
88
Extremely slow vocal fold vibration is about ____ vibrations per second and produces a (low, high) pitch.
60, low
89
Extremely fast vocal fold vibration approaches _____ vibrations per second and produces a very (low, high) pitch. Only attained by what vocal register?
2,000, high, soprano
90
Men vs. women vibration rate range and mean in Hz
Men: mean = 115, 90-500
Women: mean = 200, 150-1,000
91
4 factors that affect vocal fold rate change
VF tension, VF mass (thickness), VF length, volume of airflow
92
Increased VF tension = (increased/decreased) elasticity and (increased/decreased) vibrations
decreased, increased
93
Increased VF mass (thickness) = (increased/decreased) vibration
decreased
94
Increased VF length - (increased/decreased) vibrations
decreased
95
Male versus female: compare/contrast VF length and rate of vibration
Male VF's are longer and vibrate less, Women's VF's are shorter and vibrate more
96
Changing the volume of airflow results in _____
increase in subglottal pressure
97
Define: sound pressure level
measure of the physical magnitude/intensity
98
Perceptual correlate of intensity
loudness
99
Intensity is highly dependent on ____, standard distance from microphone?
measurement method, 30 cm
100
3 required adjustments for intensity changes
– Respiratory system (power): tracheal pressure and airflow
– Larynx (pattern; glottal configuration): LOP and LAR
– Pharyngeal-‐‐oral structures (resonance): Velar height, mandibular position, tongue position
101
Define: vocal fold registers
Reflect different modes of vocal fold vibration
• Lead to differences in vocal quality
– We refer to these different qualities as vocal registers
102
3 vocal fold registers and their frequency rangesfor males and females
Falsetto (loft, head): M 300-‐‐700; F 450 – 1100 Modal: M 80 – 450; F 130 – 525 Fry (pulse): M 8 – 80; F 8 – 80
103
Define: glottal fry
Lowest F0, VF’s close quickly, long closed phase of the cycle.
104
5 other characteristics of glottal fry
– Free margins of VF’s appear flaccid, but are tightly closed (high LOP)
– “Bubbles of air” escape, give voice “popcorn” quality. – Least flexible
– Low airflow – **Frequency
105
Define: modal
Widest range of F0
106
3 other characteristics of modal
– Normal speaking voice
– As VF relative length increases, pitch increases.
• Example: 100Hz – 300Hz: 11mm – 17mm
– What happens to thickness as length increases?
• 7mm – 4mm (F); 9mm – 6mm (M)
107
Define: falsetto
Highest F0
108
4 other characteristics of falsetto
```
– Important role of tension
– Role of length?
• 200Hz – 700Hz: 15mm – 13mm
– Role of thickness?
• 5.5mm – 4.75mm (F); 7.1mm – 6.5mm (M)
– Often VFs do not close completely
```
109
2 aspects of vocal quality in registers
pressed (louder modal phonation) and breathy
110
Define: pressed
VF's are strongly medially compressed
111
Define: breathy
Significant gap left between the vocal folds as they vibrate, resulting in excessive airflow
112
3 considerations about loudness control
* Wide range of intensity: 60dB range
* Directly related to resistance
* Resistance = pressure LOP/ flow (expiratory)
113
5 considerations about resistance during loudness control
Timing of VF closure
More subglottal pressure
LOP Dominates at lower F0’s
Expiratory airflow dominates at higher F0’s
Sustained and transient loudness changes
114
2 types of parameters of vocal quality
objective, subjective
115
3 objective parameters of vocal quality
acoustic parameters, open quotient, speed quotient
116
5 acoustic parameters of objective vocal quality
– F0 – Intensity – Jitter – Shimmer – Spectrum
117
Define: jitter
cycle to cycle variation in frequency/pitch
118
Define: shimmer
cycle to cycle variation in intensity/loudness (amplitude)
119
6 subjective parameters of vocal quality
* Hoarse
* Rough • Strained
* Strangled • Breathy • Male versus Female
120
In newborns, the length of the vocal folds is ______ mm with continual linear growth as a function of _____
2.5 -3, age
121
The cartilaginous glottis accounts for ___ to _____% of the vocal folds' length in children below ___ years of age
60-75. 2
122
The reason for the larger posterior glottis in infants and young children is that
it aids the feeding and breathing process
123
The layered structure of the vocal folds (is, is not) differentiated in newborns and young children; the ______ is very
uniform in structure (____layers by ~12 years; ___ in adulthood)
is not, lamina propria, 2, 3
124
In (children, adults), there is clear differentiation between the superficial, intermediate, and deep layers of the ______
adults, lamina propria
125
There (is/is no) ligamentous structure in newborns
is no
126
Location of larynx (located adjacent to which vertebrae) throughout development
```
• Location: larynx begins high in
neck (cricoid opposite 2/3rd vertebrae)
• Descends to ~4th vertebrae by 1 year
• To 5th vertebrae by 3 years • 6th vertebrae by 5 years
• 7th between 10-‐‐20 years
```
127
The _______ in pediatric patients is the (narrowest, widest) part and (most, least) pliable of the airway in
comparison to the adult airway, with the full-‐‐term diameter of the ________ (same as above) cited as 4 mm
subglottal space, widest, least
128
The adult vocal fold length is approximately ___ to ____ in adult males and ____ to ____ in adult females
17-21 mm, 11-15 mm
129
The (pediatric/adult) larynx maintains a (lower,higher) laryngeal position between the 1st and 3rd cervical level in comparison to an (child, adult) laryngeal position
pediatric, higher, adult
130
The epiglottis is _____ shaped, in approximately ____% of the (adult, pediatric) population and is (soft and pliable
omega, 50, pediatric
131
The whole laryngeal framework in children is much (softer/harder) than in adults
softer
132
Implications of laryngeal framework being much softer (in children).
