Assessment Flashcards
What is the most important procedure a clinician must do to diagnose a voice disorder?
Look at larynx
What does a typical voice evaluation consist of?
- Patient history
- voice sample-sustained & connected
- perceptual analysis (subjective)
- acoustic analysis (objective)
- Stroboscopic assessment
- Respiratory assessment
- Resonance/VP assessment
- Recommendations/POC
Name two types of perceptual analysis? (subjective)
- voice handicap index (Patient)
- Consensus auditory-perceptual evaluation of voice (SLP)
Perceptual analysis is _______.
subjective
Acoustic analysis is _________.
objective
What is a subjective voice analysis?
Perceptual
What is an objective voice analysis?
Acoustic
What is a type of acoustic analysis?
Multidimensional voice profile (MDVP)
What are the types of respiratory assessment?
- spirometry
- manometry
- pneumotachometry
What are types of resonance/vp assessment?
- nasopharyngoscopy
- nasometer
What happens during plan of care?
- Explain everything you found
- recommendations
What happens in acoustic analysis (MDVP)?
Feed voice into computer where it outputs/reads stats.
What is the voice handicap Index?
It’s the perceptual analysis of voice from the client’s perspective (subjective).
What is the consensus auditory perceptual evaluation of voice (CAPE-V)?
Its’ the SLPs perceptual analysis of the client’s voice.
What is pneumotachometry?
Measure of cough.
_______ ________ _______ is the perceptual analysis of voice from the client’s perspective (subjective).
Voice handicap Index (VHI)
________ ________ _______ _______ of ______ is the SLPs perceptual analysis of the client’s voice.
Consensus auditory perceptual evaluation of voice (CAPE-V)
What do you do if you are assessing a client for voice, but the client states that she is also having swallowing problems?
Clinician assesses swallowing.
How long does a typical voice evaluation without respiratory or resonance assessment last?
Typically 1 hour
What do you typically look for during an oral facial exam?
- cleft palate
- dentition
- shine strobe light on palate
Why would you do a hearing assessment for a person with voice nodules?
They usually speak loudly, and sometimes its due to a hearing loss.
What is electromyography (EMG)?
It is one way to measure muscle activity through the use of strategically placed electrodes.
-Measured in volts
What is EGG?
Measures mean flow rate (MFR) or airflow at glottis
What is included in the patient history of the assessment?
- History of Problem
- S/S: voice quality, pitch, resonance, loudness, reflux?, throat clear?, cough?, swallow probs? pain?
- social hx
- Related medical hx
- vocal hygene:
What is included in the Hx of the problem? for patient history?
- origin
- duration (when did it start)
- severity
What are the signs and symptoms you ask for in patient history?
- voice quality
- pitch
- resonance
- loudness
- reflux (heart burn, indigestion)
- throat clear
- cough
- swallow problems
- pain
- how would you describe your voice?
What does the clinician ask as part of the social history?
how do you use your voice?
What is included in related medical history in patient history?
- surgeries
- allergies
- URI/respiration
- psych/depression
- medication list
What do you want to know about vocal hygiene in patient history?
- intake of caffeine
- smoke: pipes, cigar, hookah
- hydration
What are some medications that can have an impact on voice?
- thyroid medication combined with another medication
- ADVAIR 500
- Inhalors
_________ medication should not be combined with anything else because it can have an impact on voice.
Thyroid
What is a side effect of Advair 500?
voice loss
What medication can cause white patches in larynx?
Inhalors
Name two methods used to obtain images of vocal folds.
- Oral RIgid Laryngoscopy w/ strobe light (video stroboscopy)
- Transnasal Flexible laryngoscopy
Which method uses an oral endoscope and strobe light instrument to be placed into the back of the mouth to observe vocal folds.
Oral rigid laryngoscopy
What is the fastest scoping procedure?
oral rigid laryngoscopy
It doesn’t even take two minutes
When does the video stroboscopy take a picture of the vocal folds?
Each time it flashes its taking a photo
How fast do vocal folds move?
100 vibrations per second
What are the disadvantages of oral rigid laryngoscopy)?
- It doesn’t slow anything, hence, can’t see every larynx frame.
- Not bypassing gag reflex, patient might gag.
- Invasive procedure
What are some tips with oral rigid to get a good look at larynx?
- Place oral endoscope at a 70 degree angle in the back of the tongue to see larynx
- avoid uvula between pillars
What are the disadvantages of a transnasal flexible laryngoscopy?
- less magnified
2. less resolution
What is the purpose of dual windows in laryngoscopy?
Make assessment one day and make them come again on a different day to examine the larynx again to compare.
Which imaging technique uses a flexible endoscope passed through the nasal cavity to examine the larynx?
Transnasal flexible laryngoscopy
What is transnasal flexible laryngoscopy?
An imaging technique that uses a flexible endoscope passed though the nasal cavity to examine the larynx.
How does the client rate the sentences in voice handicap index (VHI)?
Client rates each sentence as it pertains to his/her voice now. On a scale of 0-4; never to always.
How many statements are in the voice handicap index (VHI) and what are the the sections?
There are 30 statements.
First 10 statements are functional.
