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Voice > Assessment and treatment > Flashcards

Assessment and treatment Flashcards

0
Q

When must an SLP withhold their diagnosis?

A

until the ENT has evaluated

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1
Q

Ideally, when should the SLP evaluate the voice?

A

after the ENT has evaluated

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2
Q

When can SLPs and clients make treatment decisions?

A

after the client has seen the ENT

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3
Q

What ways can we inspect the larynx?

A
  • mirror laryngoscopy
  • endoscopy
  • strobascopy
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4
Q

What is a mirror laryngoscopy?

A

when a dental mirror is used to look at the vocal folds

-requires a good mirror and light source

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5
Q

What is an endoscopy?

A

a flexible scope that goes through the nose and shines down into the laryngeal space

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6
Q

what is a strobascopy?

A

when a strobe light causes the VFs to appear to slow down

-can help identify pathologies

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7
Q

How can an SLP screen a voice?

A

a connected speech sample

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8
Q

What percentage of school age kids have a voice disorder?

A

5-10%

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9
Q

What do we assess during normal voice screening?

A

loudness, quality, resonance, and pitch

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10
Q

What is one of the voice programs used for children?

A

Boone voice program for children

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11
Q

Explain the Boone voice program for children

A
  • assess different things about the voice on a three point scale (-/+/N)
  • Boone indicates that any plus or minus area should be reassessed in a few weeks
  • if plus or minus on any area after rescreening, refer to an ENT
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12
Q

What does a complete voice evaluation include?

A
  • description of the structure and function of the larynx
  • make recommendations for treatment
  • case history
  • perceptual eval
  • acoustic eval
  • assess emotional status
  • look at the consequences of the disorder and assess the vision and hearing
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13
Q

What does a good case history include?

A

patients description of the problem

  • onset and duration
  • variability
  • daily voice use
  • history of previous treatments
  • medications
  • vocal abuse checklist
  • fluid intake
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14
Q

What are some examples of non-instrumental assessment measures?

A
  • voice oral mech
  • perceptual ratings: CAPE-V, Gerbis
  • Voice handicap index
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15
Q

What are instrumental measures?

A

when you have something to aid in your assessment

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16
Q

What are some instrumental assessment measures?

A
  • endoscopy
  • laryngoscopy; direct or indirect (using a mirror)
  • acoustic assessment
  • aerodynamic evaluation
  • electroglottography (EGG)
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17
Q

What does an acoustic assessment include?

A
  • frequency
  • intensity
  • perturbation
  • spectrographic analysis
  • signal to noise ratio
  • analysis of dysphonia in speech and voice (ADSV)
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18
Q

How can you assess a person’s frequency with acoustic assesment?

A

connected speech sample (men are around 125 and woman are around 200)

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19
Q

What is frequency variability and how can you assess it?

A
  • the range of frequencies used in connected speech; measured in standard deviations
  • a normal SD is 20-30 hertz
  • if a person has more than one standard deviation, that is uncommon and indicative they have problems with controlling their voice
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20
Q

What is maximum phonation frequency range?

A

measure of the maximum range you can get

-measured in octaves

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21
Q

What kinds of things can be assessed involving intensity?

A
  • habitual intensity
  • intensity variability
  • intensity dynamic range
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22
Q

What is intensity variability?

A

range of intensity levels in connected speech

-we expect about 10 dB of differences in unemotional sentences

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23
Q

What is intensity dynamic range?

A

from your softest non whisper up to your loudest shout

-50-115 dB is a typical range

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24
Q

What is perturbation?

A

refers to the variability or irregularity of a system

-cycle to cycle variation measures of the system

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25
Q

How can we assess perturbation?

A

having a person sustain a vowel

-we are measuring jitter and shimmer

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26
Q

What is considered normal jitter?

A

around 1% or less

-Visi pitch calls it relative average perturbation

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27
Q

What is considered an average amount of of shimmer?

A

2.5% or less

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28
Q

What is a spectographic analysis?

