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1 END-TIDAL CO 2 BASED VISUAL FEEDBACK METHOD IN THERAPY OF RESPIRATORY DISTURBANCES IN STUTTERING Barbara Stankiewicz, Bogdan Adamczyk *, Krzysztof Zielinski,

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Presentation on theme: "1 END-TIDAL CO 2 BASED VISUAL FEEDBACK METHOD IN THERAPY OF RESPIRATORY DISTURBANCES IN STUTTERING Barbara Stankiewicz, Bogdan Adamczyk *, Krzysztof Zielinski,"— Presentation transcript:

1 1 END-TIDAL CO 2 BASED VISUAL FEEDBACK METHOD IN THERAPY OF RESPIRATORY DISTURBANCES IN STUTTERING Barbara Stankiewicz, Bogdan Adamczyk *, Krzysztof Zielinski, Marek Darowski Institute of Biocybernetics and Biomedical Engineering, Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland, *Institute of Physics, Maria Curie-Sklodowska University, Lublin, Poland *Institute of Physics, Maria Curie-Sklodowska University, Lublin, Poland COST B27 ENOC Joint WGs Meeting Swansea UK, 16-18 September 2006

2 2 BACKGROUND Respiratory disturbances in stuttering can influence lung ventilation and gas exchange leading even to hyperventilation or hypoventilation. A new breath regulation method based on visual feedback (VF) using on-line registered end-tidal CO 2 was implemented in computer system for therapy respiratory disturbances in stuttering. The VF method was preliminary tested.

3 3 METHODS 24 stuttering persons and fluent speakers (aged 14-37) participated in the study. Sound and expired CO2 signals were recorded while speaking without and with VF to control breathing as well as during rest respiration, before each utterance. To assess the efficiency of VF the factor of breath ergonomics during speaking (FE) was proposed and stuttering intensity was determined.

4 4 Fig. 1. The Computer-capnographic system for the therapy of respiratory disturbances in stuttering. Visual feedback method enables the regulation of the patient’s breath during speaking by controlling the end-tidal CO 2 and keeping it within the standard range determined on the basis of rest respiration.

5 5 Fig. 3. The application of therapy of respiratory disturbances in stuttering.

6 6 Fig. 2. The calculation method of FE factor of breath ergonomics during speaking. FE - factor of breath ergonomics during speaking Ph – the number of the CO 2 peaks connected with speaking; R – the number of the CO 2 peaks placed in the standard range for the end-tidal CO 2 ; A – the number of all the CO 2 peaks of the capnographic signal of an utterance.

7 7 STUTTERER No: STUTTERING INTENSITY [%] SPEAKING SPEAKING WITH ETCO 2 -BASED VF 1128 21612 395 454 5 7 660 788 896 92213 1062 1177 1274 mean values and SD: 10  56  4 STUTTERING INTENSITY - the number of the mispronounced syllables per 100 syllables of an utterance

8 8 Tab. 1. The ANOVA analysis results - comparison of FE values obtained for stutterers and fluent speakers while speaking and speaking with visual feedback. The GROUP factor at the level of 1) stutterers, and 2) fluent speakers. The CONDITION factor at the level of 1) speaking, and 2) speaking with VF. Factor: MS Effect df Effect MS Error df Errorp GROUP3356.71240.844<0.001 CONDITION4181.31240.844<0.0005 GROUP x CONDITION 2271240.844NS* * p>0.05

9 9 Fig. 4. FE - the factor of breath ergonomics during speaking (jointly: speaking with and without VF) obtained for stutterers and fluent speakers.

10 10 Fig. 5. FE - the factor of breath ergonomics during speaking obtained for stutterers and fluent speakers during speaking and speaking with the CO 2 based visual feedback.

11 11 ∆ETCO 2 =ETCO 2 (p) - ETCO 2 (rr) ∆SCO 2 =SCO 2 (p) - SCO 2 (rr) ∆ECO 2 =ECO 2 (p) - ECO 2 (rr) p – a phrase of an utterance rr – rest respiration Fig. 6. Determining of the parameters of capnographic curve.

12 12 Factor: Wilks’ lambda R Raodf 1df 2p Phrases0.713.963960.000001* Tab. 2. 1-way MANOVA analysis was carried out to compare the phrases containing tonic errors (repetitions, prolongations, and blockades) with the fluent phrases in the stuttereres’ utterances. The PHRASES factor occurred on two levels, i.e. 1) non-fluent phrases, 2) fluent phrases The results of the post-hoc Tuckey tests indicated that all three parameters (i.e. ∆ETCO 2, ∆SCO 2, and ∆ECO 2 ) had an effect on the significance of the difference between non-fluent and fluent phrases; for each parameter p<0.0005.

13 13 Fig. 7. Mean values of the change of end-tidal CO 2 during speaking in relation to rest respiration, standard deviation and standard error for non-fluent phrases containing tonic errors and fluent phrases of the stutterers’ utterances.

14 14 References 1.RACZEK B.: Speech ergonomics assessment in stutterers based on exhaled CO 2 concentration. Preliminary Study. Biocybernetics and Biomedical Engineering 20 (4), 67-76 (2000). 2. RACZEK B., ADAMCZYK B.: Concentration of carbon dioxide in exhaled air in fluent and non-fluent speech. Folia Phoniatrica et Logopaedica 56, 75-82 (2004). 3. STANKIEWICZ B., ADAMCZYK B., ZIELINSKI K., DAROWSKI M.: The system of diagnosis and therapy of respiratory disturbances in stuttering. In Abstrcts: XXXII Annual ESAO Congress, 5-8 October 2005, Bologna, Italy. Journal of Artificial Organs 28 (9), 937 (2005). 4. STANKIEWICZ B., ADAMCZYK B., ZIELINSKI K., DAROWSKI M.: Reduction of the respiratory disturbances in stuttering using a new method of breat regulation applying vusual feedback based on the CO 2 /time signal. In Abstrcts: XXXIII Annual ESAO Congress, 21-24 June 2006, Umea, Sweden. Journal of Artificial Organs 29 (5), 543 (2006). Acknowledgements This study was financed from science sources in 2004-2005 as the research project no. 3T11E 017 27 and in 2006 within the framework of statutory project St/11/2006 (IBIB PAS).

15 15 I INVITE YOU TO MY POSTER (Sunday, 17 Sept, 15:45-16:45 )


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