Chapter 2: Theoretical Bases for Clinical Reasoning Flashcards
Abductor spasmodic dysphonia
Voice problem associated with dystonia, a neurological disorder, characterized by involuntary abduction of the vocal folds during speech resulting in a weak, breathy voice. The symptoms usually diminish during nonspeech activities such as laughing, singing, speaking with an accent, coughing, whispering, speaking on inhalation, etc.
Abrupt onset of phonation
Sudden, forceful initiation of phonation associated with complete closure of the glottis and blockage of airflow prior to the initiation of phonation.
Acoustic energy
Transmission of energy associated with the compression and rarefaction of air molecules.
Aphonia
Involuntary cessation of voice in response to interruption in the vibration of the vocal folds.
Bernoulli effect
In the case of an ideal fluid, as velocity of fluid flow increases, pressure decreases, so long as the total energy remains constant. Pressure is perpendicular to the direction of flow. (Zemlin, 1998).
Breath group
An utterance produced during one breath.
Checking action
The continued engagement of the muscles of inhalation to slow the exhalation phase.
Chronic obstructive pulmonary disease (COPD)
General term for a group of progressive respiratory problems that result in persistent shortness of breath, poor air flow, cough, increased mucus production, and a wet vocal quality.
Closed-loop theory
A cognitive theory proposed by Adams (1971) that uses feedback to describe the acquisition of motor skills.
Cognition
The use of executive function, reasoning, judging, and remembering.
Cognitive work
The intellectual resources recruited to perform a function.
Decision-making process
In voice treatment, a process by which the clinician and patient choose a course of action for the rehabilitation program.
Degrees of freedom
The number of independent ways a dynamic system can move without violating the inherent limitations of the system.
Disease-oriented approach
A medical model that relies on experts to make decisions.
Emotional-physiological state
The biological arousal experienced in response to stimuli.
Empirical observation
A process whereby information is acquired through observation.
Evidence-based practice
The interaction of (1) clinical expertise and experience, (2) scientific evidence, (3) client/patient and caregiver perspectives to provide high-quality care. A treatment approach that relies primarily on qualitative research studies to make decisions about the efficacy of treatment.
Exhalation
The flow of breath from the body.
Expiratory reserve volume
Air remaining in the lungs following a normal exhalation. This air can be exhaled by contracting the expiratory muscles.
Feels
In voice therapy, the awareness of the sensations related to resonance, the difference between ease and effort, postural alignment, etc.
Forced vital capacity
The maximum volume of air that can be exhaled following a maximum inhalation.
Freedom to act
A physical state of relaxation that exists between the body’s most lax position and its stiffest resulting in an efficient use of the musculature.
Fundamental frequency
The lowest frequency of vibration of the vocal folds and the slowest frequency of a quasi-periodic waveform.
Generalized motor program
Within Schmidt’s schema theory (1975a), the generalized motor program is an abstract representation of the order, relative timing, and force of movements.
Glissando
The vocal ascent and descent of a musical scale.
Hierarchy
In voice therapy, a system of goals and procedures ranked one above another based upon complexity.
Hypothesis-driven therapy
Treatment that relies upon hypothesis development and testing.
Inertia
Newton’s third law of motion: the tendency of a body at rest to remain at rest, or when in motion to continue that motion, unless acted upon by an external force.
Inhalation
The flow of air into an organism.
Initiation of phonation
The onset of voicing associated with vocal fold vibration.
Inspiratory checking
Deliberate reduction in the alveolar pressure and air flow from the lungs as a result of engagement of the primary muscles of inhalation.
Inspiratory reserve
Additional air that can be inhaled following a tidal inhalation.
Intermittent aphonia
Momentary breaks in phonation.
Less effort
In voice treatment, less demand and strain on the subsystems of voice production.
Loudness inflection
Refers to the modification in vocal intensity necessary to cope with varying communication intent and environment.
Lung capacities
Cubic capacity of the respiratory mechanism.
Lung volume
The quantity of air in the lungs.
Mental practice
Gabriele, Hall, and Lee (1989) suggest that a memory trace can be developed or strengthened when an individual visualizes or imagines performing a motor act.
Motor archetype
Schmidt (1975a, 1975b) proposed that learned movements are formed in memory through the accumulation and refinement of memory traces that identify shared rules for programming the timing, sequence, and strength of performance.
Muscle tension dysphonia
Voice is produced with excessive laryngeal effort, stiffness, and/or expiratory drive in the absence of a laryngeal pathology.
Myoelastic-aerodynamic theory of voice production
Vocal fold vibration is a result of the interaction of muscular, elastic recoil, and aerodynamic forces (Muller, 1843; van den Berg, 1958).
Open-loop theory
A cognitive theory proposed by Adams in 1971 to describe a motor control system with preprogrammed instruction that does not use feedback.
Pascal’s law
Pressure applied within a closed structure is transmitted throughout the structure.
