Garner G1, Clinton S2
1Professional Yoga Therapy Institute, Emerald Isle, United States, 2Embody Physiotherapy & Wellness, Sewickley, United States
Background: Breathwork is a vital part of physical therapy practice but to date, not much has been written or explored concerning the relationship between the breath, voice, and phonation to examination and intervention in physical therapy practice.
Voice production - the story of your client - together with the forgotten vital sign, respiratory rate, hold critical information to impact physical therapy plans of care and outcomes for all patient populations. The thryoepiglottic, glossopharyngeal, and intrinsic and extrinsic laryngeal areas provide a new entry point that reveals novel insights into the neuroscience of musculoskeletal and neuromuscular regulation and control of pelvic function and health, which carry enormous implications for the future of pelvic physical therapy intervention. Further, these supradiaphragmatic and subdiaphragmatic relationships share a bidirectional pathway that not only dictate pelvic health but overall systemic health.
Purpose: To evolve physical therapy practice we must provide care that can address epidemic chronic pain. The voice is a critical missing piece to understand biopsychosocial, systems-based assessment and intervention, which is addressed through the study of phonation and sub-phonation in our presented work.
Methods: A literature review was undertaken of current science in phonation and sub-phonation in order to introduce a biopsychosocial, systems-based care model through physical therapy evaluation and intervention, which stands both as an economic and new assessment model to evolve physical therapy practice, improve healthcare delivery, and transform healthcare culture. Case studies were used to present the clinical reasoning process and intervention for clients with movement and vocal dysfunction.
Results:
Conclusion(s): The literature revealed no standardized method for physical therapy evaluation or intervention of cervical spine and corresponding laryngeal area, and yet the evidence overwhelmingly supports the musculoskeletal, neuromuscular, and psychobiological connection between the throat, respiratory, and pelvic diaphragms. This study concludes that early identification of vocal and corresponding cervical issues through Orofacial examination and intervention could improve care across the lifespan for individuals suffering from neck, back, or pelvic pain.
Implications: There is a need for graduate and postgraduate training in orofacial evaluation and intervention. A multidisciplinary team of health care providers could optimize service delivery of healthcare that involves the neck, pain, voice, and/or pelvic or other spine regions.
There needs to be a shift in physical therapy practice toward )inclusion of Orofacial examination. These assessments would involve a full evaluation of the three diaphragms, the Orofacial/laryngeal area, respiratory diaphragm, and pelvic diaphragm when neck, back, pelvic, or other spinal issues are suspected. There is also implication for other populations, including the neurological and shoulder complex populations.
Keywords: Orofacial, Physiotherapy, Chronic Pain
Funding acknowledgements: No funding.
Voice production - the story of your client - together with the forgotten vital sign, respiratory rate, hold critical information to impact physical therapy plans of care and outcomes for all patient populations. The thryoepiglottic, glossopharyngeal, and intrinsic and extrinsic laryngeal areas provide a new entry point that reveals novel insights into the neuroscience of musculoskeletal and neuromuscular regulation and control of pelvic function and health, which carry enormous implications for the future of pelvic physical therapy intervention. Further, these supradiaphragmatic and subdiaphragmatic relationships share a bidirectional pathway that not only dictate pelvic health but overall systemic health.
Purpose: To evolve physical therapy practice we must provide care that can address epidemic chronic pain. The voice is a critical missing piece to understand biopsychosocial, systems-based assessment and intervention, which is addressed through the study of phonation and sub-phonation in our presented work.
Methods: A literature review was undertaken of current science in phonation and sub-phonation in order to introduce a biopsychosocial, systems-based care model through physical therapy evaluation and intervention, which stands both as an economic and new assessment model to evolve physical therapy practice, improve healthcare delivery, and transform healthcare culture. Case studies were used to present the clinical reasoning process and intervention for clients with movement and vocal dysfunction.
Results:
- 7 key references were found to build the framework of the epidemiology, pathology, incidence of vocal dysfunction related to systems-based health - which included normal and abnormal voice production and the anatomical and physiological relationships of the glottis/epiglottis/larynx with diaphragm and lower core region.
- 13 key references were utilized to discuss the physical therapy examination, differential diagnosis and interventions used for orofacial dysfunction (including outcome measures).
- Case examples were presented to demonstrate the relationship between voice production, motor control, intra-abdominal pressure and pelvic floor response.
Conclusion(s): The literature revealed no standardized method for physical therapy evaluation or intervention of cervical spine and corresponding laryngeal area, and yet the evidence overwhelmingly supports the musculoskeletal, neuromuscular, and psychobiological connection between the throat, respiratory, and pelvic diaphragms. This study concludes that early identification of vocal and corresponding cervical issues through Orofacial examination and intervention could improve care across the lifespan for individuals suffering from neck, back, or pelvic pain.
Implications: There is a need for graduate and postgraduate training in orofacial evaluation and intervention. A multidisciplinary team of health care providers could optimize service delivery of healthcare that involves the neck, pain, voice, and/or pelvic or other spine regions.
There needs to be a shift in physical therapy practice toward )inclusion of Orofacial examination. These assessments would involve a full evaluation of the three diaphragms, the Orofacial/laryngeal area, respiratory diaphragm, and pelvic diaphragm when neck, back, pelvic, or other spinal issues are suspected. There is also implication for other populations, including the neurological and shoulder complex populations.
Keywords: Orofacial, Physiotherapy, Chronic Pain
Funding acknowledgements: No funding.
Topic: Women's & men's pelvic health; Musculoskeletal
Ethics approval required: No
Institution: American Physical Therapy Association
Ethics committee: Section on Women''''''''s Health
Reason not required: Process was a literature search and clinical reasoning to inform evidence based theoretical practice
All authors, affiliations and abstracts have been published as submitted.
