Voice Disorders

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Degenerative disorders

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Parkinsonism, Progressive supranuclear palsy, Shy drager syndrome, amyotrophic lateral sclerosis, hunington's disease

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Cerebellar disorders

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balance, range, rate, force of movement, all ataxic, ataxic dysphonia, arnold chiari malformation

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Disorder of muscle and myoneural junction

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Myasthemia, myotonic dystrophy

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Misc CNS Damage

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Tourette's, Spasmodic Dysphonia, Laryngeal Aphonia

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Peripheral/Cranial Nerve Damaage

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Palatopharyngeal damage, superior laryngeal, recurrent laryngeal nerve

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Symptoms neurologic disorder

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not in isolation swallowing, muscle control, respiratory control, sort out most important and treatable. May need alt. comm.

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Parkinsonism bio reason

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Degenerative-90% have larynx probs basal nuclei stop produce dopamine which stops motor funct.

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Possible cause parkinson

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head trauma, long term use of major tranquilizer, toxin in environ., genetic/viral.

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Physical effects parkinson

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Tremor, bradykinesia-loss of dynamic movement (rigid), mask like expression which is big comm. barrier, diff. initiating move.

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Voice parkinson

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red. in voluce because respiratory move, low picth, monotone, breathy, hoarse. Slow to begin speech then burst. Dyspahgia (difficulty swallow), dysarthria

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Other probs w/ parkinson

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Not have cog. impair, depression part of disease/reaction, larynx maybe assymetric and bowed vf due to atrophy.

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Treatment parkinson

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Lee Silverman Voice Treatment-must be certified must be done 4-5x's/week for 4 wks. Therapy is hard and exhuasting.
Medicine-L-dopamine

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Lee Silverman Voice Treatment focus

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improve loudness, resp. control, rate does not deal directly w/ artic/swallowing, but does become improved.

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Progressive supranuclear palsy bio reasons

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degenerative-cortex extrapyramidal/pyramidal system typicall pyramidal. cortical bulbar. Later in life in CNS.

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Physical effects of progressive supranuclear palsy

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hypertonicty results in spacticity, hyperactive relfex affects oral reflex.

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Voice progressive supranuclear palsy

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Limited range,force of movement,primary symp speech,motor move. not effect. other motor move., pitch breaks, intonation wacky, hoarseness, harsheness, short pharses, imprecise artic. hypernasal.

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Other stuff progressive supranuclear palsy

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Emotional labial-emotions not match situations, not psycologic it's neruologic. short life 3-5 yrs.

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Shy drager syndrome bio reasons

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degenerative lesions in CNS affects motor/automomic control(resp., heart,digestions) late middle age-early old age. more in M than F short span muscle weakness all over/rigid

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Voice Shy drager syndrome

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reduced range, rate, force of motion, hoarse, monoloud, monopitch, red. stress-poor intonation, red. max phonation, red. resp. support, breathiness, imprecise artic. hypernasl, vf paralysis, alt. comm.

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Amyotrophic Lateral Sclerosis bio reasons

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degenerative Involves UMN and LMNw/ UMN spasticity/LMN weakness, starts in corticospinal/corticobulbar if in CS longer life if in CB 1-3 yrs. m and f =

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Physical probs Amyotrophic Lateral Sclerosis

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overall motor impair, paralysis

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Voice Amyotrophic Lateral Sclerosis

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hoarse hard, slow rate, monopitch, breathy, tromor, hypernasal, prolonged phonemes, swallowing prob. SLP find way to comm.

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Hunington disease bio reason

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degenerative genetic found gene and can screen for it. Autosonomal dominant 50% of all children w/ one parent w/ gene will have.

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Hunington disease emotional effects

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cog. impair and emotional lability, emotional instability, keep unkempt, abusive.

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Hunington disease physical

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motor patterns that cause wrything.

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Voice Hunington disease

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hoarse breathy, strain + struggle, pitch shifts, dec. MPT, inappro. inton.

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Ataxic dysphonia bio

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cerbellar disorder-not seen in isolation effects of cerebellar ataxia-cerebellum weakness from trauma, tumor, viral inf, degenerative

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Ataxic dysphonia if trauma

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should stay consisent

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Ataxic dysphonia if degenerative

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will progressively get worse

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Ataxic dysphonia voice

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range, rate, force of move., monoloudness/pitch, low picth, extreme variation pitch, no control inton, stress, hoarse, breathy, strain and strug. artic impair

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Arnold Chiari Malformation bio

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congenital cerebellar-cause of ataxia, connective tissue holds brain to skull is defective, so squeezing through foramen magnum.

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Arnold Chiari Malformation symptoms voice

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vocal/artic because of cranial nerve nuclei onset grad. sgurically starts as ataxia

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Essential/central tremor bio

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progressive not life threat. cann start anywhere, does effect head/neck/resp. limbs/trunk.

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Essential tremor what happens

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Oscillators send out signals something goes wrong w/ control of signals. rhythmic pulses sent to muscles. In people w/ other neuro disorders

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Essential tremor voice

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Late adolescents-older adult-tremor 5-6hz, hoarse, shaky, breathy, strain+strug, changes in loud/pitch inapp. stress.

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Tourette's syndrome bio

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Mapped gene, extreme OCD, shos up early childhood 3-12yrs becomes worse, not life threat, affects motor behave.

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Tourett's syndrome voice

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strange noises, facial ticks, unusual utter., outburst, diagnosis by neuro. if can focus can be successful. can't change motor behave, vocal abusers

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Tourette's syndrom treat

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good diagnosis, explain situation, enough vocal hygine as you can.

