PRESENTERS : ELAKIYA ELANGO,

KAMALA DHARSHINE
FACULTY: MS.RISHABHA PRIYA
 Cerebral: head
 Palsy: lack of muscle control
 It is a sensorimotor disorder which is not one
condition but a group of neurological conditions
occurring as a result of abnormal brain
development or brain damage.
BOBATHS(1954)

 A neurologic disability of children in which the

primary symptoms of paralysis, weakness and
incoordination reflect motor damage.
PERKINS(1977)
SPASTIC
RESPIRATION – will be shallow (inadequate air
intake). Reduced vital capacity thus leads to
short phrase
 Poor vital capacity
 They have irregular breathing pattern( more
inhalation ,less exhalation)
 Due to improper respiratory pattern they have
short utterances of speech
 Evident tenseness when attempting longer
vocalization
 Interruption of vocalization
PHONATION – have strained strangulated voice.
Persistence of harsh voice and low pitch.
RESPIRATION – irregular breathing. Audible
inspiration and noisy breathing.
 Alter respiratory patterns
 Reduced vital capacity
 Break down in the timing of onset of
respiration and phonation leading to air
wastage
PHONATION – breathy voice
 RESPIRATION
Irregular breathing pattern (belly breath, reverse/paradoxical
breathing)
•Reduced vital capacity
PHONATION – hoarse voice.
•Breathy voice
•Reduced loudness
•Low pitch
RESPIRATION – in coordinated respiratory cycle. Paradoxical
breathing.
PHONATION – hoarse voice or predominantly breathy voice.
Loudness variability and pitch breaks present. In
coordination between inhalation and exhalation.

ASSESSMENT:
 Respiratory pattern whether abdominal or thoracic or
clavicular or paradoxical or stridor/stertor.
 S/Z ratio
 MPD are checked for.
 Breathing pattern during both speech and non speech
activity
 Phonation: The following parameters such as pitch,
loudness, quality.
MANAGEMENT (compensatory techniques)
RESPIRATION:
1.Approaches to improve respiratory / laryngeal functions.
Proper posture and head control is required to
maximize the respiratory function for speech. Physiotherapist
and occupational therapist establishes sitting system for the
child. Drugs and surgeries and given to improve posture of
normalize muscle tone.
GOAL: To achieve and maintain adequate sub
glottal pressure to produce and sustain voice.
Deep inspiration followed by prolonged
and controlled expiration provides feedback
as to how much sub glottal pressure is being
produced.
PUSHING TECHNIQUE: To facilitate the
increased vocal fold adduction.
Visual feedback through instruments.
 Abdominal distribution of muscle tone is
found in abdominal ,thorax and neck
muscles of CP children
 when strong tonic persist they should be
weakened or broken up through systematic
use of such techniques as reflex inhibition or
sensory facilitation.
 Many of the CP children seem to collapse on
sitting because much of the weight of the
trunk and head bears down on the abdominal
area , thus interfering with function of the
diaphragm and abdominal musculature.
 Back is rounded head is fixed chin
rest on the chest elevation of ribcage for
inhalation is difficult.
 sitting in a properly fitted and adjusted
relaxation chair .
 Physical therapy.
6. Developing a breathing rate of less than 30
cycles / min .
 Crossing the child’s forearm across his chest
and pressing them tightly enough against his
thorax to encourage a deeper exhalation . For
inhalation the pressure is released.
 To encourage the child to produces
prolonged exhalations such as sustained
blowing / sustained phonation .
1.Encouraging vocalization
 facilitating vocalisation
2.Coordinate phonation with exhalation
 Audible sigh the exhalation
 Phonate a vowel sound on the exhalation
3.Develop prolonged phonation without
undesirable tension
 Hold the inhaled air and to coordinate
phonation with exhalation
4.Develop variation of loudness and pitch
 Practices in producing tones at different level
of loudness and pitch level – it is increasing
laryngeal function