Speech production with flaccid paralysis of the rib cage, diaphragm, and abdomen

Anteroposterior diameter changes of the rib cage and abdomen were measured during breathing maneuvers and utterance activities in an adult subject with flaccid paralysis of the rib cage, diaphragm, and abdomen. Data were charted to solve for lung volume, volumes of the rib cage and abdomen, chest wall configuration, and inferred neck muscle actions. Free breathing was accomplished through an alternate waxing and waning of neck muscle drive or through step-wise glossopharyngeal pumping. Connected speech was performed in breath groups begun by neck gestures that "cocked" the breathing apparatus and stored recoil energy in it for use during ensuing expirations. Some breath groups were also extended through intermittent glossopharyngeal pumping. Connected speech was characterized by frugal control of the air supply through compensatory adjustments in the larynx and upper airway. Compensations involved in the breathing maneuvers and utterance activities are described, and consideration is given to two understandings--the human potential for functional restoration and the clinical evaluation and management of individuals with neuromuscular impairment.