A

a frequency by intensity time display

-frequency is on the Y axis and intensity is on the X axis

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29
Q

What is signal to noise ratio?

A

refers to the amount of energy in your frequencies and harmonics

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30
Q

What is considered noise in signal to noise ratio?

A

breathiness and other irregularity

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31
Q

What is a normal signal to noise ratio?

A

12/1 (12 units of voice for every unit of noise)

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32
Q

What does signal to noise ratio correlate best with?

A

a clinician’s perception of dysphonia

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33
Q

Explain the analysis of dysphonia in speech and voice (ADSV)

A

analyzes speech based on a cepstrum

-it’s seeing how much the harmonics of the voice emerge from background noise

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34
Q

What is similar to signal to noise ratio?

A

analysis of dysphonia in speech and voice (ADSV)

-but we get ADSV from running speech

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35
Q

What kind of will a normal voice look like on the ADSV?

A

very well defined fundamental frequencies and harmonics

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36
Q

What is a cepstral peak?

A

spike on the graph that shows you have well defined harmonics

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37
Q

What kind of cepstral peak will have will someone with dysphonia have?

A

an ill-defined peak “noisy voice”

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38
Q

What can the numbers on the cepstral peak prominence tell you?

A

high peak = high numbers, means a normal voice

low peak = low numbers, means a dysphonic voice

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39
Q

What kind of ratio does the cepstral peak prominence peak?

A

low/high ratio

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40
Q

What is the cepstral spectral index of dysphonia?

A

a multivariate estimate of perceived dysphonia

-supposed to be a numerical back up of the perceptual rating on the CAPE-V

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41
Q

What kind of numbers would a mildly dysphonic voice have according the the cepstral spectral index of dysphonia?

A

around 38

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42
Q

What kind of numbers would a moderately dysphonic voice have according the the cepstral spectral index of dysphonia?

A

around 49

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43
Q

Can numbers of the cepstral spectral index of dysphonia be above 100 or below 0?

A

yes-below 0 means very normal voice and above 100 means very bad voice

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44
Q

What kind of things are assessed during aerodynamic evaluation?

A
  • things that tell you about the valving of the larynx
  • lung volumes and capacities
  • air pressure
  • air flow
  • laryngeal resistance
  • duration
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45
Q

How much air pressure does normal speech need?

A

5-10 centimeters of water

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46
Q

How much air pressure capacity do most humans have?

A

up to 50 cmh2o

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47
Q

How can you make a tool to measure air pressure?

A

with a straw and water container; mark the container

-see if client can blow bubbles at certain depths

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48
Q

What is assessed with airflow?

A

the volume of air that passes through the glottis in a specified amount of time

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49
Q

What is airflow measured in?

A

CC/sec or mL/sec

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50
Q

How can airflow be assessed?

A

usually by sustaining a vowel

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51
Q

What kind of air flow would someone with a breathy voice have?

A

high airflow

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52
Q

How much airflow would someone with a normal voice pass through their glottis while sustaining /ah/?

A

100 cc/sec

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53
Q

How much airflow would someone with tight strained voice pass through their glottis while sustaining /ah/?

A

less than 100 cc/sec

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54
Q

What is laryngeal resistance?

A

a ratio of intra-oral pressure to peak airflow while creating the /pi/ sound

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55
Q

What does less resistance t the glottis mean?

A

the voice is breathy

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56
Q

What kind of laryngal resistance does a tight sounding voice have?

A

a lot of glottal resistance

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57
Q

What is an electroglottography (EEG)

A

a test that uses electrodes on either side of your thyroid that pass a current from electrode to electrode through the larynx

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58
Q

When the vocal folds are open, is there more or less resistance for an electroglottography (EEG)?

A

more resistance

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59
Q

Does resistance for EEG increase or decrease when the glottis is closed?

A

decrease

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60
Q

What causes the wave appearance of the EGG?

