1. Paradoxical Vocal Fold Movement (PVFM) Information for high school athletic coaches

2. Normal Vocal Folds Open to take air in (inhalation) and to let air out (exhalation) Closed to make certain speech sounds Note: Vocal folds can also be called vocal cords

3. Description of PVFM Vocal folds close during inhalation Results in shortness of breath Can also be called Vocal Cord Dysfunction or Vocal Fold Dysfunction It is often misdiagnosed for Asthma

4. Demographics of PVFM Occurs more in females Age range: 10-40 years old Characteristics: competitive, perfectionist, high standards

5. Demographics Specific to Athletes Age range: 11-18 years old Female higher incidence (3:1) Similar characteristics: perfectionist, competitive in games and practices, and are critical of their own performance

6. Signs and Symptoms Wheezing when breathing in Tightness in neck Problems getting air in Inhalers are not helpful Have difficulties talking Quick to begin and end Triggered by exercise or emotional stress

7. Differences between PVFM and Asthma PVFMAsthma -Problem with inhalation -Wheezing during inhalation -Quick start and finish -Tension in the neck -No response to inhalers -Triggered by exercise or stress -Limited or no coughing after exercise has stopped -Problem with exhalation -Wheezing during exhalation -Gradual start with a longer recovery -Tension in the chest -Responds to inhalers -Multiple triggers including exercise, allergens, air temperature, and colds -Coughing experienced after exercise has stopped Adapted from Mathers-Schmidt, B. (2001)

8. Indirect Management of PVFM Know the signs and symptoms of PVFM Reduce stress when possible Educate your team and assistant coaches to raise awareness

9. Direct Management of PVFM: How you can help Tell the athlete to breath from the stomach rather than from the chest Have the athlete relax their neck, shoulders, and chest Be supportive Encourage controlled breathing and panting Have the athlete visualize and open passageway for air intake Encourage the athlete to breath while producing “s” or “sh.”

10. Steps to Take After an Episode Refer to a doctor Stay involved in the process A speech language pathologist will help with breathing strategies and techniques for preventing a PVFM episode Maintain communication with the SLP

11. References Gregore, D. (2011). UD Student Health Service: Staff Resources. Welcome to the University of Delaware. Retrieved December 12, 2011, from http://www.udel.edu/shs/staff/manuals/technical http://www.udel.edu/shs/staff/manuals/technical Koester, M., & Amundson, C. (2002). Seeing the forest through the wheeze: a case-study approach to diagnosing paradoxical vocal-cord dysfunction.Journal of Athletic Training, 37(3), 320-324. Mathers-Schmidt, B. A. (2001). Paradoxical Vocal Fold Motion: A tutorial on a Complex Disorder and the speech-language pathologist's role. American Journal of Speech-Language Pathology, 10, 111-125. Normal Vocal Cords. Health.com: Health News, Wellness, and Medical Information. Retrieved December 12, 2011, from http://www.health.com/health/library/mdp/0,,zm6118,00.html http://www.health.com/health/library/mdp/0,,zm6118,00.html Plonsker, Dr. L. (Professor) (2011, December 7). Assessment and treatment of pediatric voice disorders. Lecture, Stevens Point. Sandage, M. (2006). Sniffs, Gasps, and Coughs: Irritable Larynx Syndrome Across the Lifespan. The ASHA Leader, 16-21.