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Voice (ST's role (Conduct voice assessments , Educate, implement…
Voice
ST's role
Conduct voice assessments
Educate, implement treatment protocols
Evaluate treatment outcomes to monitor progress
Provide indirect (modify vocal abusive behaviours-improve vocal hygiene reduced excessive things they do in ADL), direct (therapy voicing exercises)- can use microphones, whistles instead
Appropriate info, counselling
Act as multidisciplinary team member eg. with ENT, psychologists, singing teachers, gastroenterologists
Function of voice
Audbility
Paraling features: personality, emotions
Ling features: grammar eg. high rising terminal helps us ask qns, but sometimes might not be intending to ask qn
Influence social interaction
Exert control over listener: pt can manipulate vol, pitch, quality
Enables listener to make inferences about speaker
Normal voice
Loudness: voice loud enough to be heard- depends what culture perceives
Pleasantness: X dysphonic qualities
Flexibility: to express emotion
Representation: matches age, gender
Production
Hygiene: voice produced w/o vocal trauma, laryngeal lesions
Causes of voice disorder
X appropriate voice use eg. habitual, non-productive throat clearing, shouting, vocal noises, abusive singing, talk too fast. Vocal folds pushed to their limits, too much friction, Speak loudly/screaming in noisy backgrounds=Lombard effect
Infection, disease eg. papillomatosis, laryngitis,gastroesophageal reflux: acid can spill onto larynx, pharynx
systemic change eg.dehydration, pharmaco agents, hormones
Congenital: eg cleft palate, laryngeal web
Physical trauma eg. intubation injury
surface irritation eg. smoking
Parameters of voice
Pitch
too high/low
monopitch
reduced range
uncontrolled
F0 in Hertz
No. of vocal fold vibratory cycles/second
Determined by vocal fold mass, length, tension
Male: 100-150Hz
Female: 180-250Hz
Loudness
Too high/too low
mono-loudness
Reduced range
uncontrolled
Vocal intensity (dB)
Amplitude of sound wave
Varies w respiratory airflow, subglottal pressure, vocal fold resistance
Conversational speech=75-80dB
Quality
Perception of how clear a voice sounds eg. roughness in voice-assume they smoke, It is dysphonic; breathy voice but breathy voice can be disordered also
Variations
Vocal fold config (mass, tension, length)
Regularity vocal fold vibration
Degree of vocal fold closure
Supra-glottic config (muscle tension)
Types
Strain: excessive effort, tension, constriction vocal tract, over adduction vocal folds
Breathy: perception of excessive air leakage during phonation, vocal folds X completely adducted during closed phase of vibratory cycle
Rough: lack clarity, bcos irregular vibration vocal folds
Glottal fry: rapid series low pitched pops/tap, creaky quality
Vocal behaviours
Pitch break: sudden, expected involuntarily high/low pitch in convo
Phonation break: sudden, involuntarily, short breaks during voice production
Tremor: involuntary rhythmical variation in pitch/loudness voice
Resonance
Relates to oral, nasal quality In voice
Reflects degree of
Velopharyngeal closure upon phonation air escaping thru nose
Types
Hyper nasality
Hypo nasality
Mixed nasality
Voice production
Lungs (power): air breathed out
Vibrating airstream: modified by articulators (filter), resonators
Larynx (source): expiratory air passes b/w vocal folds, vibrate, produce sound source of speech mechanism
Types of vocal disorders
Fnal
Caused by faulty habits voice use, psychoneuroses, personality disorder
Muscular tension dysphonia
Vocal nodules, vocal polyps
Fnal dysphonia-psychological causes
Psychogenic voice disorders: total, partial loss phonation bcos conversion rxn
Physical symptoms X linked to anatomical/psychological disease
Organic
Due to physical abnormality in structure @ sites in vocal tract
Contact ulcer
Intubation granuloma
Cancer
Endocrine changes
Papilloma
Laryngeal web
Neurological
Bcos imbalance in coordination neurological structures, processes involved in normal voice
Vocal cord palsy. Causes are: thyroidectomy, heart, lung transplants, penetrating injuries to larynx, chest
Parkinson's disease
Spasmodic dysphonia/laryngeal dystonia
Definitions
Voice
Medium thru which speech produced
Sound vibration of vocal folds w/i larynx
Modified by articulators, resonators of speech mechanism--> speech
Voice disorder
Aphonia: absence of voice
Dysphonia: abnormal voice
Quality, pitch, loudness, flexibility differs from voices of others of similar age, sex, cultural group
Structures voicing
Explanation
Cartilages, bones
Muscles (extrinsic, intrinsic)
Nerves
Child vs. adult
VF child < adults (6-8mm)
Membranous, cartilaginous portions of VF equal
Child: softer cartilage, lax supporting ligaments
Testosterone thickens laryngeal cartilage in M, mass 2x that of women
Narrower part adult larynx-glottic opening
Narrower part child larynx- cricoid cartilage
Children: Larynx more anterior, superior
Minor changes laryngeal soft tissue oedema--> marked changes airflow resistance (1mm swelling--> increased breathing effort 40%. Below larynx swelling more severe in child if diameter smaller
Assessments
Types
Perceptual
Use voice profiles: CAPEV, GRBAS
diff rating scales: Dysphonia- 2 phonations
Instrumental
Laryngeal exam
Computer based assessments of respiration, laryngeal dynamics, vocal fold vibratory patterns, acoustic analysis
ENT evaluation: rigid, flexible fiberscope, spirometry, laryngeal airflow, electroglottography (electrical muscle mvm vocal fold), spectrogram (need to know if C or V produced)
QOL, impact voice disorder questionnaire
Occupational/vocation effects: Is employment affected by voice problem, daily communication effects
Is voice problem making you withdraw socially? Ppl cannot unds you?
Emotional effects eg. embarrass
Impt notes
Voice assessments: Need to do prior to treatment starting (baseline), after treatment ends (evaluate treatment outcomes).
Re-assess pt after pre-determined period of time post treatment to evaluate generalisation, retention skills learnt in clinic
Treatment
All clients w suspected voice disorder needs ENT exam before voice therapy. Need the diagnosis from ENT first. Eg. Reinke's edema X be treated by therapy
Types
Indirect: Vocal hygiene, conservation strategies, counselling
Direct treatment: voice techniques to facilitate normal voice production, enhance voice efficiency, how to retrain way speaker uses their voice
Service delivery: Indv therapy-usual practice