Physiological empathy
In voice therapy, a clinician and patient use careful observation and kinesthetic awareness to create a vicarious experience of a motor act and to modify the patient’s effortful manner of phonation.
Physiological framework
In voice therapy, the clinician’s reliance on an understanding of the underlying physiology of the voice problem to develop an appropriate management plan.
Physiological model
In voice therapy, a treatment plan based on integrating empirical observation with an understanding of normal anatomy and physiology.
Pitch break
Sudden, involuntary shift in pitch.
Pleural linkage
The mechanism by which the lungs are “linked” to the thoracic wall, allowing movements of the chest wall to be transmitted to the lungs.
Procedural memory
Verdolini (2000a) suggests that motor patterns are developed without conscious awareness, but require attention, repeated practice, and sensory attention.
Prototype
An original representation from which others evolve.
Quiet tidal volume (QTV)
The amount of air inhaled and exhaled during quiet breathing.
Random practice
In voice therapy, practice might include varying factors such as the phonemic context, cognitive and linguistic complexity, conversation partners, and communication environment while incorporating a specific vocal technique. (Sherwood & Lee, 2011)
Recall schema
Schmidt and Lee (2011) proposed that repetition of a motor act builds a representation of the motor program. The recall schema is used to program a motor act.
Recognition schema
Schmidt and Lee (2011) proposed that repetition of a motor act builds a template of the motor program. The recognition schema is used to evaluate and monitor the efficiency and accuracy of a movement.
Reflux (backflow)
A flowing back; a process of refluxing. Within the context of swallowing it refers to the flow of food or stomach contents back into the esophagus, pharynx, larynx, and/or mouth, usually associated with relaxation of the lower esophageal sphincter.
Relaxation pressure
Intrapulmonic pressure due to tissue elasticity, torque, gravity, and intra-abdominal pressure (Zemlin, 1998).
Reliability
The extent to which a procedure produces the same results on repeated trials. The consistency of the patient’s response.
Resonance
Dynamic changes in the shape and configuration of the vocal tract that create resonant frequencies in the vocal tract and allow for the differentiation of speech sounds.
Resting expiratory level (REL)/resting lung volume (RLV)
A state of equilibrium exists in the respiratory system at approximately 38% of vital capacity due to the coupling of the chest wall–lung unit. The exhalatory pull of the lungs is balanced by the inspiratory pull of the chest wall, and any movement away from REL requires muscular activity.
Schema theory
Schmidt and Lee (2011) proposed that motor learning occurs when a model that predetermines the order, strength, and duration of the contraction of the muscles is built in memory.
Self-regulation
The control of negative forces that interfere with perseverance.
Self-sustained oscillation
Titze (1994) postulated that a nonlinear, interactive source-filter that incorporates the inertive reactance of the vocal tract with the airflow and pressures at the level of the glottis facilitates self-sustained vibration of the vocal folds.
Sensory awareness/feedback
In voice therapy, attention to and reliance on the resonating characteristics of the vocal tract.
Simultaneous initiation of phonation
Coordinated adduction of the vocal folds to phonation neutral position with airflow to initiate phonation with an easy onset.
Source-filter theory
Speech production system consists of the sound source (vocal folds) and the filter or resonator (the vocal tract) (Fant, 1970).
Tactile-kinesthetic feedback
In voice therapy, the attention to and reliance upon sensory feedback.
Tessitura
Refers to the texture of a song or role; the range within which the majority of the pitches lie; the tessitura of a song may or may not match the tessitura of a voice.
Theoretical framework
When considering voice problems we use theory to frame the processes of voice assessment and treatment.
Timbre
The color or tone of the voice provided by the harmonic overtones.
Tongue base
The posterior one-third portion of the tongue.
Transglottal pressure differential/Transglottal pressure drop
Reduction in air pressure as air flows across the glottis. When a vowel is articulated, the transglottal pressure differential is similar to the subglottal pressure, but when a constriction occurs to produce a consonant the supraglottal pressure is elevated and the transglottal pressure differential diminishes. Zemlin (1998) provides the following formulae to calculate the transglottal pressure differential (subglottal pressure – supraglottal pressure = transglottal pressure differential)
Validity
The extent to which a tool measures the intended variable.
Vibrato
The regular and relatively even pattern of oscillation above and below a pitch; a 4 to 6 Hz undulation of frequency and amplitude is considered to be within normal limits. A healthy vibrato adds richness and depth to the tone of the singing voice.
Vital capacity
The quantity of air that can be exhaled after a maximum inhalation.
Vocal longevity
The stamina and endurance necessary to produce a voice that will last and meet one’s needs throughout a lifetime. (Titze & Verdolini Abbott, 2012)
Whisper
Sound produced without vocal fold vibration.
Xerostomia
Dryness in the mouth that may be associated with medication, Sjögren’s syndrome, radiation therapy, or idiopathic origins.
