3 Effective Breathing Exercises for Speech Therapy

Patients who have dysarthria or voice disorders can struggle with breath support and strength.

In this article, you’ll learn 3 breathing exercises for speech therapy and which patients to use them with. Plus, you’ll get a mini breath-support goal bank!

For our bestselling patient handouts and worksheets, check out the Adult Speech Therapy Starter Pack!

Who Needs Breathing Exercises for Speech Therapy?

Respiration is a major subsystem responsible for voice. And although not every patient with dysarthria or voice disorders benefits from breathing exercises, it’s an important treatment area for many (Stemple, 2018).

Gold standard treatments like LSVT LOUD® and vocal function exercises include coordination of respiration and phonation. But patients with more severe respiratory impairments may need to build up enough breath support before they can do these programs (Desjardins, 2020).

To decide which of your patients would benefit from breath support exercises, focus on the underlying impairment.

To do this, ask yourself:

• What signs and symptoms am I seeing?
• Will speech therapy help my patient communicate more naturally and intelligibly?
• If yes, what speech subsystem is most impacting their speech naturalness and intelligibility?
• If the answer is breath support or strength, consider breath support exercises
• If not, breathing exercises may not be the best choice

Below, we’ll cover specific diagnoses that may benefit from breath support exercises.

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• 24 More Dysarthria Exercises
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Breathing Exercises For Dysarthria

Patients who have dysarthria may have reduced breath support and strength. Dysarthria can cause a weak, breathy, strangled, or harsh voice with reduced intensity and minimal words per breath group.

Breath support exercises may improve dysarthria caused by the following diagnoses:

• Parkinson’s disease
• Stroke
• Traumatic brain injury
• Huntington’s disease
• Multiple sclerosis
• Neuromuscular diseases (muscular dystrophy, myasthenia gravis, ALS)
• Nonfluent variant primary progressive aphasia (nfvPPA)

(ASHA, n.d., 1)

For more dysarthria exercises, read 24 Dysarthria Exercises For Adults.

Breathing Exercises For Voice Disorders

Voice disorders can affect breath strength and control. Dysphonia may cause a weak, breathy, hoarse, strangled, or rough vocal quality due to reduced breath support.

The following voice disorders may benefit from breath support exercises:

• Functional voice disorders, including:
  • Vocal tension/hoarseness
  • Vocal fatigue
  • Muscle tension dysphonia
  • Phonotrauma
  • Ventricular phonation
  • Phonation breaks
  • Asthenia (weak voice)

• Structural voice disorders including vocal nodules or glottal stenosis

• Neurologic voice disorders, including:
  • Parkinson’s disease
  • Multiple sclerosis
  • Pseudobulbar palsy
  • Recurrent laryngeal nerve paralysis
  • Adductor/abductor spasmodic dysphonia

(ASHA, n.d., 2)

For more on voice exercises, read Voice Therapy Exercises for Adults.

1. How To Build Breath Support for Speech

To build up breath support for speech, start with controlled breathing.

As your patient’s breath control improves, ask them to say voiceless sounds on the exhale. Move on to more complex and longer utterances.

How to build up breath support:

1. Breathe in slowly for 3 seconds
2. Hold your breath for 3 seconds
3. Release the air slowly for 3 seconds
4. Practice breathing in this controlled manner
5. Next, add voiceless sounds. Inhale, hold, then exhale out a voiceless sound for as long as you can:
   • hhh
   • sss
   • thhh
   • fff
   • shhh
6. Next, add a vowel to the end of the sound and hold it out for as long as you can:
   • hhha, hhhoe, hhhi, hhhow, whho
   • sssah, ssso, ssseee, sssow, sssue
   • thhhaw, thhho, thhhee, thhhow, thhhew
   • fffa, fffoe, fffeee, fffow, fffoo
   • shhha, shhhow, shhhe, shhhaow
7. Next, say a phrase on the exhale:
   • How are you?
   • I am good
   • 1, 2, 3, 4, 5
   • Sunday, Monday, Tuesday, Wednesday
   • January, February, March

Video: How To Build Up Breath Support

Speech-language pathologist Alisha Kleindel demonstrates how to build up breath support in patients with dysarthria, voice disorders, or apraxia of speech.

2. Diaphragmatic Breathing Exercises for Speech Therapy

Another breathing exercise for speech therapy is diaphragmatic breathing.

As your patients build up their breath support, have them progress to voiceless sounds, then vowels, then sentences, and so on.

How to do diaphragmatic breathing to build breath support:

1. Sit up as straight as you can
2. Practice ‘belly’ breathing. Put one hand on your stomach and the other hand on your chest:
   • When you breathe in: Your stomach goes out. The hand on your chest remains still
   • When you breathe out: Feel your stomach pull in. The hand on your chest remains still
3. Add voiceless sounds. Breathe in, feeling your stomach go out. As you breathe out, feel your stomach go in as you say a voiceless sound: sss, shh, fff
   • Hold each for as long as you can
4. Gradually work up to saying vowel sounds while diaphragmatic breathing: ahh, ooh
   • Hold each for as long as you can
5. Work up to single words while diaphragmatic breathing: hello, your first name
6. Work up to longer words, phrases, and sentences while diaphragmatic breathing

Video: Diaphragmatic Breathing To Build Breath Support

Watch how to use diaphragmatic breathing to build up breath support with your patients.

3. Advanced Breathing Exercises

Once your patient has built up enough breath support, they may benefit from advanced breathing exercises. Enter respiratory muscle strength training (RMST)!

RMST, including expiratory muscle strength training (EMST) and inspiratory muscle strength training (IMST), are evidence-based ways to improve respiratory muscle strength in people who have dysarthria or dysphonia.

A recent systematic review found that certain exercises, including EMST and IMST, improve respiratory and voice outcomes in some people with voice disorders (Desjardins, 2020).

Since EMST strengthens expiratory muscles, it can increase respiratory strength during phonation (AKA during expiration/exhalation). With more strength behind the vocal cords, the quality, duration, and intensity of the voice improves. Breath coordination and resonance may also improve.

Read Expiratory Muscle Strength Training For Adult Speech Therapy to learn more.

If appropriate, also consider LSVT LOUD® and vocal function exercises.

Breath Support Goals for Speech Therapy

The following goals target breath support and strength:

1. The patient will demonstrate appropriate diaphragmatic breathing at the word level in 80% of trials given max verbal cues.
2. The patient will produce phrases of up to 5 words in one breath in 80% of opportunities given moderate verbal cues.
3. The patient will produce sustained phonation ‘ah’ over 7 seconds or longer given utilization of breath support strategies in 80% of opportunities with mild cues.
4. The patient will demonstrate appropriate vocal loudness at the conversation level given adequate breath support given 3 consecutive therapy sessions without cues.

For more speech therapy goals, check out the Goal Bank for Adult Speech Therapy

More Breath Support Resources

References

1. American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. Retrieved Feb, 2024 from https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/
2. American Speech-Language-Hearing Association. (n.d.). Voice Disorders. (Practice Portal). Retrieved Feb, 2024, from www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/.
3. Brewer, C. (2021). The Adult Speech Therapy Workbook. Harmony Road Design
4. Desjardins, M., & Bonilha, H. S. (2020). The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature. Journal of voice : official journal of the Voice Foundation, 34(4), 648.e1–648.e39. https://doi.org/10.1016/j.jvoice.2019.01.011
5. Stemple, J. A., Roy, N. & Klaben, B. K. (2018). Clinical voice pathology: Theory and management, sixth edition. Plural Publings, Incorporated.