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END-TIDAL COEND-TIDAL CO22 BASED VISUAL FEEDBACK BASED VISUAL FEEDBACK

METHOD IN THERAPY OF RESPIRATORY METHOD IN THERAPY OF RESPIRATORY DISTURBANCESDISTURBANCESIN STUTTERINGIN STUTTERING

Barbara Stankiewicz, Bogdan AdamczykBarbara Stankiewicz, Bogdan Adamczyk**,,Krzysztof Zielinski, Marek DarowskiKrzysztof Zielinski, Marek Darowski

Institute of Biocybernetics and Biomedical EngineeringInstitute of Biocybernetics and Biomedical Engineering,,

Polish AcademPolish Academyy of of Sciences, Warsaw, Poland 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

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BBACKGROUNDACKGROUND

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 CO2 was implemented in computer system for therapy respiratory disturbances in stuttering. The VF method was preliminary tested.

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METHODSMETHODS

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.

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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 CO2 and keeping it within the standard range determined on the basis of rest respiration.

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

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100%A

R

A

PhFE

Fig. 2. The calculation method of FE factor of breath ergonomics during speaking.

FE - factor of breath ergonomics during speakingPh – the number of the CO2 peaks connectedwith speaking; R – the number of the CO2

peaks placed in the standard range for the end-tidal CO2; A – the number of all the CO2 peaks of the capnographic signal of an utterance.

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STUTTERER No:

STUTTERING INTENSITY [%]

SPEAKINGSPEAKING WITHETCO2-BASED VF

1 12 8

2 16 12

3 9 5

4 5 4

5 12 7

6 6 0

7 8 8

8 9 6

9 22 13

10 6 2

11 7 7

12 7 4

mean values and SD:

10 5 6 4

STUTTERING INTENSITY- the number of the mispronounced syllables per 100 syllables of an utterance

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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, and2) fluent speakers. The CONDITION factor at the level of 1) speaking, and 2) speaking with VF.

Factor:MS

Effectdf

EffectMS

Errordf

Error p

GROUP 3356.7 1 240.8 44 <0.001

CONDITION 4181.3 1 240.8 44 <0.0005

GROUP x CONDITION

227 1 240.8 44 NS*

* p>0.05

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MEAN+SDMEAN-SD

MEAN+SDEMEAN-SDE

MEAN

G R O U P

FE

[%

]

0

10

20

30

40

50

60

70

80

90

100

STUTTERERS FLUENT SPEAKERS

p<0.001

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

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MEAN+SDMEAN-SD

MEAN+SDEMEAN-SDE

MEAN

MEAN+SDMEAN-SD

MEAN+SDEMEAN-SDE

MEAN

C O N D I T I O N

FE

[%

]

0

10

20

30

40

50

60

70

80

90

100

SPEAKING SPEAKING WITH VF

STUTTERERS

FLUENT SPEAKERS

p<0.005

NS

p<0.01

NS

Fig. 5. FE - the factor of breath ergonomics during speaking obtained for stutterers and fluent speakers during speaking and speaking with the CO2 based visual feedback.

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∆ETCO2=ETCO2 (p) - ETCO2(rr)

∆SCO2=SCO2 (p) - SCO2(rr)

∆ECO2=ECO2(p) - ECO2(rr)

p – a phrase of an utterance rr – rest respiration

Fig. 6. Determining of the parameters of capnographic curve.

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Factor:Wilks’

lambdaR Rao df 1 df 2 p

Phrases 0.71 3.96 3 96 0.000001*

Tab. 2. 1-way MANOVA analysis was carried out to compare the phrasescontaining tonic errors (repetitions, prolongations, and blockades) withthe fluent phrases in the stuttereres’ utterances. The PHRASES factoroccurred 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. ∆ETCO2, ∆SCO2, and ∆ECO2) had an effect on the significance ofthe difference between non-fluent and fluent phrases; for each parameterp<0.0005.

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MEAN+SDMEAN-SD

MEAN+SDEMEAN-SDE

MEAN

P H R A S E S

ET

CO

2 [%

]

-1,4

-1,0

-0,6

-0,2

0,2

0,6

1,0

1,4

NON-FLUENT FLUENT

p<0.0005

Fig. 7. Mean values of the change of end-tidal CO2 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.

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References1. RACZEK B.: Speech ergonomics assessment in stutterers based on exhaled

CO2 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 CO2/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).

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