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82 Cards in this Set
- Front
- Back
Functional disorder
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no physical basis psychogenic can range from mild to severe sound like someone w/ organic
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Types of functional disorders
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ventricular phonation, conversion disorder,mutational falsetto, pardoxical vf movement
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ventricular phonation
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can be functional disorder related to emotional state true vf and vent. vibrate @ diff. freq. diplaphonia
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conversion disorder
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can take place anywhere, loss of voluntary control over striate muscles. may result in paralysis, hearing loss, not caused by physical prob.
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reason for conversion disorder
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serves a purpose by removing person from stress brain's way of coping over long periods. More common in woman becoming more common in children.
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coversion disorder types
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mutism, conversion aphonia, conversion dysphonia
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mutism
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no attemps @oral prod. everything is normal/vegetative functions normal laryngeal funct. noted by coughing and throat clearing. not worried about not talking. chronic stress
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Conversion aphonia
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80% are women only produce whispering caused by anger, conflict stress in life, maybe be acute stress, had coversion b4 no distress about aphonia
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conversion dysphonia
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hoarse, breathy, harshness: ranging from one setting to hoarse all of the time.
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Treat coversion disorder
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begin with vegetative behavior (cough/throat clearing)cough->phonation->cough->sustained phonation->change vowels->then consonants->normal phonation
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Treat conversioin disorder maintenance
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come back w/ someone they trust to practice in therapy room. long term phonate in public, no need to reduce vocal abuse.
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Mutational falsetto/puberphonia
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seen in young adult males: persistent use of pre-adolescent voice after puberty not conscious, no physical prob, emotional immaturity
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characteristics puberphonia
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psychological out, high laryngeal position, weak, breathy, only medial edge vibrate, bad medial comp. sound like poor breath support, but not not using correct.
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Therapy puberphonia
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not motivated for therapy teach deep breathing, use vegetative function and shaping into speech. using voice outside diff. easier practice w/ strangers make referral psychiatrist
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Child like speech
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version puberphonia in female dress young, child like artic. and lang. exaggerated facial and intonation
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Results child like speech
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emotional respone to being treated like cute child. marry ment wo are willing to care no reason for change.
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therapy child like speech
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deep breathing, vegetative function, refer to psych
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Pardoxical vocal fold move
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vocal fold clousure when breathing in people perfectionist. eating disorders, mostly young women. nothing looks wrong misdiagnose asthma.
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Pardoxical treat
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deep breathing then constrict lips blow 5x's 15x's a day
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transgender voice
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not many female to male patients-male to female-can raise voice above 165Hz can appear female. hardest will be non-verbal and intonation
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Case History parts
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source of info, rapport w/ patient, general communication, background info
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Source of info case history
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limited to the one's patients give get from: ENT, other SLP, teachers coworkers, family
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Rapport w/ patient for case history
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not get good info if not good rapport
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General comm skills for case history
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eye contact, able to respond, good conversational skills, learn coop.
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Background info case history
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bio, health-med prob, intubation, surgery, injury, family history, overall health, onset of prob-when/percept acute/slow anything preceed, patient's descrip.
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Voice eval gen concepts
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describe voice determine appropriate treatment. may or may not get max pref. because people asked to do things they don't norm. do.
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Voice eval goals
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define charc., limits of ability, id what's wrong, need for related treat, need for treat, determine severity, prognosis therapy, cog. impair, interpersonal, cause, tailor assessment.
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Laryngectomy
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part/all larynx removed, presence of malignant tumor, severe laryngeal trauma, non funct larynx
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laryngectomy impact on communication
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partial: some ability to comm, may be hoarse breathy or other abnorm. Total: need alt. comm.
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Cause of cancer
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smoking: amount and duration alcohol add to smokers risk inc. 50%, occ. exposure chem/smoke, gentic, diet, reflux.
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cancer stats
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1-2% of all cancers comprises 20% all head/neck cancers new cases: m 10,000 f-2,200 deaths m-3,000 f-750
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Early glottic
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T! lesions involves only one vf, normal mobility, options: endoscopic laser resection, radiation
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Moderate to advance glottic cancer
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T2-T4 radiation therapy v chemo RT, partial laryngectomy, supracricoid laryngecotmy, total.
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Symptoms of laryngeal cancer
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hoarsness, dyspnea, stridor, dysphagia, coughing, expercotoration of blood.
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signs of cancer
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lump in neck tenderness in laryngeal area, lack of sound fullness, cricothyroid/thryhyoid membrane, whitish irregular lesions in vf
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Role of SLP for cancer
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per operative consule, referral by physicia, meet patient prior to admit, meet w/ patient's family, find best mode of comm.
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Other roles of slp cancer
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be cognizant of referring practices of physicians some may advocate esophageal speeech, some may pan to TEP, provide info, discuss concerns, help after sugery.
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Modes of alaryngeal speech
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artificial larynx, esophageal speech, tracheoesophageal speech
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advantages of artifical larynx
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easy to train, immediate restore of speech, portable
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disadvantages of artifical larynx
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mech. sound, require use of onne hand, limited control of pitch, operating expense, battery dependant.
