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29 Cards in this Set

  • Front
  • Back
Assessment of Voice
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
Case History
• 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
Description of other relevant behaviors
• Oral Mechanism Exam
• Hearing Test
• Screen for any articulation (e.g., dysarthria) and language issues
• Screen for swallowing issues
Assessment of voice
• 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
perceptual assessment of voice
• Breathing
-Thoracic
-Clavicular
-Diaphragmatic

• Observe for Tension (laryngeal)
Assess vocal registers (pitch)
1.) Description of the client’s vocal registers
-Pulse
-Modal
-Loft

2.) Special pitch problems
-E.g., diplophonia, falsetto, vocal fry, ____________
assessing loudness/intensity
• Too loud
• Too soft
• Monoloudness
assessing quality (resonance too)
Use Your Ear
-s/z ratio: Ratio of 1.4 (1.2 new guidelines) or greater may indicate vocal fold issues
-Reading Passage
-Conversation
listen for??
-Breathiness, Hoarseness, Harshness, Tremor
-Definitions of terms above?
breathiness- incomplete glottal closure resulting in escaping air
hoarsness- noise in the voice
CAPE-V
• 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
6 parameters
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
Objective Assessment Measures (covered by guest)
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)
stimuability
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)
the voice team
• A team is involved for management of ALL voice disorders
-the team includes
SLP, ENT, pysc, surgeon, neurologist, endocronologist, voice coaches
treatment
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)
Direct Approach
1. Listening skills
2. Physical hygiene
3. Mental Hygiene
4. Posture and Movement
5. Regulation of breathing
6. Relaxation
7. Voice training
1. listening skills
• Teaches self-monitoring skills
• Listen for any misuse of voice
• Work on pitch recognition and discrimination
• Match sounds, e.g., various pitches, loudness
2. Physical Hygiene (covered by guest)
• 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
3. mental hygiene
• 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
4 & 5. Posture/Breathing
• 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)
6. relaxation
easy onsets
- Pre-voice exhalation
- Start with vowels, build up to words, phrases, and sentences
6. relaxation
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)
7. voice training
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
7. voice training
intensity
- Too loud (rating scales) check hearing first
- Too soft (teach diagphramatic breathing) or use masking noise
- LSVT
treatment
Boone Techniques (70's)
– Humming
– Pushing
– Chanting
– Yawn-Sign Technique
– Chewing….
is it effective?
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!
Confidential Voice
– 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
Lessac-Madsen Resonant Voice Therapy (LMRVT)
- Humming
- Production of “resonant” words and phrases – forward focus of voice
- Includes hygiene, confidential voice
- Positive treatment outcomes but few studies
Vocal Function Exercises (VFE; Stemple)
- 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