Assessment and treatment Flashcards
0
Q
When must an SLP withhold their diagnosis?
A
until the ENT has evaluated
1
Q
Ideally, when should the SLP evaluate the voice?
A
after the ENT has evaluated
2
Q
When can SLPs and clients make treatment decisions?
A
after the client has seen the ENT
3
Q
What ways can we inspect the larynx?
A
- mirror laryngoscopy
- endoscopy
- strobascopy
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
5
Q
What is an endoscopy?
A
a flexible scope that goes through the nose and shines down into the laryngeal space
6
Q
what is a strobascopy?
A
when a strobe light causes the VFs to appear to slow down
-can help identify pathologies
7
Q
How can an SLP screen a voice?
A
a connected speech sample
8
Q
What percentage of school age kids have a voice disorder?
A
5-10%
9
Q
What do we assess during normal voice screening?
A
loudness, quality, resonance, and pitch
10
Q
What is one of the voice programs used for children?
A
Boone voice program for children
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
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
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
14
Q
What are some examples of non-instrumental assessment measures?
A
- voice oral mech
- perceptual ratings: CAPE-V, Gerbis
- Voice handicap index
15
Q
What are instrumental measures?
A
when you have something to aid in your assessment
16
Q
What are some instrumental assessment measures?
A
- endoscopy
- laryngoscopy; direct or indirect (using a mirror)
- acoustic assessment
- aerodynamic evaluation
- electroglottography (EGG)
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)
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)
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
20
Q
What is maximum phonation frequency range?
A
measure of the maximum range you can get
-measured in octaves
21
Q
What kinds of things can be assessed involving intensity?
A
- habitual intensity
- intensity variability
- intensity dynamic range
22
Q
What is intensity variability?
A
range of intensity levels in connected speech
-we expect about 10 dB of differences in unemotional sentences
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
24
What is perturbation?
refers to the variability or irregularity of a system
| -cycle to cycle variation measures of the system
25
How can we assess perturbation?
having a person sustain a vowel
| -we are measuring jitter and shimmer
26
What is considered normal jitter?
around 1% or less
| -Visi pitch calls it relative average perturbation
27
What is considered an average amount of of shimmer?
2.5% or less
28
What is a spectographic analysis?
a frequency by intensity time display
| -frequency is on the Y axis and intensity is on the X axis
29
What is signal to noise ratio?
refers to the amount of energy in your frequencies and harmonics
30
What is considered noise in signal to noise ratio?
breathiness and other irregularity
31
What is a normal signal to noise ratio?
12/1 (12 units of voice for every unit of noise)
32
What does signal to noise ratio correlate best with?
a clinician's perception of dysphonia
33
Explain the analysis of dysphonia in speech and voice (ADSV)
analyzes speech based on a cepstrum
| -it's seeing how much the harmonics of the voice emerge from background noise
34
What is similar to signal to noise ratio?
analysis of dysphonia in speech and voice (ADSV)
| -but we get ADSV from running speech
35
What kind of will a normal voice look like on the ADSV?
very well defined fundamental frequencies and harmonics
36
What is a cepstral peak?
spike on the graph that shows you have well defined harmonics
37
What kind of cepstral peak will have will someone with dysphonia have?
an ill-defined peak "noisy voice"
38
What can the numbers on the cepstral peak prominence tell you?
high peak = high numbers, means a normal voice
| low peak = low numbers, means a dysphonic voice
39
What kind of ratio does the cepstral peak prominence peak?
low/high ratio
40
What is the cepstral spectral index of dysphonia?
a multivariate estimate of perceived dysphonia
| -supposed to be a numerical back up of the perceptual rating on the CAPE-V
41
What kind of numbers would a mildly dysphonic voice have according the the cepstral spectral index of dysphonia?
around 38
42
What kind of numbers would a moderately dysphonic voice have according the the cepstral spectral index of dysphonia?
around 49
43
Can numbers of the cepstral spectral index of dysphonia be above 100 or below 0?
yes-below 0 means very normal voice and above 100 means very bad voice
44
What kind of things are assessed during aerodynamic evaluation?
- things that tell you about the valving of the larynx
- lung volumes and capacities
- air pressure
- air flow
- laryngeal resistance
- duration
45
How much air pressure does normal speech need?
5-10 centimeters of water
46
How much air pressure capacity do most humans have?
up to 50 cmh2o
47
How can you make a tool to measure air pressure?
with a straw and water container; mark the container
| -see if client can blow bubbles at certain depths
48
What is assessed with airflow?
the volume of air that passes through the glottis in a specified amount of time
49
What is airflow measured in?
CC/sec or mL/sec
50
How can airflow be assessed?
usually by sustaining a vowel
51
What kind of air flow would someone with a breathy voice have?
high airflow
52
How much airflow would someone with a normal voice pass through their glottis while sustaining /ah/?