– Less susceptible to blunt trauma
| – More susceptible to collapse due to negative inspiratory pressures developed during breathing
133
```
The presence of the ______ prominence does not occur until substantial changes happen in vocal
fold ______ (approximately between the ages of 10 and 14 years)
```
thyroid, length
134
The _________ does not assume its adult configuration until adolescence
thyroid cartilage
135
The _______ are proportionately (larger, smaller) versus adult configuration
arytenoids, larger
136
4 most important differences in male versus female laryngeal anatomy
– A larger thyroid lamina
– A more acute thyroid angle, giving prominence to the thyroid notch or “Adam’s apple”
– Thicker vocal folds – Larger glottal space
137
Aging and skeletal, muscular systems, vocal folds
• Aging causes general changes to the entire body including the skeletal and muscular systems
• The muscle systems can experience
structural change and fatigue that reduce the contractile force capability of the muscle
– More evidence suggests marked vocal fold atrophy and vocal fold edema
138
What aging effects happen to the larynx over time?
Vocal fold bowing
Prominence of the vocal process
Glottic proportion
Phase and amplitude symmetry of the mucosal wave Tremor of the laryngeal structures
139
Define: presbylaryngis
the term used to refer to the changes associated with the aging larynx (atrophy, bowing, etc.)
140
A network of ______ located in the _____ of the brainstem control respiration.
neurons, medulla
141
Signals from the _______ travel via ________ to reach the muscles of the _______.
– Book example: For inspiration, signals are sent through spinal neurons to the diaphragm via the phrenic nerve
brainstem, peripheral spinal nerves, chest wall
142
There is a rhythmic pattern of ______ for breathing that can occur automatically (with, without)
voluntary input from the _____
neuronal firing, without, cortex
143
Define: central pattern generator for respiration
There is a rhythmic pattern of neuronal firing for breathing that can occur automatically without
voluntary input from the cortex.
144
Overall goal of central pattern generator
regulate gas levels (oxygen and CO2)
145
________ and ________ send (efferent,afferent) information primarily by CN-____ ---> adjust ________
Chemoreceptors, mechanoreceptors, afferent, CN-X, ventilatory parameters
146
Another way to modulate breathing?
Awareness- depth or frequency will change- often when we become aware of our breathing it is because it is unpleasant
147
5 higher brain centers
– Emotion – Awareness – Crying – Breath holding
| – SPEECH
148
3 ventilatory parameter considerations
terminology, measures, putting it together
149
Lungs and thorax typically operate as a unit via a _______
pleural linkage (contact unit)
150
Resting position in the contact unit is (different/the same) when the two (lungs and thorax) are separated
different
151
When separated at rest, what happens to the lungs and thorax?
```
lungs = collapsed
thorax = more distended/expanded state
```
152
When the pleural linkage is at rest, what happens to the lungs and thorax?
```
lungs = somewhat expanded
thorax = somewhat compressed
```
153
In adjustment of the lung-thorax unit, there is also constant interplay between what 2 other structures?
chest/rib cage, abdominal wall
154
Define: volume, unit of measurement
The size of a space; here it is the “size” of air within the lungs; Liters
155
Define: capacity
A combination of volumes that share a functional purpose
156
Define: resting lung volume
the amount of air in the lungs at rest position
157
Define: tidal volume (TV)
volume of air for one cycle of quiet breathing – M 600mL, F 450mL
158
Define: inspiratory reserve volume (IRV)
volume that can be inhaled after tidal inspiration -‐‐ 2500mL
159
Define: expiratory reserve volume (ERV)
Volume that can be exhaled after tidal expiration. AKA – resting lung volume, 1000mL
160
Define: residual volume (RV)
volume of air remaining after maximum expiration, 1100mL
161
Define: dead air space
anatomical and physiological 150mL (amount that remains in lungs even after maximal exhalation)
162
Vital capacity formula
IRV + ERV + TV (4-5 L)
163
Functional Residual Capacity formula
ERV + RV (2L)
164
Total Lung Capacity formula
TV + IRV + ERV + RV (5-7 L)
165
Inspiratory Capacity formula
TV + IRV (3L)
166
Pressure: definition, units of measurement
Pressure = force distributed over an area (Force/area)
| Measurement – mm Hg & cm H2O
167
Atmospheric pressure
Atmospheric = 760 mm Hg/ 0 cm H2O
168
Boyle's Law- definition, formula
inverse relationship between volume and pressure.
