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82 Cards in this Set

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