Jeannette D Hoit

• PhD
• Professor at University of Arizona

Objectives: To define effective communication and identify its key elements specific to critically ill patients with an artificial airway. Design: A modified Consensus Development Panel methodology. Setting: International video-conferences. Main outcome measures: Definition of effective communication and it's key elements. Results: Eight e...

Purpose A conceptual framework is proposed to better understand the experience of people who have dyspnea (breathing discomfort) when speaking: its nature, its physiological mechanisms, and its impacts on their lives. Method The components of the framework are presented in their natural order. They are a Speaking Domain (Speaking Activities and Sp...

Purpose The use of noninvasive ventilation (NIV) is on the rise as an alternative to tracheostomy for individuals with neuromuscular disorders with life-prolonging and quality-of-life benefits. This pilot study was designed to determine if mouthpiece NIV (M-NIV) alters speech in individuals with muscular dystrophy (MD). Method Eight men (23–44 yea...

Purpose To determine if people with Parkinson’s disease (PD) experience dyspnea (breathing discomfort) during speaking. Method The participants were 11 adults with PD and 22 healthy adults (11 young, 11 old). Participants were asked to recall experiences of breathing discomfort across different speaking contexts and provide ratings of those experi...

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22–42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne’s; 1 with Becker’s...

Purpose The aim of this study was to describe experiences of speaking with 2 forms of noninvasive positive pressure ventilation (NPPV)—mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP)—in people with neuromuscular disorders who depend on NPPV for survival. Method Twelve participants (ages 22−68 years; 10 men, 2 women) with...

Purpose The vocalizations of young infants often sound nasalized, suggesting that the velopharynx is open during the 1st few months of life. Whereas acoustic and perceptual studies seemed to support the idea that the velopharynx closes for vocalization by about 4 months of age, an aeromechanical study contradicted this (Thom, Hoit, Hixon, & Smith,...

The dysarthria associated with spinal cord injury (SCI) is characterized by speech impairments that reflect respiratory dysfunction and its downstream effects on phonation, articulation, and prosody. The exact nature of the dysarthria is determined in large part by the level of SCI and whether or not diaphragm function is spared. Individuals with i...

For more than a decade, there has been a trend toward increased use of noninvasive positive pressure ventilation (NPPV) via mask or mouthpiece as a means to provide ventilatory support without the need for tracheostomy. All indications are that use of NPPV will continue to increase over the next decade and beyond. In this article, we review NPPV, d...

Purpose The purpose of this study was to determine the typical pattern for inspiration during speech breathing in healthy adults, as well as the factors that might influence it. Method Ten healthy adults, 18–45 years of age, performed a variety of speaking tasks while nasal ram pressure, audio, and video recordings were obtained. Inspirations were...

The aims of this study were: 1) to determine if healthy adults inspire through the nose, the mouth, or both the mouth and nose during speech breathing, 2) to determine if the nature of the speech task influences whether healthy adults inspire through the nose, the mouth, or both the mouth and nose.

Objectives Symptoms of stress velopharyngeal incompetence (SVPI) have been reported by many wind instrument players. The current study was designed to determine (1) if symptoms of SVPI were accompanied by aeromechanical signs of SVPI and (2) if signs of SVPI differed across musical tasks. Design Participants were studied during a single recording...

Sequential swallowing is the act of swallowing multiple times, without pausing. Because sequential swallowing requires breath-holding, it seems likely that it could increase the drive to breathe. This study was designed to determine if sequential swallowing is accompanied by an increased drive to breathe in young, healthy adults. We predicted that...

Dyspnea (breathing discomfort) is a serious and pervasive problem that can have a profound impact on quality of life. It can manifest in different qualities (air hunger, physical exertion, chest/lung tightness, and mental concentration, among others) and intensities (barely noticeable to intolerable) and can influence a person's emotional state (ca...

Clinical evaluation of velopharyngeal function relies heavily on auditory perceptual judgments that can be supported by instrumental examination of the velopharyngeal valve. Many of the current instrumental techniques are difficult to interpret, expensive, and/or unavailable to clinicians. Proposed in this report is a minimally invasive and inexpen...

Purpose To determine if respiratory and laryngeal function during spontaneous speaking were different for teachers with voice disorders compared with teachers without voice problems. Method Eighteen teachers, 9 with and 9 without voice disorders, were included in this study. Respiratory function was measured with magnetometry, and laryngeal functi...

Purpose To review the principles of neural plasticity and make recommendations for research on the neural bases for rehabilitation of neurogenic speech disorders. Method A working group in speech motor control and disorders developed this report, which examines the potential relevance of basic research on the brain mechanisms involved in neural pl...

Purpose To examine the influence of visual information on speech intelligibility for a group of speakers with dysarthria associated with Parkinson’s disease. Method Eight speakers with Parkinson’s disease and dysarthria were recorded while they read sentences. Speakers performed a concurrent manual task to facilitate typical speech production. Twe...