100 cc/sec
53
How much airflow would someone with tight strained voice pass through their glottis while sustaining /ah/?
less than 100 cc/sec
54
What is laryngeal resistance?
a ratio of intra-oral pressure to peak airflow while creating the /pi/ sound
55
What does less resistance t the glottis mean?
the voice is breathy
56
What kind of laryngal resistance does a tight sounding voice have?
a lot of glottal resistance
57
What is an electroglottography (EEG)
a test that uses electrodes on either side of your thyroid that pass a current from electrode to electrode through the larynx
58
When the vocal folds are open, is there more or less resistance for an electroglottography (EEG)?
more resistance
59
Does resistance for EEG increase or decrease when the glottis is closed?
decrease
60
What causes the wave appearance of the EGG?
the appearance of more or less resistance of the vocal folds
61
What does the EGG help you visualize?
how long the folds are staying in each phrase (open and closed)
62
What does the best kind of evaluation involve?
both instrumental and non instrumental measures
63
What are some simple types of instrumentation that aid in speech evaluation?
keyboard, pitch pipe or tuner, sound level meter, spirometer
64
What are some higher tech things you can use to help with voice assessment?
Visi-Pitch, computerized speech lab, phonatory aerodynamic system, videostraboscopy, rigid scope, flexible scope, ambulatory phonation monitor
65
What is a sound level meter?
helps you look at intensity measures (habitual itensity, etc)
66
What does a computerized speech lab?
measures very similar things to the Visi-Pitch but has better sound equipment
-more for research
67
What does the phonatory aerodynamic system?
looks at subglottal air pressure, glottal resistance, and airflow
68
What is a videostroboscopy?
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
What is a rigid scope?
when you pull the tongue out and insert the scope into the back of the patients throat
70
What is a flexible scope?
a scope that goes through the nose
| -SLPs can only pass a nasal scope under the direct supervision of a physician
71
What is an ambulatory phonation monitor?
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
What is auditory feedback?
when a patient is able to hear their voice recording back to them
73
What machine helps with auditory feedback
the facilitator
74
What does the facilitator do?
provides real time amplification, allows the patient to wear head phones, has a metormone
-also does looping
75
What is looping?
recording a sample and then playing it back continuously
76
What can the facilitator/auditory feedback help with
- rate issues
- Parkinson's patients (will help slow rate down)
- helping a person analyze their own voice
77
What is the change of loudness technique?
help someone be aware of their loudness and help them establish a new amplitude
78
When is change of loudness often used?
When someone is too loud
79
What are some things we need to coach people on during change of loudness?
- the appropriate way to create loudness
- the different voice levels
- negative repercussions of improper voice use
80
What are the different voice levels?
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
What is something important to check before you work on change of loudness?
hearing and psychiatric state
82
What is an effective way to help change of loudness?
masking at about 75 dB
83
What is chant talk?
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
During chant talk, do you want a lot of stress or a little?
a little
85
Who can benefit from chant talk?
people who exhibit glottal attack/hyperfunction
86
What do you train a person to do after they have exhibited proper chant talk?
gradually add more prosody back into the conversational speech
87
What are good things to use during practice of chant talk?
- counting
- days of the week
- reading the passage
88
What is the chewing technique?
using over exaggerated chewing motions to reduce mandibular tension
89
What does the chewing technique help with?
mandibular tension, strain in the voice, hard attack
90
Why is chewing sometimes not liked by adults?
they feel foolish
91
What do we need to assure a client when using the chewing technique?
that this is a temporary technique
92
What do you start with when chewing the then move to?
-non sense sounds, then move to automatic things such as counting
93
What is chewing similar to?
Froeschel's breath chewing
94
What is confidential voice?
when you coach people on using their voice 2
95
What is confidential use helpful for?
reducing hyperfunction
96
What is easy onset?
teaching a client to start everything with an /h/ sound
97
What is easy onset beneficial for?
reducing glottal stopping, reducing hyperfunction
98
What should you start with, then move to while using the easy onset technique?
start with /h/ words, then move to /h/ phrases
99
What is some feedback you could use with a client who is still exhibiting hyperfunction after the use of easy onset?
tell them to pretend they are breathing warm air on cold glass
100
What does counseling involve?
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
What is digital manipulation?
applying pressure or movement to structures to facilitate a better voice
102
What can digital manipulation be used for?
- too high of pitch
- too low of pitch
- too melodic of a voice
103
What kind of clients often use digital manipulation?
vocal folds paralysis clients
104
What digital manipulation technique would you use to try and lower pitch?
have the client find their adams apple and then instruct them to press in and down
105
What digital manipulation technique would you use with someone trying to monitor vertical movements?
have the person monitor the movement of their larynx with their hand
-educate them about how that is not normal
106
What is the digital manipulation technique used for patients with unilateral vocal fold paralysis?
press inwardly on the thyroid cartilage on the effected side to try and meet the uneffected vocal fold
107
Explain the elimination of abuses technique
helping someone eliminate unwanted vocal behaviors
| -very important for someone with muscle tension dysphonia and anyone displaying a significant number of techniques
108
What won't be effective if abuses aren't addressed?
therapy
109
What is important to obtain to effectively track vocal abuses?
a baseline
110
What can be helpful for someone who is trying to establish a new pitch?