The next 10 statements (10-20) are physical
The last 10 statements (20-30) are emotional
What is the ceiling of the voice handicap index (VHI)?
61-120 is severe (BAD)
How is the severity rated in voice handicap index (VHI), perceptual analysis?
1-30: mild voice disorder
31-60 moderate voice disorder
61-120 severe voice disorder
What do you need to see severity of a voice disorder with the consensus auditory-perceptual evaluation of voice (CAPE-V)?
ruler
What are the parameters assessed during the consensus auditory-perceptual evaluation of voice (CAPE-V)?
- roughness
- breathiness
- pitch
- loudness
- strain
How are the parameters in the CAPE-V assessed?
- sustained vowels /a/ and /i/ for 3-5 seconds
- Patients have to read six sentences
- spontaneous speech in response to “tell me more about your voice problem”
What does the clinician do when assessing the parameters from the CAPE-V?
Clinician places an X on the continuum of mildly deviant, moderately deviant, severely deviant
What is a type of acoustic analysis?
Multidimensional voice program that reports quickly by analyzing the sustain phonation of “ahhhh”
What doe Multidimensional voice program (MDVP) recognize based on fundamental frequency?
Gender of person being assessed.
When assessing voice using the Multidimensional voice program (MDVP) which fundamental frequency is more realistic?
Running speech fundamental frequency is more realistic than sustained phonation fundamental frequency.
Describe and interpret the different parts of the MDVP report.
The spectogram at the top is a visual representation of the voice production X: time, Y: amplitude
Lime green: Where the person should be
Olive green: what they have produced within normal limits
Red: what they have produced outside of normal limits
When assessing professional singers what are you looking at?
Looking at dynamic range and semi tone. Enough semi tone or are they missing ranges?
Is their pitch normal, too high, too low?
How does the montage on the screen of the videosctroboscopy results look?
Ten frames in a row; which is shown to the doctor
What are the parameters that are rated from a videostroboscopic examination?
- vocal fold edge
- glottal closure
- phase closure
- vertical level of vf approximation
- amplitude
- mucosal wave
- vibratory behavior
- phase symmetry
- periodicity
- hyperfunction
What are you looking for when examining the edges of vocal folds?
smoothness; are there any lesions
What is glottal closure?
The degree to which the vocal folds close during maximum adduction during phonation.
What is phase closure?
The degree to which the vocal folds move together during vocal fold closure during phonation.
What is the vertical level of vocal fold approximation?
The degree to which the vocal folds meet on the same vertical plane during phonation.
What is the rating scale for the parameters rated from a videostroboscopy?
1-5; smoothness - roughness
What is amplitude of vibration?
The degree of movement from the medial to the lateral aspects of the vocal fold during phonation.
What is mucosal wave?
The assessment of the degree of traveling wave that is present on the superior surface of the vocal fold during phonation.
When does amplitude increase?
If client gets louder.
What is vibratory behavior?
Identification of portions of the vocal fold that are non-moving during phonation.
- Doesn’t mean they don’t have VF vibration
- If absent, probably due to cancer
What is phase symmetry?
The degree to which the vocal fold move symmetrically during vocal fold closure during phonation.
What is periodicity?
regularity of successive cycles of vibration during phonation.
-Normal period of vocal fold vibration
What is hyperfunction?
Extraneous activity in the form of ventricular compression/phonation and/or A-P press.
________ is extraneous activity in the form of ventricular compression/phonation and/or A-P press.
Hyperfunction
___________ is regularity of successive cycles of vibration during phonation.
Periodicity
_______ ________ is the degree to which the vocal fold move symmetrically during vocal fold closure during phonation.
Phase symmetry
________ ________ is identification of portions of the vocal fold that are non-moving during phonation.
vibratory behavior
_____ ______ is the assessment of the degree of traveling wave that is present on the superior surface of the vocal fold during phonation.
mucosal wave
________ of _________ is the degree of movement from the medial to the lateral aspects of the vocal fold during phonation.
Amplitude of vibration
_____ _____ of _____ _______ is the degree to which the vocal folds meet on the same vertical plane during phonation.
Vertical level of vf approximation
_____ ____ is the degree to which the vocal folds move together during vocal fold closure during phonation.
phase closure
_____ _____ is the degree to which the vocal folds close during maximum adduction during phonation.
Glottal closure
Name three types of respiratory assessment.
- Spirometer
- Manometer
- Pneumotachometer
What does the spirometer measure?
Measures respiratory flow, volumes, and lung capacities
FVC, FEV 1
What does the manometer measure?
Measures air pressure
Maximum inspiratory pressure (MIP)
Maximum expiratory pressure (MEP)
__________ measures respiratory flow, volumes, and lung capacities.
Spirometer
______ measures air pressure.
Manometer
What does the pneumotachometer measure?
Measures cough strength (peak flow), inspiratory muscle phase, laryngeal compression (of vf’s) phase
Name two types of resonation assessment.
- Nasometer
2. nasopharyngoscopy
What does the nasometer measure?
Measures nasalance
What does the nasopharyngoscopy assess?
Assesses vp closure
What is included in POC/recommendations?
-patient education
-modified voice rest
-voice home exercises
-reflux management
-vocal hygene
-voice therapy and or re-eval
referral for something else?
