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Non-invasive positive pressure ventilation (NPPV) has recently been applied to the patients with multiple system atrophy (MSA) with various respiratory complications including vocal cord abduction impairment and respiratory disturbance by the central origin. Any consensus guidelines on setting up the inspiratory positive airway pressure (IPAP) and expiratory one (EPAP), however, have not been raised yet. To investigate this problem, we made the upper airway tract model with moderately and severely narrow glottis using a training/test lung and the artificial vocal cord which was developed for a humanoid talking robot in Waseda University. The artificial vocal cord was molded out of a high performance thermoplastic rubber in imitation of the human larynx. Previous studies using with a high-speed camera and a sound analyzer showed that the artificial vocal cord resembled human larynx closely both morphologically and functionally. The opening and closing movements of the artificial vocal cord were observed fiberscopically under various conditions of IPAP (4-20 cmH2O) and EPAP (4-10 cmH2O). The maximal glottic width during inspiration and expiration were measured by a pair of calipers on the video-monitored display. Both of the moderately and the severely narrow artificial vocal cords without non-paralytic factors showed typical paradoxical movement showing adduction in inspiration and abduction in expiration, which is characteristic to vocal cord abductor impairment seen in MSA. In the model with moderately severe narrow glottis, this paradoxical movement was released under any positive pressures of continuous (CPAP) and bilevel (Bilevel PAP) modes. In the model with severely narrow glottis, however, there existed a threshold in setting up the optimal EPAP to release the paradoxical movement. In conclusion, EPAP-leading procedure seems to be preferable to IPAP-leading procedure to dilate the narrow glottis as a pneumatic splint in the managements of the patients with MSA presenting with a paralytic type of vocal cord abductor impairment.

We developed a three-dimensional mechanical vocal cord model for Waseda Talker No. 7 (WT-7), an anthropomorphic talking robot, for generating speech sounds with various voice qualities. The vocal cord model is a cover model that has two thin folds made of thermoplastic material. The model self-oscillates by airflow exhausted from the lung model and generates the glottal sound source, which is fed into the vocal tract for generating the speech sound. Using the vocal cord model, breathy and creaky voices, as well as the modal (normal) voice, were produced in a manner similar to the human laryngeal control. The breathy voice is characterized by a noisy component mixed with the periodic glottal sound source and the creaky voice is characterized by an extremely low-pitch vibration. The breathy voice was produced by adjusting the glottal opening and generating the turbulence noise by the airflow just above the glottis. The creaky voice was produced by adjusting the vocal cord tension, the sub-glottal pressure and the vibration mass so as to generate a double-pitch vibration with a long pitch interval. The vocal cord model used to produce these voice qualities was evaluated in terms of the vibration pattern as measured by a high-speed camera, the glottal airflow and the acoustic characteristics of the glottal sound source, as compared to the data for a human. [ABSTRACT FROM AUTHOR]