Visi-Pitch, keyboard, etc
111
Initially, how do you want a person to speak when they begin finding a new pitch?
monotone
| -then add prosody back in
112
Once a person settles into a new pitch, what should they start with when practicing?
vowel, then words, then phrases
113
Why might a person be resistant to establishing a new pitch?
they may feel like you are trying to change their personality
114
What is focus or tone focus?
when a person has good oral resonance and can feel the sound coming from your oral cavity
115
How should the tone be during tone focus?
centered from top to bottom and front to back
116
What kind of feedback is helpful for tone focus?
tactile; have the person put their fingers on the bridge of their nose
117
What kinds of words are ideal to use while practicing tone focus?
words that begin and end with a nasal
118
After the client understands tone focus, what should you have them do?
remove their hands
119
What is glottal fry?
relaxing the vocal folds so you only need to adduct them very loosely; causes the air to just bubble through the folds
120
What frequency is true glottal fry produced at?
65-75 hz
121
what kinds of people benefit from glottal fry?
people with muscle tension, nodules, spasmodic dysphonia, ventricular dysphonia
122
Why is glottal fry helpful for someone with vocal nodules?
during glottal fry, the vocal folds are shorter and fatter, so they are more likely to close around the nodules
123
What do you start with when practicing glottal fry?
vowels, then move to a list
| -gradually have the client move back into a normal register
124
What is a good phrase to use while practicing glottal fry when trying to move back into a normal register?
"easy does it"
125
What is head positioning similar to?
digital manipulation, but you don't use your fingers
126
What kinds of clients can benefit from head positioning?
people who have vocal fold paralysis and hyperfunction
127
What do you do during head positioning?
rotate the head to the weak side to try and compress that side so it is closer to the midline
128
What kind of head positioning technique do you use if original technique isn't working?
turn your head toward the strong side
| -or try the chin up, chin down and to the side approach
129
What is hierarchy analysis?
when a client rates their speaking situations from least to most stressful
130
What is a technique you can use while working on hierarchy analysis?
have the client demonstrate a voice that is good or bad and identify the behaviors for each
131
What is inhalation phonation?
speaking on inhalation
132
Who often benefits from inhalation phonation?
clients with psychogenic voice problems and venrticular dysphonia
133
What does research say about inhalation phonation?
you can only use your try vocal folds
134
What do you tell a client to do during inhalation phonation?
raise their pitch slightly, and phonation on inhalation, then exhale and try and maintain that pitch
135
What is laryngeal massage/manual circumlaryngeal massage?
using massaging/circular motions under the hyoid
136
Who often benefits from laryngeal massage?
clients who carry their larynx too high
| -can often reduce dysphonia in one session
137
What is masking?
presenting white noise at about 70-75 dB
138
Who often benefits from masking?
clients with psychogenic aphonia
139
Do you explain how masking works when you use it with a client?
no
140
What is also beneficial during masking?
audio/video recording the session so the client can self assess
141
Who benefits from nasal glide?
client with MTD, spasmodic dysphonia, and any disorder the relates to the thickening of the vocal folds (Reinke's edema)
142
People tend to have less tension when they are producing what kinds of sounds?
glides and nasals
143
What is the open mouth approach?
similar to chewing; focusing on using a very open mouth while speaking
144
What kinds of clients benefit from the open mouth technique?
people who have a lot of mandibular tension
145
Who benefits from the pitch inflection technique?
anyone who presents with a monotone voice
146
What do you start at when practicing pitch inflection?
at the word level, then work on upward and downward shifting of pitch
147
What kinds of things do you need to explain to someone working on pitch inflection?
where people tend to have the most changes in pitch
| -i.e., questions, end of a sentence, stressed words
148
What other technique helps with pitch inflection?
audiofeed back/looping
149
Who benefits from redirected phonation?
people with psychogenic aphonia and dysphonia
150
What is involved in redirect phonation?
using reflexive voicing tasks to help someone find their voice
151
Why can relaxation be beneficial?
helps take the work out of phonating
| -can be beneficial for people with muscle tension dysphonia
152
What approaches can you use for relaxation?
- ragdoll
- progressive/differential relaxation
- guided relaxation
- neck stretching
153
What is respiration training?
teaching someone proper breath support so they can appropriately produce volume
154
What are some things you can use with during respiration training?
breath support activities, good posture, diaphragmatic breathing, spirometer
155
What is tongue protrusion?
using the /i/ vowel (because it is the furthest forward vowel) and protrude the tongue slightly
156
Who benefits from tongue protrusion?
clients with hyperfunction and ventricular phonation
157
What does tongue protrusion do?
open up the oral cavity and relax the structures
158
What is a good sound to start with when using tongue protrusion?
/mi mi mi/ and gradually pull the tongue back in as you are saying it
159
What is helpful for visual feedback?
Visi-Pitch and Dr. Speech
| -Visi-Pitch games and tracking
160
What is yawn sigh?
when you have a person combine a yawn and sigh before they start a word or phrase
161
What does yawn sigh help with?
hyperfunction, someone who carries the larynx too high
| -helps relax the structures and open the oral cavity
162
What should you start with when using the yawn sign technique?
short /h/ words and vowels and then move into phrases
