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What’s breathing got to do with speech therapy??

Last week, I was sick.  My only symptom was chest tightness making me cough.  I couldn’t take a deep breath; well, I really couldn’t take A breath without coughing.  I knew I would have to go through the rigmarole of being tested for COVID before I could get any relief, so I put it off a little, hoping it would go away.

It didn’t.  

In fact, it got worse.  It got so bad, that I couldn’t even sit up from lying down without coughing and gasping for air.  It felt like I was being suffocated.

And then it occurred to me.  This is what my COPD patients describe as how they feel.  

Except they get no relief.  

It is about 12 steps from the side of my bed to my commode; I could barely make it.  I missed two zoom meetings, because I couldn’t breathe in enough to talk without coughing.  What kind of life is that?   

It’s not a life; it’s barely survival.   It was just existence; no quality, no pleasure, just tension.  Am I going to be able to breathe in 5 minutes?  What happens if I can’t stop coughing?  What happens if I get sick? I’m going to aspirate on my vomit because I don’t have the breath support to NOT inhale it… Oh, I was in a negative mind cycle for sure!

I had to employ the rescue breathing techniques I’ve learned over the years in order to be able to put on my socks!   FORGET about trying to go up or down the steps… whichever floor I’m on, is where I’m staying!  (downstairs because I have to let the dogs out to do their business)  

I knew what I had to do to get myself better, though.  1- get tested for COVID 2-have someone listen to my lungs, 3-get some medication, 4- start respiratory muscle strength training as soon as I can expand my lungs!

“So, what does all this have to do with speech therapy??” 

Thank you for asking!

When you can’t breathe, you can’t talk. 

When you can’t breathe, you can’t swallow efficiently.

When I can’t take in enough air, I can only say a few words before my voice cuts out.  Then,  I’m whispering and people can’t understand me.  My body doesn’t have enough breath force to make my normal voice; I sound breathy and hoarse.  My muscles become tense because I am squeezing my shoulder, neck, and throat muscles trying to make up for that lack of air to make my voice.  I can’t hold a normal length conversation because I’m gasping for air after a few sentences.  I can’t talk to people when we are out to dinner, because I cannot breathe well enough to talk over the crowd.  That means, I don’t go out to eat with my friends or family.  

Oh, and I also can’t finish my meal.  Eating takes my breath away.  Sometimes the food goes down the wrong way, because I’m gasping for air at the end of my meal.  Then I’m coughing a lot and that just takes all my energy.  It’s easier if I don’t go out or don’t eat.  Forget it if there’s something dry; I suck those crumbs down the wrong way when I try to breathe and then I’m coughing so much I can’t take another bite. 

And, I hate being the last person at the table.  My family gets up and leaves because I take so long; it’s embarrassing.  At the end of the meal, I have to sit there and catch my breath before I can get up and move!  Now I’m losing weight, I’m tired; I know I need to exercise, but I don’t have the energy, but the less I do, the harder it is to breathe… 

Does this sound like anyone you know?  (other than me last week?)

The negative cycle:  Less air, less energy, less food intake, less energy, less movement, less respiratory strength, less air, less energy, less movement, contact ulcers from not moving, less eating, skin breakdown from lack of nutrition, less energy, less movement, and so on. 

“Is it possible that one intervention method could make that big of a difference for a breathless starving person?”  


“But, who can help you breathe?”



It depends on why you can’t breathe.  

If you can believe it, some people are so tense, they forget how to breathe the way we were meant to, so sometimes, it is a matter of relaxation of overly tense musculature.  OR,  it could require retraining the breathing pattern.

Some people can’t stop coughing long enough to breathe (me, last week), so I teach methods to reduce, or stop the coughing- aka rescue breathing techniques.

Some people, (like me right now) have weak muscles for breathing, and so they can benefit from respiratory muscle strength training.  This is one therapeutic intervention I love to do. It doesn’t require a prescription.  And, it’s a relatively easy activity, that helps so much more than your speech and/or swallowing, according to research, of course.  

I’m not talking about breathing in and out of a spirometer.  That’s not respiratory muscle strength training.  That is a way to measure lung capacity.  Very different!  I’m talking about a special instrument that is specifically designed with levels of resistance, to re-train and strengthen the muscles you use for breathing.  When done correctly, it will increase the strength of the muscles you use for inhalation and exhalation. It’s much like lifting weights to increase your arm strength.  You start with a low weight, repeat, add more weight, repeat.