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esophageal speech
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2 tbs of air on one max injection 2-3 words on one inject, diff to learn, cannot inject if PE segement is too tight, diff. to hold air if PE is too flaccid
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Advantages of esophageal speech
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no ext. device, more natural sound, hands free
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disadvantage of esophageal speech
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hard to learn artic. must be excellent, low vocal intensity.
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Trachesophageal speech
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small puncture is made through tracheoesophageal party wall into the esophagus and prosthesis w/ 1 way valve is place in tract.
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TEP
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primary puncture at time of laryngectomy, sec. punture 6 wks post op, maitain puncture w/ catheter.
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TEP prosthesis
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indwelling: extended wear place and removed by SLP/MD ex dwelling are removed and cleaned by patient
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General assessment of reading/conversation
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severity-perceptual, quality-perceptual, intell-if reduced why tape and listen again to see if correct
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Describe structure and funct
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need good info from ENT to deter if the funct is as good as can be for structure that is present
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respiratory adequacy for phonation
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reading, s/z ratio, max phonation time, vital capacity, phonation quotient, stridor, coughing/throat clearing, fund. freq, dB three trials each
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reading
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check for resp. support, used for one who does not converse well Do they run out of breath?
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max phonation time
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how long can sustain a vowel 20-25 sec adult/7-10 sec child
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s/z ratio
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how long sustain s/how long sustain a z. normal ratio 1 above 1.5 lesion, above 2 neurologic/big lesion, but it's not diagnostic
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stridor
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not ever normal indicative of not getting enough resp. support
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glottal closure reflex
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normal used to stabilize thorax
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coughing/throat clearing
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if can't neurological work on swallowing
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Pitch
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measure fund freq. range, habitual pitch, optimum pitch, pitch perturbation, quantifiying pitch variables.
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Pitch measured?
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reading, speaking, sustaining vowel-quantifiable measure done w/ CSL
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Uh-huh method
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gives a good estimate of optimum pitch
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Yawn sigh approach
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yawn to sigh measure middle sigh for optimum pitch
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siren method
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begin @ comfy range go as high as they can for optimum pitch
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Jitter rates
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Normal jitter rates womean .65% men .9 up to 1% okay. must used sustained vowel for jitter higher jitter typically correlated w/ hoarseness
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Pitch perturbation
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jitter cycle to cycle variation in freq.
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Intensity
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overall intensity in conversation is 50-60dB
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Range of intensity
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perceptually indicated by appropriate intensity range. If in appropriate measure w/ CSL
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Depression
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may show lack of intensity range
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intensity perturbation
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cycle to cycl variation in loudness shimmer
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Shimmer
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too much percieved as hoarseness calculated in dB should be under .5 dB and lower than men
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Qualitative
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perceptual quality, pitch loudness (hoarseness, breathiness, harshness, tremor, strain/struggle, diplphonia, vocal fry)
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Hoarseness
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lack of clairy in vocal tone, assoc. w/ increased jitter/shimmer. Due to any type of voice disorder big charac. of non normal voice can occur w/ strain/struggle, breathiness
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breathiness
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audible air escape during phonation can be learned caused by lesion/paralyzed vf not diagnostic may occur w/ harshness, tremor, assoc. w/ decrease intensity
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harshess
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assoc. w/ muscle tension hard glottal attacks, hard onset, assertive business, vocal fatigue + pain. usually learne but can be neurologic assoc. w/ degenerative disease.
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tremor
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reg. rhythmic variation in pitch and loudness not under voluntary control. always neuro. may only have tremor. rarely interferes w/ swallowing/intell.
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strain/struggle
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sound like strangle diff. in initiation and controlled phonation. voice fades in/out. phonation can stop mid utter. neuro/learned. stress and tension people who talk on res. air
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vocal fry
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poor resp support can be ween w/ any
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diplophonia
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two diff freq vibrating usually functional, but can be psysiologic.
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sites of vf hypertension
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sites of stress. observabal tens in neck, reports of v fatigue/pain @ end of day. hard gloatl attack and strained voice quality. function rarely neuro. first symptom of bad disorders.
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Role of SLP pre-op consult
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referral by physician, meet patient prior to admission, meet w/ patients family, so patient may listen better.
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Role of SLP pre op
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provide info, discuss concerns, help after surgery, reinforce essential info, correct misunderstand, allow time for ?, discuss comm. opt.
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pre op physiological impact
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can, conccern about diagnosis/survival
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post op physiological impact
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concern about comm. adjustment, fear of cancer, recovery, adjust to anatomic changes, caring for stoma, manage necess. equip.
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Psychosocial concerns
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health, cancer, econmoic, family, marriage, loss of id.
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Role of SLP laryngectomy
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support, training, ed for pre-op, w/ patient and family, maintenance and care for devices, helping w/ novel experiences and prob solve, being up to date with current
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