A

the appearance of more or less resistance of the vocal folds

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61
Q

What does the EGG help you visualize?

A

how long the folds are staying in each phrase (open and closed)

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62
Q

What does the best kind of evaluation involve?

A

both instrumental and non instrumental measures

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63
Q

What are some simple types of instrumentation that aid in speech evaluation?

A

keyboard, pitch pipe or tuner, sound level meter, spirometer

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64
Q

What are some higher tech things you can use to help with voice assessment?

A

Visi-Pitch, computerized speech lab, phonatory aerodynamic system, videostraboscopy, rigid scope, flexible scope, ambulatory phonation monitor

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65
Q

What is a sound level meter?

A

helps you look at intensity measures (habitual itensity, etc)

66
Q

What does a computerized speech lab?

A

measures very similar things to the Visi-Pitch but has better sound equipment
-more for research

67
Q

What does the phonatory aerodynamic system?

A

looks at subglottal air pressure, glottal resistance, and airflow

68
Q

What is a videostroboscopy?

A

a microphone that you place on the side of the thyroid cartilage and a velcro strap that attaches around your neck
-the microphone takes the signal to the computer then calculates your fundamental frequency, which tells the strobe light how fast to flash

69
Q

What is a rigid scope?

A

when you pull the tongue out and insert the scope into the back of the patients throat

70
Q

What is a flexible scope?

A

a scope that goes through the nose

-SLPs can only pass a nasal scope under the direct supervision of a physician

71
Q

What is an ambulatory phonation monitor?

A

like a heart monitor for your voice

  • measures your voice throughout the day
  • can measure things like % of phonation time, fundamental frequency, intensity, vocal dosage
72
Q

What is auditory feedback?

A

when a patient is able to hear their voice recording back to them

73
Q

What machine helps with auditory feedback

A

the facilitator

74
Q

What does the facilitator do?

A

provides real time amplification, allows the patient to wear head phones, has a metormone
-also does looping

75
Q

What is looping?

A

recording a sample and then playing it back continuously

76
Q

What can the facilitator/auditory feedback help with

A
  • rate issues
  • Parkinson’s patients (will help slow rate down)
  • helping a person analyze their own voice
77
Q

What is the change of loudness technique?

A

help someone be aware of their loudness and help them establish a new amplitude

78
Q

When is change of loudness often used?

A

When someone is too loud

79
Q

What are some things we need to coach people on during change of loudness?

A
  • the appropriate way to create loudness
  • the different voice levels
  • negative repercussions of improper voice use
80
Q

What are the different voice levels?

A

voice 1: whisper
voice 2: don’t want to wake someone sleeping
voice 3: normal conversational voice
voice 4: voice used to talk across a large room
voice 5: yelling

81
Q

What is something important to check before you work on change of loudness?

A

hearing and psychiatric state

82
Q

What is an effective way to help change of loudness?

A

masking at about 75 dB

83
Q

What is chant talk?

A

trying to get someone to sound like they are talking on one tone and breath
-have the person stretch their vowels and connect your sounds to the next

84
Q

During chant talk, do you want a lot of stress or a little?

A

a little

85
Q

Who can benefit from chant talk?

A

people who exhibit glottal attack/hyperfunction

86
Q

What do you train a person to do after they have exhibited proper chant talk?

A

gradually add more prosody back into the conversational speech

87
Q

What are good things to use during practice of chant talk?

A
  • counting
  • days of the week
  • reading the passage
88
Q

What is the chewing technique?

A

using over exaggerated chewing motions to reduce mandibular tension

89
Q

What does the chewing technique help with?

A

mandibular tension, strain in the voice, hard attack

90
Q

Why is chewing sometimes not liked by adults?

A

they feel foolish

91
Q

What do we need to assure a client when using the chewing technique?

A

that this is a temporary technique

92
Q

What do you start with when chewing the then move to?

A

-non sense sounds, then move to automatic things such as counting

93
Q

What is chewing similar to?

A

Froeschel’s breath chewing

94
Q

What is confidential voice?