Purpose To reveal the qualities and intensity of speaking-related dyspnea in healthy adults under conditions of high ventilatory drive, in which the behavioral and metabolic control of breathing must compete. Method Eleven adults read aloud while breathing different levels of inspired carbon dioxide (CO2). After the highest level, participants pro...

To determine the age at which infants achieve velopharyngeal closure during vocalization. Longitudinal with repeated measures. Laboratory. Six healthy infants were studied monthly from ages 2 to 6 months while they interacted with a parent and an investigator. The presence or absence of velopharyngeal closure, as determined by sensing ram pressure...

Respiratory dysfunction is a major cause of morbidity and mortality in spinal cord injury (SCI), which causes impairment of respiratory muscles, reduced vital capacity, ineffective cough, reduction in lung and chest wall compliance, and excess oxygen cost of breathing due to distortion of the respiratory system. Severely affected individuals may re...

Purpose Quick respiratory hyperkinesia can be difficult to detect with the naked eye. A clinical method is described for the detection and quantification of quick respiratory hyperkinesia. Method Flow at the airway opening is sensed during spontaneous apnea (rest), voluntary breath holding (postural fixation), and voluntary volume displacement (in...

Purpose The purpose of this study was to determine the relation of respiratory oscillation to the perception of voice tremor. Method Forced oscillation of the respiratory system was used to simulate variations in alveolar pressure such as are characteristic of voice tremor of respiratory origin. Five healthy men served as speakers, and 6 clinicall...

We sought to improve speech in tracheostomized individuals receiving positive-pressure ventilation. Such individuals often speak with short phrases, long pauses, and have problems with loudness and voice quality. We studied 15 adults with spinal cord injuries or neuromuscular diseases receiving long-term ventilation. The ventilator was adjusted usi...

We conducted a survey to determine the nature of the communication challenges associated with ventilator use. Fifty-three ventilator users responded to the survey, either during a one-on-one interview or by self-completion over the Internet. Most respondents reported having speech problems, but surprisingly few had participated in speech therapy. R...

Pulmonary ventilation during speech breathing reflects the sum of the airflow changes used to speak and to meet the metabolic needs of the body. Studying interactions between speaking and breathing may provide insights into the mechanisms of shared respiratory control. The purposes of this study were to determine if healthy subjects exhibit task-sp...

Two men with high cervical spinal cord injuries and phrenic nerve pacers were studied with and without an elastic binder around the abdomen. Speech improved with the binder, as determined by listener preference ratings provided by 10 judges and by the subjects themselves. Improvement was substantial in one subject and slight in the other. The subje...

This study was conducted to explore the influence of speaking on ventilation. Twenty healthy young men were studied during periods of quiet breathing and prolonged speaking using noninvasive methods to measure chest wall surface motions and expired gas composition. Results indicated that all subjects ventilated more during speaking than during quie...

A protocol is offered for use by the speech-language pathologist in conducting a physical examination of the rib cage wall. Structural and performance observations are used to reveal possible rib cage wall dysfunction. A worksheet is provided to guide the examiner. The present protocol, together with those presented in companion publications on the...

A protocol is presented for use by the speech-language pathologist in conducting a physical examination of the abdominal wall. Structural and performance observations are used to reveal the nature and degree of possible abdominal wall dysfunction. A worksheet is offered to guide the examiner.

A protocol is presented for use by the speech-language pathologist in conducting a physical examination of the diaphragm. Five clusters of performance activities are used to reveal the nature and degree of possible diaphragm dysfunction. A worksheet is offered to guide the examiner.

Competition between airflow requirements for speaking and gas exchange occurs in ventilator-dependent tracheotomized subjects who can 'steal' air from alveolar ventilation during the ventilator's inflation phase to produce sound. We wondered whether these subjects adopted strategies to minimize hypoventilation when speaking, particularly when venti...

Questionnaires regarding ventilator-supported communication were sent to 150 speech-language pathologists in the United States. Fifty-seven questionnaires were completed and returned. Results indicated that respondents had had little or no graduate course-work in ventilator-supported communication; rather, the majority of their education and traini...

Six subjects who were tracheostomized and chronically ventilator-supported because of neuromuscular disease or injury were studied to determine if their speech could be improved. Using subjects' own portable ventilators, adjustments were made that reduced inspiratory flow and added positive end-expiratory pressure (PEEP). These adjustments resulted...

A phrenic nerve pacer is a neural prosthesis used by some individuals with ventilatory insufficiency. This report provides a description of the phrenic nerve pacer and contains a case study of a young man in whom speech production during phrenic nerve pacing was examined and contrasted to that during mechanical (positive-pressure) ventilation. Resu...

Respiratory function during speaking and singing was investigated in six male professional country singers. Function was studied using magnetometers to transduce anteroposterior diameter changes of the rib cage and abdomen while subjects performed various respiratory maneuvers, speaking activities, and singing activities. Results indicated that res...

