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36 Cards in this Set
- Front
- Back
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why is there no set voice therapy regimen?
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voice therapy is highly individualized, depending on
- the cause of the problem - maintaining factors - motivation of the patient - availability of appropriate management and treatment |
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define diagnostic probe
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An informal technique in which a test task or instructional condition is altered in order to observe if a change in the student's performance results
the response to the probe and its effect on voice determine if that therapy approach will be used |
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what is the primary voice management role in the preschool child
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the identification and possible treatment of laryngeal disease rather than as a preliminary evaluative step for voice therapy
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what is the most common voice problem in the school age child
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hoarseness related to vocal hyperfunction
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how would a clinician identify situations of a child being vocally abusive?
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child must be observed in various play settings, in the classroom or at home
- help from the children themselves - teachers - parents |
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how can a vocal abuse graph help in therapy?
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having to monitor yelling, the child is motivate to reduce it
the child's pride in his graph helps him continue to decrease his vocal abuse |
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what is the primary task of voice clinicians with patients?
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to explore the various therapy techniques that might produce a "good" voice
clinician provide needed psychological support |
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what is the recommended step after diagnostic evaluation
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voice therapy
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Define facilitating approaches or techniques
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the selected therapy technique facilitates a "target" or a more optimal vocal response by the patient
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what are the 25 facilitating approaches in voice therapy?
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auditory feedback
change of loudness chant-talk chewing confidential voice counseling digital manipulation elimination of abuses establishing a new pitch focus glottal fry head positioning hierarchy analysis inhalation phonation laryngeal massage masking nasal/glide stimulation open-mouth approach pitch inflections redirected phonation relaxation respiration training tongue protrusion /i/ visual feedback yawn sign |
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what are the perspectives in which the facilitating approaches are presented?
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1. kinds of problems for while the approach is useful
2. procedural aspects of the approach 3. typical case history showing utilization of the approach 4. evaluation of the approach |
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auditory feedback
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affects: loudness, quality
procedure: REAL TIME AMPLIFICATION - letting patients hear themselves while speaking METRONOME PACING - using a metronome helps with decreasing or increasing rate of speech LOOP PLAYBACK - allow patient to hear immediately what was just said |
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change of loudness
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affects : pitch, loudness, quality
procedure: DECREASE: develop awareness for different voices, make the patient aware of the problem, practive using a quiet voice INCREASE: explain the soft voice, explore pitch level comfortability, respiration training |
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chant talk
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affects: loudness, quality
- those with hyperfunction elevation in pitch, prolongation of vowels, lack of syllable stress, softening of glottal attack procedure: imitate the chant voicing pattern, then alternate between regular voice and chant talk (designed to take the work out of phonation) |
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chewing
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affects: pitch, loudness, quality
vocal hyperfunction who speak through clenched teeth, very little mandibular & labial movments high tension & hard glottal attack procedure: look in a mirror and do exagerated chewing, add light voice which doing the chewing motion, count and chew, then words and phrases wtih chew, then diminish the exagerated chewing |
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confidential voice
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affects: loudness, quality
using a soft, confidential voice instead of a voice with much effort and hyperfunction procedure: produce the breathy voice with less loudness, temporarily |
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counseling (explanation of problem)
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affects: pitch, loudness, quality
explaining the voice problem procedure: putting the voice problem in proper perspective (varies for each individual) |
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digital manipulation
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affects: pitch, quality
finger pressure on the larynx to adjust pitch procedure: LOWERING PITCH: apply finger pressure on thyroid, pitch will drop (practive this until they can do it without the pressure) VERTICAL MOVEMENT OF LARYNX: monitory movement while phonating, produce sounds on the scale, low - high (vice versa), learn the movements of the larynx UNILATERAL VF PARALYSIS: pressure on lateral thyroid, looking for a louder voice, if no increase, have patient turn head |
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elimination of abuses
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affects: loudness, quality
vocal abuse & vocal misuse procedure: identify vocal abuse, become aware of abuse, plot daily vocal abuses on a graph |
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establishing a new pitch
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affects: pitch, quality
procedure: decribe where the target pitch is, patient recieves feedback of pitch that they are using, work on single words (begin with vowels) in a pitch monotone, then introduce phrases, then in real life conversations |
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focus
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affects: pitch, loudness quality
some might have tongue too far back or forward, voice from deep in throat procedure: ANTERIOR: tongue high = sound babyish. repeat back phonemes, play feedback POSTERIOR: whispered words help, then use light voice POOR VERTICAL FOCUS: get the voice out of the throat, use increased nasality, bring the voice to the front (feel vibrations) |
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glottal fry
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affects: pitch, loudness, quality
creating a relaxed manner with little subglottic pressure procedure: can produce during inhalation or exhalation, let out half the breath and produce /i/, stretch it as long as possible, work on the tone |
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head positioning
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affects: pitch, quality
procedure: demonstrate various head positions |
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hierarchy analysis
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affects: pitch, loudness, quality
procedure: patient learns in which situation a good voice is produce, then clinician will work on producing a good voice in the bad situations |
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inhalation phonation
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affects: pitch, loudness
introduces high pitch inhalation voice it is a true vocal vibration so this can help those with ventricular phonation procedure: demonstrate inhalation phonation with shoulder elevating, then produce inhaltion-exhaltion matched phonations, have patient do inhalation phonation, and matched phonation, |
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laryngeal massage
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affects: pitch, quality
procedure: yawn sign is first attempted, then gental manipulation and massage of the larynx is performed until clearer voice quality or lower pitch |
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masking
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affects: pitch, loudness
helpful with aphonic patients procedure: add masking (noise) which causes person to increase their intensity |
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nasal/glide stiumulation
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affects: quality
helps with dysphonias related to fold thickening, nodules, and polyps procedure: produce words with nasals and glides in them, monosyllabic containing nasal consonants, then introduce /a/ in between each nasal word |
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open-mouth approach
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affects: loudness, quality
used to increase resonance procedure: watch themselve open their mouth and talk in a mirror, use the ventriloquist-puppet analogy, |
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pitch inflections
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affects: pitch
modulation of pitch during phonation work with vocal monotony procedure: work downward and upward shift of pitch on the same word, eexaggerating on beginning of pitch change, |
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redirected phonation
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affects: pitch, loudness, quality
difficultly "finding their voice" procedure: find some kind of vegetative phonation (coughing, gargling, humming, laughing, playing the kazoo, singing, throat clearing, trilling, uh-humm) and redirecting the sound to speaking voice |
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relaxation
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affects: pitch, loudness, quality
stress management procedure: find times of relaxation (head rotation, open throat relaxation) |
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respiration training
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affects: loudness, quality
controlly expiration procedure: demonstrate how air can set vibration, prolong vowels, reduce number of words on a speaking breath, |
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tongue protrusion /i/
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affects: pitch, quality
helps with tightness of the voice, ventricular phonation procedure: work on protruding the tongue out while producing /i/, jaw is to drop open, then go up and down in pitch, then chant /mimimimi/, slowly slip the tongue back into the mouth |
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visual feedback
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affects: pitch, loudness, quality
matching pitch lines, air volumes, pressure flow working to improve or optimize vocalization procedure: feedback instruments are introduced, patient can try to imitate what they see/hear patient can follow certain voicing patterns |
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yawn-sigh
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affects: pitch, loudness, qualtiy
used for minimizing tension of vocal hyperfunction procedure: yawn sigh = larynx in low position, tongue is forward, slight opening between vocal folds, phaynx is dialated explaine the yawn, then slight exhale with light phonation, then say words beginning with /h/, omit the yawn part, |