A

when you coach people on using their voice 2

95
Q

What is confidential use helpful for?

A

reducing hyperfunction

96
Q

What is easy onset?

A

teaching a client to start everything with an /h/ sound

97
Q

What is easy onset beneficial for?

A

reducing glottal stopping, reducing hyperfunction

98
Q

What should you start with, then move to while using the easy onset technique?

A

start with /h/ words, then move to /h/ phrases

99
Q

What is some feedback you could use with a client who is still exhibiting hyperfunction after the use of easy onset?

A

tell them to pretend they are breathing warm air on cold glass

100
Q

What does counseling involve?

A

counseling a client on what they want to achieve in their life and their job

  • discuss how their voice may be impacting that
  • put the voice disorder into perspective
101
Q

What is digital manipulation?

A

applying pressure or movement to structures to facilitate a better voice

102
Q

What can digital manipulation be used for?

A
  • too high of pitch
  • too low of pitch
  • too melodic of a voice
103
Q

What kind of clients often use digital manipulation?

A

vocal folds paralysis clients

104
Q

What digital manipulation technique would you use to try and lower pitch?

A

have the client find their adams apple and then instruct them to press in and down

105
Q

What digital manipulation technique would you use with someone trying to monitor vertical movements?

A

have the person monitor the movement of their larynx with their hand
-educate them about how that is not normal

106
Q

What is the digital manipulation technique used for patients with unilateral vocal fold paralysis?

A

press inwardly on the thyroid cartilage on the effected side to try and meet the uneffected vocal fold

107
Q

Explain the elimination of abuses technique

A

helping someone eliminate unwanted vocal behaviors

-very important for someone with muscle tension dysphonia and anyone displaying a significant number of techniques

108
Q

What won’t be effective if abuses aren’t addressed?

A

therapy

109
Q

What is important to obtain to effectively track vocal abuses?

A

a baseline

110
Q

What can be helpful for someone who is trying to establish a new pitch?

A

Visi-Pitch, keyboard, etc

111
Q

Initially, how do you want a person to speak when they begin finding a new pitch?

A

monotone

-then add prosody back in

112
Q

Once a person settles into a new pitch, what should they start with when practicing?

A

vowel, then words, then phrases

113
Q

Why might a person be resistant to establishing a new pitch?

A

they may feel like you are trying to change their personality

114
Q

What is focus or tone focus?

A

when a person has good oral resonance and can feel the sound coming from your oral cavity

115
Q

How should the tone be during tone focus?

A

centered from top to bottom and front to back

116
Q

What kind of feedback is helpful for tone focus?

A

tactile; have the person put their fingers on the bridge of their nose

117
Q

What kinds of words are ideal to use while practicing tone focus?

A

words that begin and end with a nasal

118
Q

After the client understands tone focus, what should you have them do?

A

remove their hands

119
Q

What is glottal fry?

A

relaxing the vocal folds so you only need to adduct them very loosely; causes the air to just bubble through the folds

120
Q

What frequency is true glottal fry produced at?

A

65-75 hz

121
Q

what kinds of people benefit from glottal fry?

A

people with muscle tension, nodules, spasmodic dysphonia, ventricular dysphonia

122
Q

Why is glottal fry helpful for someone with vocal nodules?

A

during glottal fry, the vocal folds are shorter and fatter, so they are more likely to close around the nodules

123
Q

What do you start with when practicing glottal fry?

A

vowels, then move to a list

-gradually have the client move back into a normal register

124
Q

What is a good phrase to use while practicing glottal fry when trying to move back into a normal register?

A

“easy does it”

125
Q

What is head positioning similar to?

A

digital manipulation, but you don’t use your fingers

126
Q

What kinds of clients can benefit from head positioning?

A

people who have vocal fold paralysis and hyperfunction

127
Q

What do you do during head positioning?

A

rotate the head to the weak side to try and compress that side so it is closer to the midline

128
Q

What kind of head positioning technique do you use if original technique isn’t working?

