Surface Electromyography to Identify Laryngeal Tension in Selective Mutism: Could this be the Missing Link?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 12, Issue 2
Abstract
Selective mutism (SM) is an anxiety based disorder that impedes the ability to speak in varied situations. The purpose of this paper is to share a study providing information using surface electromyography to measure laryngeal tension for voice initiation in 33 children with SM. Results indicated that elevated laryngeal tension was present when children with SM were asked to produce vowel sounds and speech. Requests for speech at the beginning of the evaluation process produced significantly more tension when compared to measures obtained after children became more familiar with the setting and evaluators. The findings provide a better understanding of the physiological consequences of anxiety on voice production at the level of the larynx in children with SM. In order to speak, an individual needs to have the ability to initiate phonation (voice), as well as to turn it ‘on’ and ‘off’ as needed. Such ability depends on well controlled laryngeal muscle activity paired with coordination with respiratory and articulatory (oral) systems. Normal vocalization requires that air within the lungs flows outward in a steady manner while the vocal folds approximate to initiate vibration (voice). Then the voice travels outwards toward the articulators (tongue, teeth, lips, palate, etc.) where it is shaped into speech sounds to form words. Although individuals may be able to automatically or reflexively activate each system independently, unless a voluntary control of those systems exists, speech production is not possible [1]. Selective Mutism (SM) is an anxiety disorder in which the individual experiences failure to speak in specific social situations where there is an expectation to speak such as at school despite being able to speak in situations where anxiety is low, such as at home with family. Lack of speech is not due to a lack of knowledge [2]. Rather, physiological sensations of anxiety appear to impact the person’s ability to speak. The purpose of this short communication is to share a systematic assessment procedure that focuses on vocal initiation and control to provide a better understanding of the physiological consequences of anxiety on voice production at the level of the larynx. Prevalence estimates of SM range from 0.03% to 2%. Onset is often between 3 and 6 years. Symptoms are typically present in the early school age years [3]. The ability to vocalize can be divided into involuntary (crying, coughing, etc.) and voluntary (speech production) functions. It is important to understand such a distinctive division because the neurological pathways associated with each behavior originate in different parts of the nervous system. Involuntary voicing, also described as innate vocalizations, are controlled at the level of the sensory and motor nuclei of the lower brain stem and spinal cord. These areas are responsible for basic interactions and coordination of the laryngeal, respiratory and articulatory systems [1,4]. Voluntary vocalizations, as those needed for speech production, are controlled by communication between the Anterior Cingulate Cortex (ACC) and the Periaqueductal Grey (PAG), which are associated with purposeful voice initiation and its emotional implications [1,4]. The ACC has been described as a specialization area responsible for emotional self-control, problem solving, and adaptive responses to changing conditions [5]. Our alternative physiological explanation for the inability to speak by those with SM is based on the understanding of intricate interactions between the ACC and the PAG in translating intentions into actions. In patients with anxiety disorders, reductions in the right anterior cingulate cortex and the left inferior frontal gyrus gray matter volumes (GMVs), were identified [6].
Authors and Affiliations
Cesar E Ruiz, Evelyn R Klein
Keywords
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- EP ID EP592730
- DOI 10.26717/BJSTR.2018.12.002222
- Views 194
- Downloads 0
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