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29 Cards in this Set
- Front
- Back
Assessment of Voice
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1. Referral – Provides initial statement of the problem
2. Case History 3. Description of Speech Behaviors 4. Description of Other Relevant Behaviors 5. Stimulability: Voice change probes 6. Decision making and Goal Setting |
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Case History
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• Medical Information, e.g., craniectomy, tumor in brainstem
• Past history of speech and voice disorders • Description of the Problem • Onset and ___???__________ • How variable is the problem • Description of Daily Voice Use (note any misuse/abuse) • Additional Information |
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Description of other relevant behaviors
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• Oral Mechanism Exam
• Hearing Test • Screen for any articulation (e.g., dysarthria) and language issues • Screen for swallowing issues |
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Assessment of voice
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• Acoustic analysis of voice, e.g., CSL, tf32, Praat, Visi-Pitch
• Listen and observe – Ears are the best instrument (perceptual assessment)! -Assess breathing -Assess pitch, loudness, and quality -Assess resonance |
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perceptual assessment of voice
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• Breathing
-Thoracic -Clavicular -Diaphragmatic • Observe for Tension (laryngeal) |
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Assess vocal registers (pitch)
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1.) Description of the client’s vocal registers
-Pulse -Modal -Loft 2.) Special pitch problems -E.g., diplophonia, falsetto, vocal fry, ____________ |
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assessing loudness/intensity
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• Too loud
• Too soft • Monoloudness |
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assessing quality (resonance too)
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Use Your Ear
-s/z ratio: Ratio of 1.4 (1.2 new guidelines) or greater may indicate vocal fold issues -Reading Passage -Conversation |
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listen for??
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-Breathiness, Hoarseness, Harshness, Tremor
-Definitions of terms above? breathiness- incomplete glottal closure resulting in escaping air hoarsness- noise in the voice |
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CAPE-V
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• Consensus of Auditory Perceptual Evaluation of Voice
• Developed via an ASHA initiative • Potential standardized instrument for evaluating and documenting voice quality • Evaluates 6 parameters *recent studies suggest it is reliable and valid |
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6 parameters
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1. Overall Severity: global, integrated impression of voice deviance
2. Roughness: perceived irregularity in the voicing source 3. Breathiness: audible air escape in the voice 4. Strain: perception of excessive vocal effort (hyperfunction) 5. Pitch: perceptual correlate of fundamental frequency 6. Loudness: perceptual correlate of sound intensity |
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Objective Assessment Measures (covered by guest)
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1. Referral to an Ear Nose and Throat Physician
2. indirect View of Larynx 3. Endoscopy (Videostroboscopy or LVES) -Oral Endoscopy -Transnasal Endoscopy 4. ENT may order a biopsy (further medical intervention) |
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stimuability
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What is stimulability? try out different treatment approaches and see if patient responds
-Obviously, treatment options will vary depending on type of voice disorder -helps show prognosis (likely course of disease) |
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the voice team
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• A team is involved for management of ALL voice disorders
-the team includes SLP, ENT, pysc, surgeon, neurologist, endocronologist, voice coaches |
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treatment
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Three interdependent approaches:
1. Medical Approach o Surgery, radiation, medication, psychiatry 2. Environmental approach o Modify or reduce conditions which damage the voice 3. Direct Approach (Direct vocal rehabilitation) |
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Direct Approach
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1. Listening skills
2. Physical hygiene 3. Mental Hygiene 4. Posture and Movement 5. Regulation of breathing 6. Relaxation 7. Voice training |
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1. listening skills
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• Teaches self-monitoring skills
• Listen for any misuse of voice • Work on pitch recognition and discrimination • Match sounds, e.g., various pitches, loudness |
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2. Physical Hygiene (covered by guest)
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• Reduce abuses, e.g., throat clearing, smoking, overuse of voice, (amplifier)
• Hydration and Amplifier use show high-quality treatment efficacy (Thomas & Stemple, 2007) • How about complete voice rest? Reflux o Diet changes o Sleep with the mattress at an angle o Reflux/Allergy Medication Conclusion: Use hygiene in conjunction with other approaches |
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3. mental hygiene
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• Counseling
-Speak in terms patient can understand and listen to patients’ concerns and fears -Explain why their voice is the way it is -Referral to a psychiatrist or psychologist, as needed |
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4 & 5. Posture/Breathing
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• E.g., Sedentary occupations, lose abdominal muscle control for respiratory efficiency, or shoulder droop
• Sufficient exercise for respiratory support and efficiency • Demonstrate correct breathing techniques (use diaphragmatic breathing, not clavicular breathing) |
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6. relaxation
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easy onsets
- Pre-voice exhalation - Start with vowels, build up to words, phrases, and sentences |
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6. relaxation
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Laryngeal Tension
- Glottal fry - Imagery, /h/ words - Relaxation exercises, meditation, & deep breathing - Humming - Massage: Shows treatment efficacy (Roy et al.) - Biofeedback: Shows treatment efficacy (Thomas & Stemple, 2007) |
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7. voice training
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Pitch changes
- Optimum pitch is no longer worked on (usually it improves as vocal fold pathology reduces) - Resonant or Forward voice - Raise and lower pitch - Pitch warm ups |
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7. voice training
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intensity
- Too loud (rating scales) check hearing first - Too soft (teach diagphramatic breathing) or use masking noise - LSVT |
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treatment
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Boone Techniques (70's)
– Humming – Pushing – Chanting – Yawn-Sign Technique – Chewing…. |
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is it effective?
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No systematic research has been conducted on these techniques. Does not mean they are NOT effective, but the evidence to prove they are effective is not there!
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Confidential Voice
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– Used in conjunction with vocal hygiene and resonant voice techniques
– Speak in a soft, breathy tone for several weeks – Only 1 study so far to support it |
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Lessac-Madsen Resonant Voice Therapy (LMRVT)
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- Humming
- Production of “resonant” words and phrases – forward focus of voice - Includes hygiene, confidential voice - Positive treatment outcomes but few studies |
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Vocal Function Exercises (VFE; Stemple)
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- Objective is to restore balance between respiration, phonation, and resonance
- Vocal warm-ups, pitch glides up and down, and prolongation of /o/ at selected pitches - Use front focus and low loudness - Appears to have effective treatment outcomes across multiple studies |