Chapter 13 Flashcards
Categories of voice disorders include
Functional disorders, neurogenic disorders, psychogenic disorders
result from vocal misuse or abuse: vocal nodules, contact ulcers, granulomas
Functional disorders
damage to the nervous system. Partial/complete vocal fold paralysis and voice-Parkinson’s Disease and ALS.
Neurogenic disorders
result from psychological and emotional conflict, such as extreme stress or anxiety- may include tense voice or aphonia
Psychogenic disorders
tense voice or aphonia are example of ____ disorder
Psychogenic disorders
Partial/complete vocal fold paralysis and voice-Parkinson’s Disease and ALS are examples of z____ disorders
Neurogenic disorders
vocal nodules, contact ulcers, granulomas are examples of ___ disorders
Functional disorders
During a screening, you must listen for _____, _____,and ____
Quality, pitch, and intensity (loudness)
The following is used to conduct a screening:
- Imitate words or phrases
- Count to 20
- Recite alphabet
- Read short passage
- Conversational speech sample
- Vowel prolongation
- Sustain s/z
Client perception includes
Voice Handicap Index (VHI)
Perceptual and Instrumental Exam goes over
Pitch, Intensity, Vocal Quality, Vocal Habits, Resonance, Respiratory Support, Posture, Tension & other behaviors
the average pitch that the patient uses during speaking and reading
Fundamental frequency - habitual pitch
In perpetual and instrument exam,to examine pitch you must look at
- Fundamental frequency- Habitual pitch
- Pitch Range
For pitch range calculate the ________
Calculate highest/lowest pitch (aaaahhhh) glissando up and down
In the perceptual and instrumental exam, for intensity, you must
Measure in decibels &
Vary loudness
To measure intensity, have the client ____
Whisper, speak softly, speak loudly, shout
Counting with increasing intensity
In the perceptual and instrument exam, for vocal quality,
Conduct a CAPE-V (Consensus Auditory- Perceptual Evaluation of Voice)
The CAPE_V goes over:
- Overall severity
- Roughness
- Breathiness
- Strain
- Pitch
- Loudness
- Additional- Diplophonia, vocal fry, falsetto, asthenia, aphonia, pitch instability, tremor, wet/gurgling voice
During respiratory support for speech, observe:
- Conversational speech
- Taking a deep breath
During respiratory support for speech, look for:
- Tension
- Shallow inhalation
- Noisy Inhalation
- Mouth Breathing
- Running out of air
- Weak voice
- Fatigue
Determine how well the vocal folds close, open and vibrate. This is known as
Maximum phonation time
The first step in maximum phonation time is
Ask the patient to sustain a vowel
In maximum phonation time, after asking the patient to sustain a vowel, then-
Time the length of the production
In maximum phonation time, after timing the length of production, then-
Repeat 2x and record the longest
Typically the maximum phonation time for males is
25-35 sec
Typically the maximum phonation time for females is
15-25 sec
Typically the length of concern for maximum phonation time is
less than 10 secs
Assess respiratory and phonatory efficiency. This is known as
S/z ratio
_____ is an indicator of laryngeal pathology
S/Z ratio
The first step in S/Z ratio is
To ask the patient to sustain /s/ - time it 2x
The second step in S/Z ratio is to
Ask the patient to substain /Z/ - time it 2X
The third step in S/Z ratio is
Divide the longest /S/ by the longest /Z/
Exalting full steps of S/Z ratio
Ask the patient to sustain /s/- Time it 2x
Ask the patient to sustain /z/- Time it 2x
Divide the longest /s/ by the longest /z/
Normal S/Z ratio results are
Normal = 1.0 ratio
Typically the results for S/z ratio in children is
10 secs for children
Typically the results of s/z ratio for adults is
20-25 secs for adults
Laryngeal pathology results of s/z ratio are
Laryngeal pathology = >1.0
Laryngeal pathology occurs when
A. Normal duration of /s/
B. Reduced duration of /z/
Respiratory Inefficiency results for s/z ratio is
Respiratory Inefficiency = 1.0
Respiratory inefficiency occurs when
Reduced duration for both sounds
What the the three types of results for s/z ratio
Normal
Laryngeal pathology
Respiratory inefficiency
instrument that measures aerodynamic properties of speech: sound pressure levels, air flow and air pressure
Aerophone
complete hardware and software system for acoustic analysis of aspects of voice, speech and fluency
Computerized speech lab
fiberoptic tube fitted with a light and camera that can be directed into the oral cavity for visual viewing of the larynx
Digital endoscope
Assessment hardware and software types
Pair with perceptual assessment
Aerophone
Computerized speech lab
Digital Endoscope
Apps available
Faulty sound vibration in the oral, nasal and or pharyngeal cavities
Assessment of resonance
too much vibration during vowels and voiced oral consonants
Hypernasality
During nasal emisssion, air escapes through the _____ during speech
Nose
Audible nasal emission on certain sounds /s/ and /z/.
Phoneme specific velopharyngeal dysfunction
too little sound vibration in the nasal cavity /m/ sounds like /b/
Hyponasality
airflow in the oral cavity is obstructed, often by enlarged tonsils, resulting in muffled quality
Cul-de-sac resonance
Some disorders of resonance are due to incomplete closure of the velopharyngeal port. These include:
Hypernasality
Nasal emission
Phonemic specific velopharangeal dysfunction
Other disorders of resonance are due to a physical obstruction. These include:
Hypernasality
Cul-de-sac resonance
Made from a piece of bendy straw or piece of tubing. This is known as ____
Nasal listening tube
The first step in nasal listening tube is
Place one end in your ear and the other end at the client’s nostril
The second step for nasal listening tube is -
Ask the client to speak or perform a speech task
To conduct a nasal listening tube test you must
- Place one end in your ear and the other end at the client’s nostril
- Ask the client to speak or perform a speech task
If the nasal listen tube reveals that the clinician hears sound during the production of vowels or plosives. This is known as which disorder
Hypernasality
If the nasal listening tube reveals minimal to no sound during production of nasal speech, this is known as ____
Hyponasality/ curl-de-sac
In order to assess velopharayngeal function (VPF) you must
- Gently pinch the client’s nose
- Ask him/her to repeat some of the non-nasal sentences containing pressure consonants
In order to assess Hyponasality, you must
Repeat words or phrases with multiple nasal sounds
The removal of all or parts of the larynx
Laryngectomy
Assessment of alaryngeal clients includes
Anatomical changes
Respiratory/vocal changes
Preoperative and postoperative consultation
Assess of alaryngeal client for preopertaive consultation
- What they know
- New mode of communication
- Family support
- Support Groups
- Rehabilitated Laryngeal speaker present
- Provide printed information
- Informal assessment of cognition, speech, language etc.
Assessment of alaryngeal clients postoperative consultation
- Review Pre-operative discussion
- Discuss alaryngeal communication systems
A. Artificial larynx- electronic or mechanical instrument that provides sound source as speech is shaped by the articulators
B. Esophageal speech- the speaker takes in air through the mouth traps it in the throat and releases it back through the mouth. It is hard to master
C. Tracheoesophageal puncture
electronic or mechanical instrument that provides sound source as speech is shaped by the articulators
Artificial larynx
the speaker takes in air through the mouth traps it in the throat and releases it back through the mouth. It is hard to master
Esophageal speech
Three types of alaryngeal communication systems
Artificial larynx
Esophageal speech
Tracheoesophageal
