Breathing – the Foundation of Proper Speech

Breathing is one of the most fundamental functions of the human body. We breathe automatically every day and rarely stop to consider how much the way we breathe affects other activities – including speech.

From a neurological speech and language therapy perspective, breathing is one of the foundations of effective communication. Speech is, in essence, a modulated exhalation. Without efficient, effective and properly coordinated breathing, it is difficult to achieve adequate voice volume, produce longer phrases fluently or maintain natural intonation.

For this reason, assessing respiratory function and, when necessary, working to improve it are important elements of neurological speech and language therapy. This applies both to children experiencing difficulties with speech development and to adult patients, including those who have had a stroke or who live with neurological conditions.

How do we breathe while speaking?

Breathing at rest differs from the breathing used during speech. At rest, inhalation and exhalation are similar in duration and follow a regular rhythm. When we begin to speak, these proportions change.

Inhalation becomes shorter and faster, while the exhalation phase becomes significantly longer. It is during exhalation that the voice is produced and the entire utterance is formed.

The costodiaphragmatic breathing pattern, also referred to as thoracoabdominal breathing, is considered the most functional pattern for speech. It enables efficient management of airflow and provides appropriate respiratory support for the larynx and vocal folds.

Proper respiratory function makes it possible to produce longer phrases without frequently having to take another breath. It also helps control voice volume and speaking rate, while allowing natural breathing pauses that correspond with the structure of the utterance.

What can happen when respiratory function is impaired?

An abnormal breathing pattern or reduced respiratory capacity can affect speech in many different ways.

One of the more common symptoms is a shortened speech exhalation. The patient quickly runs out of air and has to inhale frequently, which may cause utterances to be interrupted at points that do not correspond with the natural structure of a sentence.

Another difficulty may be quiet or weak phonation. This is particularly important in patients with dysarthria, people who have undergone neurosurgical procedures and patients with neurodegenerative conditions.

Difficulties may also involve the coordination of breathing and phonation. In some cases, a patient begins speaking at an inappropriate point in the respiratory cycle or releases a significant amount of air before voice production even begins.

Clavicular breathing can also be observed in clinical practice. This breathing pattern is shallow and inefficient. It may occur in both children and adults, including in situations involving increased muscle tension or in the course of certain neurological disorders.

Another area of concern is difficulty coordinating breathing and swallowing. This is particularly important in patients with dysphagia, as proper coordination between these two functions also contributes to safe eating and drinking.

How does a neurological speech and language therapist assess breathing?

Assessment of respiratory function begins with observing the patient. A neurological speech and language therapist pays attention to the patient’s breathing pattern and rhythm both at rest and during speech.

What matters is not only how the patient inhales, but also how they manage their airflow while speaking and whether they are able to coordinate exhalation appropriately with the onset of phonation.

Clinical assessment may include tasks such as sustained vowel phonation, evaluating the number of syllables that can be produced on a single exhalation, and observing the length and quality of spoken phrases.

If additional symptoms are present or there is reason to suspect problems extending beyond the scope of neurological speech and language therapy, the patient may also be referred for an ENT or pulmonology consultation.

What does respiratory therapy involve?

There is no single set of exercises suitable for every patient. Therapy should always be adapted to the patient’s age, abilities and the underlying cause of their difficulties.

Therapy may include learning an appropriate costodiaphragmatic breathing pattern and gradually developing control over the exhalation phase. Exercises may be performed while lying down, sitting and standing, and various forms of feedback can be used to help patients develop greater awareness of how their own body works during breathing.

Depending on individual needs, therapy may also include exercises aimed at prolonging exhalation, gradually extending phonation and spoken phrases, as well as practising the distinction between nasal and oral breathing.

An important component is respiratory-phonatory coordination. The patient learns to initiate phonation during a calm, controlled exhalation and to manage airflow appropriately throughout the entire utterance.

For individuals with reduced voice volume, therapy may also include respiratory support training. In people who stutter, selected breathing techniques may form one component of a broader therapeutic approach aimed at supporting speech fluency.

When is working on breathing particularly important?

Respiratory function may require particular attention in children with delayed speech development and articulation disorders, as well as in adults with neurological conditions.

Breathing exercises are often incorporated into therapy for patients following a stroke who experience dysarthria, people with Parkinson’s disease or amyotrophic lateral sclerosis (ALS), patients with voice disorders and people who stutter. Respiratory therapy may also be important following certain ENT and oncological procedures involving the head and neck.

The scope of therapy should always be based on an appropriate diagnosis and the individual needs of each patient.

Breathing as Part of Proper Speech

Proper breathing is not only essential for physical well-being. It is also one of the foundations of speech, influencing its volume, fluency, intonation and clarity.

For this reason, neurological speech and language therapy does not treat respiratory function as an isolated element. It is part of a broader mechanism that also encompasses phonation, articulation and the coordination of the entire utterance.

If you notice that you or your child experiences difficulties with breathing while speaking, frequently needs to take additional breaths, has a quiet voice or becomes tired quickly during longer utterances, it is worth consulting a specialist. An appropriate assessment can help identify the source of the difficulty and allow therapy to be tailored to the patient’s individual needs.