A

turn your head toward the strong side

-or try the chin up, chin down and to the side approach

129
Q

What is hierarchy analysis?

A

when a client rates their speaking situations from least to most stressful

130
Q

What is a technique you can use while working on hierarchy analysis?

A

have the client demonstrate a voice that is good or bad and identify the behaviors for each

131
Q

What is inhalation phonation?

A

speaking on inhalation

132
Q

Who often benefits from inhalation phonation?

A

clients with psychogenic voice problems and venrticular dysphonia

133
Q

What does research say about inhalation phonation?

A

you can only use your try vocal folds

134
Q

What do you tell a client to do during inhalation phonation?

A

raise their pitch slightly, and phonation on inhalation, then exhale and try and maintain that pitch

135
Q

What is laryngeal massage/manual circumlaryngeal massage?

A

using massaging/circular motions under the hyoid

136
Q

Who often benefits from laryngeal massage?

A

clients who carry their larynx too high

-can often reduce dysphonia in one session

137
Q

What is masking?

A

presenting white noise at about 70-75 dB

138
Q

Who often benefits from masking?

A

clients with psychogenic aphonia

139
Q

Do you explain how masking works when you use it with a client?

A

no

140
Q

What is also beneficial during masking?

A

audio/video recording the session so the client can self assess

141
Q

Who benefits from nasal glide?

A

client with MTD, spasmodic dysphonia, and any disorder the relates to the thickening of the vocal folds (Reinke’s edema)

142
Q

People tend to have less tension when they are producing what kinds of sounds?

A

glides and nasals

143
Q

What is the open mouth approach?

A

similar to chewing; focusing on using a very open mouth while speaking

144
Q

What kinds of clients benefit from the open mouth technique?

A

people who have a lot of mandibular tension

145
Q

Who benefits from the pitch inflection technique?

A

anyone who presents with a monotone voice

146
Q

What do you start at when practicing pitch inflection?

A

at the word level, then work on upward and downward shifting of pitch

147
Q

What kinds of things do you need to explain to someone working on pitch inflection?

A

where people tend to have the most changes in pitch

-i.e., questions, end of a sentence, stressed words

148
Q

What other technique helps with pitch inflection?

A

audiofeed back/looping

149
Q

Who benefits from redirected phonation?

A

people with psychogenic aphonia and dysphonia

150
Q

What is involved in redirect phonation?

A

using reflexive voicing tasks to help someone find their voice

151
Q

Why can relaxation be beneficial?

A

helps take the work out of phonating

-can be beneficial for people with muscle tension dysphonia

152
Q

What approaches can you use for relaxation?

A
  • ragdoll
  • progressive/differential relaxation
  • guided relaxation
  • neck stretching
153
Q

What is respiration training?

A

teaching someone proper breath support so they can appropriately produce volume

154
Q

What are some things you can use with during respiration training?

A

breath support activities, good posture, diaphragmatic breathing, spirometer

155
Q

What is tongue protrusion?

A

using the /i/ vowel (because it is the furthest forward vowel) and protrude the tongue slightly

156
Q

Who benefits from tongue protrusion?

A

clients with hyperfunction and ventricular phonation

157
Q

What does tongue protrusion do?

A

open up the oral cavity and relax the structures

158
Q

What is a good sound to start with when using tongue protrusion?

A

/mi mi mi/ and gradually pull the tongue back in as you are saying it

159
Q

What is helpful for visual feedback?

A

Visi-Pitch and Dr. Speech

-Visi-Pitch games and tracking

160
Q

What is yawn sigh?

A

when you have a person combine a yawn and sigh before they start a word or phrase

161
Q

What does yawn sigh help with?

A

hyperfunction, someone who carries the larynx too high

-helps relax the structures and open the oral cavity

162
Q

What should you start with when using the yawn sign technique?

A

short /h/ words and vowels and then move into phrases

Voice (5 decks)

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