| P = 1/V
169
Define: tidal breathing
passive or quiet breathing
170
Physiological function of tidal breathing
oxygen and carbon dioxide exchange to maintain homeostasis
171
Air moves from regions of (higher, lower) pressure to regions of (higher, lower) pressure
higher, lower
172
Define: quiet inspiration
inspiratory muscles
(mainly, the diaphragm, secondarily, the external intercostals) expand the thoracic cavity upon
contraction
173
During tidal breathing, ________ is increased), _________ is
| decreased (less than the atmospheric pressure)
lung volume, interthoracic air pressure
174
Air flows into or out of the lungs until _______?
air pressure within the lungs is equal to atmospheric pressure
175
Define: quiet expiration
begins when gravity and elastic forces act upon the ribcage, decrease lung volume, increase intrathoracic pressure
(more than the atmospheric pressure)
176
Define: forced inspiration
accessory inspiratory muscles are recruited to help the diaphragm and the external intercostals increase the lung volume
177
During forced inspiration, _______ is increased,________ is decreased (Much less than the atmospheric pressure)
lung volume, interthoracic air pressure
178
Define: forced (active) expiration
All expiratory /abdominal muscles contract, pushing against the diaphragm, which is raised
179
During forced expiration, there is Decreased ________, and increased _________ (Much more than the atmospheric pressure)
lung volume, interthoracic air pressure
180
Define: relaxation pressure
Respiratory maneuver
| • The pressure produced entirely by nonmuscular forces of the respiratory apparatus
181
Relaxation pressure varies according to _____
volume of air in the lungs
182
Lung air volume relationship with relaxation pressure
– How distorted is the system? – Highest volume = greatest relaxation pressure – Lowest volume = smallest relaxation pressure
183
The amounts of air within the lungs are expressed as a percentage of _______ (horizontal axis)
vital capacity
184
Meaning of points to left or right of relaxation pressure diagram
Points to the right of zero atmospheric pressure represent pressures greater than the atmospheric
pressure • left of zero are subatmospheric (negative)
185
How is speech breathing maintained?
Maintained with precise control of the expiratory muscles to meet the requirements of phonation (VF) and articulation
(Articulators)
186
Define: speech breathing
Continuous airflow to maintain the VF vibration
| -‐‐ intrathoracic/subglottal air pressure has to be developed and maintained 5-‐‐20 cm H2O
187
Characteristics of inspiration and expiration during speech breathing
Prolonged and controlled expirations -‐‐ Rapid inspiration
188
4 other functions that happen during of speech breathing
“Checking” function of inspiratory muscles
• Abdominal muscles contract to push against the diaphragm
Controlling the airflow
-‐‐ Vocal folds serve as resistance to increase subglottal pressure
189
What muscles are active during speech breathing?
External intercostals, expiratory (thoracic and abdominal) muscles
190
External intercostals- actions during speech breathing
(major inspiratory muscle) still contracting for active exhalation, to control exhalation (airflow brakes) in order
to maintain just the necessary pressures for speech
191
Respiratory cycle (does, does not) begin from vegetative (quiet) breath. Why?
Does not. you need more volume that will grant you more recoil à less work )
192
____ to ____% of vital capacity is used as the power source of the speech mechanism
35-70%
193
3 prominent functions of the respiratory system in speech
1) Provide a power source: subglottal pressures build up, vocal folds act as resistance
2) Increase loudness of voice: subglottal pressure and loudness are directly related-‐‐-‐‐the higher the pressure, the bigger the amplitude of VF vibration
3) Utterance/ speech duration : related with the rate of airflow, determined by firing of the muscle fibers (6-‐‐8 phonemes / sec)
194
5 clinical conditions that affect the respiratory system
1). Asthma
– Chronic inflammation of bronchioles; inflammation, swelling occurs reducing airways; ciliary action is suppressed; mucous production is increased
2). Chronic obstructive pulmonary disease – Catchall for many disorders
– Emphysema
• Breakdown of alveolar walls and capillaries due to long-‐‐term exposure to air particulate matter (smoke, dust)
3). Vocal fold paralysis/paresis
4). Ventilator dependent – high cervical spine injury
5). Neurodegenerative disease or stroke
195
Maximum expiration and inspiration points on relaxation curve
Maximum expiration on lower bottom part of righthand line to central relaxation curve, maximum inspiration on upper top part of lefthand line to central relaxation curve