Here is where I struggle.  How much information do you want?  How much science do you want to hear?

Just a general review:  our lungs take in oxygen, when we breathe in, the oxygen gets transferred to the blood and the heart pumps it all around our body.  The oxygen is exchanged for carbon dioxide, the heart brings the CO2 back to our lungs, and we expel it.  Think of CO2 this way; it is a waste product (like urine).  If we don’t get enough O2, the CO2 starts to build up, we get sleepy, feel dizzy, some people start to hallucinate, and our organ cells start to die.  Nobody wants that, right?  

The main muscles we use for breathing are our diaphragm and our intercostal muscles (the muscles between our ribs).  There are 2 sets of intercostal muscles; the external intercostals, which are for elevation of the ribs to breathe in, and the internal intercostals, which are to squeeze the rib cage for exhalation.  There are a host of other muscles that assist with breathing, but for respiratory muscle strength training, I focus on these 3.  

Now, think about this:  Our diaphragm depresses, which expands our lungs and should make our bellies bigger, when we breathe in. At the same time, our external intercostals elevate our ribs! This allows the lungs to expand, to take more oxygen in.  More oxygen = good!  If those muscles are weak, your ribs cannot lift, your lungs cannot get as full, therefore you cannot get as much oxygen to your lungs. Which means less oxygen to your heart, less to your muscles, less to your brain, and so on.

Our body’s systems are connected.  What are the two things that need to happen in order to survive?  Our heart needs to beat and our lungs need to breathe.  We can go without food or water for days.   We can live without limbs.    We can have our reproductive system taken completely out, and we still live on.  But, if we stop breathing… we cannot survive.  So, it makes sense that if your respiratory strength is impaired, it will adversely affect any of your other systems.

SOOOOooooooo, if the muscles you use for breathing are weak, it makes sense that you will have multiple complications, because your heart isn’t able to take around enough oxygen to the rest of your body.  Then, enter that negative cycle from above! 

Now for the studies on respiratory muscle strength training and it’s benefits:

  • In a study that questioned whether exercise endurance helped breathing, or breathing helped exercise endurance,  scientists found that it is the BREATHING that helps the exercise endurance.  If your muscles are stronger for breathing, your whole body will be stronger for exercising.    (HAJGHANBARI, et al, 2013)
  • When looking at critically ill patients, inspiratory muscle strength training (IMST) “has been shown to improve inspiratory muscle strength, exercise performance, or quality of life in patients with chronic obstructive pulmonary disease (COPD) (14), chronic heart failure (15), asthma (16), or cystic fibrosis (17), as well as in athletes (18).”  Additionally, it was found that with IMST, people were able to be taking off mechanical ventilation faster than without.  (Vorona et. al, 2018)

Expiratory muscle strength training helps people be able to expel the CO2 from their lungs with more force, it helps with their ability to cough unwanted material from their lungs, and helps them feel less dizzy and fatigued.

Study after study, review after review has shown that by increasing respiratory muscle strength, we can increase overall muscle strength, decrease dizziness/fatigue, improve brain function, reduce breathlessness with COPD patients, increase cough response in people with strokes, reduced frequency of asthma attacks in people diagnosed with asthma, and improved heart rate with people diagnosed with CHF.  RMST helps people with neurodegenerative disease, asthma, dysphagia, back pain… honestly, do a google scholar search.  There is a plethora of evidence supporting the use of respiratory muscle strength training and it’s wide range of health benefits.

But for Resurgence Neuro Rehab purposes, it helps people with their voice and swallowing.  I am all about helping other aspects for my people, don’t get me wrong!  Our bodies are connected and I genuinely want all my people to be well. 

If you’re experiencing any shortness of breath, inability to use your voice, coughing/choking on dry crumbs, inability to stop coughing, please ask your doctor for a speech therapy referral!  

And, if you come to me for therapy; for voice or for swallowing – shoot, even for memory/cognitive therapy-  get ready to exercise your respiratory muscles!  I may just be doing it with you!   


(For those of you on the edge of your seats, yes, I did go to urgent care.  I tested negative for COVID, and I got some medication.  My oxygen levels were fine, lungs were clear, and no fever (the MD thought it was due to the dry, cold air aggravating my lungs.) Today, I’m feeling much better and am happy to report I can go up and down the stairs with little difficulty.

Great news! Resurgence patients can now manage appointments & billing online 24/7.