6/7/09

Breathing

“Take a breath, slow down, relax…” What is it about stuttering that prompts this reaction in listeners? Stuttering does disrupt airflow. After all, breathing stops momentarily during a block and to breathe is to live. Prolongations and the repetitions of sounds and syllables alter speech rate. Stuttering often includes signs of tension in the face, neck and chest. And so, the empathic, and even the pragmatic, listener may feel that suggesting a stutterer ‘breathe and relax’ will be comforting and make perfect sense.

However, since the altered breathing and physical tension are symptoms – not the cause – of stuttering, this well meaning advice can make matters worse. Symptoms are clues. Clues help us solve mysteries, in this case, the mystery of stuttering. While treating the symptoms of a problem can ease our suffering, it may not promote healing. When I see a child whose repertoire of secondary behaviors includes quick gasps for air, eventually I also hear that he was instructed to ‘take a breath and relax’ as an immediate way out of his struggled speech. Like a bandage placed on an unwashed abrasion, this quick fix fails to really help at all.

My recent attention to breathing came about because of clues that led to impaired breathing as the cause of distress in two cases. Well, breathing was very near to the underlying causes. One was a member of my own family who contracted pneumonia. The other was an elementary school age client who suffers from allergies.

James L. Coyle, Ph.D., CCC-SLP, BRS-S co-presented “Dysphagia Practice: Aspiration Pneumonia and the Role of the Speech-language Pathologist” on May 2, 2009 for Northern Speech Services, Inc. I attended his enthusiastic and detailed presentation on the anatomy and physiology of the respiration system. Human beings breathe to feed the body with oxygen rid it of carbon dioxide. The lungs are loaded with tiny alveoli, like bunches of delicate grapes, which provide an enormous amount of surface area for this very purpose. Molecules of O2 inhaled pass from the lungs into the blood and molecules of CO2 leave the blood, go into the lungs and are exhaled. Damage to the alveoli impair breathing and create distress. In both cases, treatment of the underlying disease is the critical issue. Lawrence Hall Science, The University of California; Berkeley has a nice description of this for kids. (1)

Medical treatments for disease often involve medications. Antibiotics for pneumonia help cure the disease and therefore improve breathing. However, medications often have the side effects. And for the student I’m referring to in this blog, a switch from Allegra to Singulair to treat his allergies seemed to increase fluency substantially. Of course, medication changes should be done with medical supervision. The link betweeen medication and behvior may vary from person to person, and could be a valuable clue to anyone's stuttering mystery.

Human beings are adaptable. So, when faced with difficulty, we search for solutions. Given what we know at the time, we do the best we can. While it may seem obvious to increase air intake by expanding the lungs, it’s not that simple. A child who activates the muscles in his chest and shoulders to expand his lungs is increasing tension, not relaxation. The muscular work of breathing is the responsibility of the diaphragm. There is a simple animation of the diaphragm in a YouTube video called “3D view of diaphragm” (2). The narrative is quite complex, so I suggest the mute button for young children. However, there’s also a fun YouTube video called “Harmonica Playing for Beginners: diaphragmatic breathing” in a which a friendly instructor demonstrates how the diaphragm plays an important role in the breath support and relaxation while playing the harmonica (3). Therefore, unless the child is capable of self-monitoring such subtle muscle control, direct instruction to ‘breathe and relax’may be counterproductive.

For those interested in singing, a website called ‘The Singing Universe” has a section called “Breathing for Singing” which describes breathing exercises to help develop awareness of breathing from the diaphram (4) . I’m thinking of taking singing lessons to experience this instruction personally. 

Take good care of your lungs. 

(1) http://www.lhs.berkeley.edu/familyhealth/activities/breathing/
(2) http://www.youtube.com/watch?v=hp-gCvW8PRY
(3) http://www.youtube.com/watch?v=6qYigsgj68w
(4) http://singinguniverse.com/dnn/Learn/BreathingforSinging/tabid/56/Default.aspx
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.