This investigation examined the influence of cognitive-linguistic processing demands on speech breathing. Twenty women were studied during performance of two speaking tasks that were designed to differ in cognitive-linguistic planning requirements. Speech breathing was monitored with respiratory magnetometers from which recordings were made of the...

This paper examines how breathing differs in the upright and supine body positions. Passive and active forces and associated chest wall motions are described for resting tidal breathing and speech breathing performed in the two positions. Clinical implications are offered regarding evaluation and treatment of breathing behavior in clients with spee...

This investigation was designed to determine if velopharyngeal function during speech production, as reflected in measures of nasal air flow, differs with age in adults. Eighty subjects were studied, 40 women and 40 men, representing four age groups (20–30, 40–50, 60–70, and 80+ years). Results showed no age-related differences in nasal air flow. S...

This investigation provides the first detailed description of speech production during mechanical ventilation. Seven adults with tracheostomies served as subjects. Recordings were made of chest wall motions, neck muscle activity, tracheal pressure, air flow at the nose and mouth, estimated blood-gas levels, and the acoustic speech signal during per...

This investigation was designed to test the hypothesis that voice onset time (VOT) varies as a function of lung volume. Recordings were made of five men as they repeated a phrase containing stressed /pi/ syllables, beginning at total lung capacity and ending at residual volume. VOT was found to be longer at high lung volumes and shorter at low lung...

An investigation was conducted to determine if laryngeal valving economy, as reflected in measures of laryngeal airway resistance during vowel production, differs with age in women. Seventy healthy women were studied, 10 each at age 25, 35, 45, 55, 65, 75, and 85 years. Results indicated that laryngeal airway resistance did not differ significantly...

Established procedures for making chest wall kinematic observations (Hoit & Hixon, 1987) and pressure-flow observations (Smitheran & Hixon, 1981) were used to study respiratory and laryngeal function during whispering and speaking in 10 healthy young adults. Results indicate that whispering involves generally lower lung volumes, lower tracheal pres...

Ten men with cervical spinal cord injury were studied using magnetometers to record surface motions of the chest wall during speech breathing. Individual speech breathing patterns reflected inspiratory and expiratory muscular sparing. Subjects compensated for expiratory muscle impairment by speaking at large lung volumes, presumably to take advanta...

An investigation was conducted to elucidate the nature of speech breathing in children and adolescents and to determine if sex and age influence performance. Eighty healthy boys and girls representing four age groups (7, 10, 13, and 16 years) were studied using helium dilution to obtain measures of subdivisions of the lung volume and using magnetom...

Thirty healthy women representing three age groups (25, 50, and 75 years) were studied with respect to general respiratory function and speech breathing. Certain subdivisions of the lung volume differed with age: vital capacity, expiratory reserve volume, and residual volume. Speech breathing also differed with age and was characterized by differen...

An investigation was conducted to determine if laryngeal valving economy, as reflected in measures of laryngeal airway resistance during vowel production, varies across adulthood. Sixty healthy men were studied, 10 from each of six age groups--25, 35, 45, 55, 65, and 75 years (+/- 2 years). Results indicated that there are age-related differences i...

Electromyography was used to investigate abdominal muscle activity during singing in four subjects, all of whom were trained classical singers. Results revealed regional differences in abdominal activation during the expiratory side of the breathing cycle. These were characterized by high-amplitude activity in the lateral region and low-amplitude a...

Abdominal muscle activity was investigated during resting tidal breathing and speech production in upright and supine body positions in five male and five female young adult subjects. Results showed that patterns of abdominal electromyographic (EMG) activity were highly dependent on body position. Data for resting tidal breathing resembled those of...

Thirty healthy men representing three widely different age groups (25, 50, and 75 years) were studied with respect to general respiratory function and speech breathing. Subdivisions of the lung volume were found to differ with age and most markedly so for measures of vital capacity and residual volume. Speech breathing also was found to differ with...

Diameter changes of the rib cage and abdomen were recorded during tidal breathing and speech production in 12 adult male subjects grouped on the basis of prominence on three body type components: relative fatness, relative musculoskeletal development, and relative linearity. Data were charted to solve for lung volume, volume displacements of the ri...

We examined the electromyographic (EMG) activity of two human elbow-flexor muscles, biceps brachii and brachioradialis, during isometric contractions. The task required subjects to match the EMG level of one of the muscles (the control muscle) to one of four target levels (5, 10, 15, or 20% of maximum) at various elbow angles. A new technique was d...

This study explored the relationship between the perception and production of voice onset time (VOT) in apraxic subjects. Spectrograms of the words, "bees" and "peas" spoken by apraxic subjects were acoustically analyzed to obtain a measure of VOT. The subjects also identified the initial cognate ("b" or "p") from synthetically generated speech spa...