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Multiple Sclerosis bio

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scarring of nerves, myelin sheath around nerve gets scarred, imparis ability to transmit signal. early adult more common near equator. remitt and relapse

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Multiple Sclerosis voice

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weak: speech, swallowing, phonation. red.: louness cont., pitch, pitch cont. short utter, hypernasal, slow sppech, impair resp control. range from normal-unitell.

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Multiple Sclerosis treat

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alt. comm. w/ aphonia, work w/ whatever you can change, medical treat symptoms.

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Spasmodic Dysphonia bio

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part of dystonia, focal dystonia abrupt onset years to get diagnosis spasms of muscles in larynx, cause unknown. onset early adult can be 8-9yrs.

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Spasmodic Dysphonia adductor

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most common only during phonation-spasm closed sound like strangle, probs initating/sustaining, tesnion inc. pitch break dec, intensity, hoarsenes, harshness, strain + struggle, mild-unintell, impact work/social

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Spasmodic Dysphonia abductor

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voicing stops PCA spasms vf open, periodic aphonia, trouble w/ voicing and voiceless.

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Spasmodic Dysphonia treat

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botox used to paralize muscle-through outside of neck into larynx must be careful about eating/drinking voice therapy w/ botox vocal funct. exercise

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Myasthenia bio

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muscus lik substance in nerve synaspe(myoneural junt) autoimmune, prevent acetylcholine-neurotransmitter to cross synapse for muscle contract. early adulthood women 50's men

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Myasthenia Physical

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Muscle function restored after rest progressively worse through day, muscles attached to CN are more succeptable than muscle to spinal nerve.

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Myasthenia voice

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muscles get tired after 30-40 sec late in disease treated w/ tensilon/prostigmine. myasthenia laryngis only voluntary muscles.

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Myotonic Dystrophy bio

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many diff. dystorphy, weakness+paralysis of facial+laryngeal muslces, progressive early adulthood. genetic autosomal

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Myotonic Dystrophy voice

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breathiness+fatigue slurred aphonia, dec. pitch+intensity, swallowing

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Laryngeal apraxia bio

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damage to premotor area of the frontal lob broca's area plans which muscles to activate in which order. Maybe w/ oral or whole body from stroke/trauma

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Laryngeal apraxia voice

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normal-aphonic, trial and error effors for phonation, trouble start phonate, silent groping, slow, labored, inconsistency in quality.

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Peripheral/Cranial Nerve Damage

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CN X Vagus-strke, trauma, heart surger, cervical spin fusions, viral, idiopathic. lesions can be intramedullary and extramedullary CNX nuclei location

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Palatopharyngeal unilateral damage

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weakness of velum + pharynx effecte mild-severe hypernasal/food out nose, mild nasal emission of air on pressure consonants-worse for bilateral

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Superior laryngeal damage unilateral

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cricothyroid in larynx-red. in change in pitch, mild breathiness/hoarseness, dec. med. compression, dec. intensity, cause epig. to shift to one side.

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SLN damage bilateral

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mod-severe: ability change pitch, impaired intensisy, monotone, dec. intonation, hoarse/breathy, personal amp. device, teach to use extrinsic.

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Recurrent laryngeal nerve unilateral

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abductor-1 vf stuck open cataveric position, mild to mod swallow, breathy, low pitch range, vocal fatigue, use working vf, ENT can push paralyzed vf toward midline dec all probs, but hoarseness

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RLN bilateral

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vf stuck open, abductor paralysis cricothyroid can produce enough tension to move toward midline, but no PCA to move away.

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RLN bilateral voice

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sounds good, can't take deep breath, worst airway during physical activity, nothing can be done, breathing phrasing, glottal closure gone, comp. w/ vent. folds.

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Treatment basis

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what caused, will it get worse, how bad is damage?

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Treatment nerve lesions

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best chance of treat. low/unilateral, teach abusive habits because won't be abusive because not enough force. teach GCR, inc. tension so can id sensation, throat clearing and coughing because inc. vf closure inc. intensity, and inc. ability change int.

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Teach nerve lesions

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teach GCR, inc. tension so can id sensation, throat clearing and coughing because inc. vf closure inc. intensity, and inc. ability change int.

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Respiration help nerve lesions

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help w/ good resp. support, deep inhale, controlled exhale, work, also teach stress/intonation patterns, work on range and variability w/ extrinsics. biofeedback on CSL

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Basics about nasal cavity

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always same resonant freq, mouth changes resonants moving structures, all lang. have balance bt oral and nasal sounds. mnng and adjacent vowels

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Causes of excessive nasal resonants

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soft palate and pharynx paralysis, anatomic anomolies, and cleft palate.

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Hypernasality

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semivowels and vowels cannot measure it's qualitative, effects more speech tahn hypo. mild-severe. not voice doesn't originate in larynx.

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Hyponasality

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dec. nasality on mnng and adjacent vowel caused by adenoids, tonsils, polyps, deviated septum, preferred by listeners

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Hypernasality and Hyponasality treatment

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cannot fix probs due to velopharyngeal closure-surgery and prostethis.

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stridency

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learned lest likely to most are vocal abusers-metallic sounding voice-tightened muscle of pharynx. middle aged men-aggressive, hard glottal, tension.

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Stridency voice treatment

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shift down melodic resonants, dec. percep of hypernasal w/ very percise artic. open mouth and rate give palate a chance to work the best. check velopharyngeal competence.