Chapter 7: Voice Management (Physiologic Voice Therapy) Flashcards
What is physiologic voice therapy? (3 ideas)
- based on vocal function
- aims to improve the relationship/balance between 1. respiratory support, 2. laryngeal muscle strength + control + stamina, and 3. supraglottic modification of the laryngeal tone/resonance
- treats the voice holistically, not one single focus
Physiologic voice therapy is modification of the ______________ _____________ of the voice producing mechanisms: (3)
underlying physiology
1) respiration
2) phonation
3) resonance
What are the 2 types of voice disorders?
1) pathology leads to loss of balance between the voice systems
2) loss of balance between the voice systems leads to pathology
What are 2 examples of when a pathology leads to loss of balance between the voice systems?
1) granuloma
2) presbylarynx
What are 2 examples of when the loss of balance between the voice systems leads to pathology?
1) nodules
2) muscle tension dysphonia
What is an example of how the same pathology/problem may lead to different responses with nodules?
1) the system is overworked: increased glottic and subglottic effort
2) the system is underused: decrease respiratory and/or glottic effort
What is an example of how the same pathology/problem can lead to different responses with unilateral VF paralysis?
1) overwork the system (increase supraglottic effort)
2) underuse the system (decreased effort and permit falsetto for better approximation)
Many voice disorders share this same problem = _____ of __________ ______________ _______
and will respond to the same approach = ____________ of _______________ __________
Loss of normal physiological balance
Restoration of physiologic balance
What is physiological voice therapy treatment focused on?
returning the system to (more) normal patterns of production
Physiological therapy approaches may consider multiple different cases have same basic concerns such as: (3)
1) lack of glottic closure
2) leading to inefficient use of glottal/phonatory systems
3) and possible compensatory patterns
Physiologic approaches to therapy can do what? (4)
1) simplify therapy planning
2) address underlying physiology rather than specific symptoms
3) may use 1 or a combo of approaches
4) used with the understanding that other areas may need to be addressed
What does the semi-occluded vocal tract do? (3)
1) improve vocal function in normal and disordered voices
2) heightens source (VF vibration), by raising supra- and intra-glottal pressures
3) impedance matching by VF adduction and epilarynx tube narrowing makes voice more efficiency (reduces VF tissue collisions)
What is are 3 types of semi-occluded vocal tract?
1) non-speech SOVT
2) artificial lengthening of the vocal tract
3) speech-based SOVT
What are 3 non-speech SOVT exercises?
1) humming
2) tongue/lip trills
3) /ol/-buzz
What are 3 artificial vocal tract lengthening exercises?
1) kazoo
2) straw
3) tube
What are 3 speech-based SOVT exercises?
1) resonant voice therapy
2) accent method of voice therapy
3) flow phonation
What are vocal function excersizes?
a series of isometric/isotonic vocal exercises designed to balance the laryngeal musculature, improve stamina, and maximize glottal efficiency
What do vocal exercises accomplish?
improvement of the 3 subsystems of voice production (resonance, respiration, phonation)
Vocal function exercises work because there is a direct relationship between the condition of the ___________ __________ and the _______ of _______.
laryngeal musculature
quality of voice
Direct laryngeal exercises should be effective in improving the voice of individuals with vocal ______________
hyperfunction
For vocal function exercises to be fully effective, voice therapy must restore the normal __________ ________________ of the intrinsic laryngeal muscles. And the patient must learn to ____________ that through the precise _____________ of these _________.
dynamic equilibrium
maintain
adjustment of these muscles
Vocal function exercises are a set of ___________ voice ______________ that are similar in theory to ___________ __________.
They are designed to ________________ and ________________ the ____________ musculature.
And to improve efficiency of the relationship among what 3 things?
systematic voice manipulations
physical therapy
strengthen and coordinate the laryngeal musculature
1) airflow
2) vocal fold vibration
3) supraglottic treatment of phonation
The larynx is made of multiple ____________, ___________, and __________ ________.
It is a _________ system.
And it can become __________, ____________, or ________________ in its function.
cartilages, muscles, and connective tissue
jointed
injured, weakened, or imbalanced
How are disorders/injuries of the larynx typically treated? (5 “steps”)
What is missing?
1) voice rest/modified use
2) hygiene counseling
3) supports (amplification)
4) treatment of symptoms (meds, behavioral therapy)
5) return to original activity
systematic vocal exercise to rehabilitate the laryngeal complex
What are the 4 steps of VFEs?
1) warm up
2) stretching exercise
3) contracting exercise
4) adductory strengthening exercise
In VFEs, what are 5 manner of production components?
1) posture
2) breathing
3) placement
4) onset
5) muscle engagement
What is the first VFE exercise goal warm-up done on?
sustain the vowel /i/ for as long as possible on the musical note F
(F above middle C for females, middle for males)
VFE exercise 1 goal is based on the patients personal ___________ and _____________, what is the range of efficient voice production flow rates?
anatomy and physiology
80-200 liters/second
What does an air flow rate below 80 liters/second indicate? Above 200?
- limiting the air flow through the system
- allowing excessive air through the system
What are the 2 methods for calculating VFE goal 1?
1) determine pts expiratory volume, divide by 80 (most efficient system), and obtain # of seconds pt should sustain tone
2) sustain lightest /s/ possible for as long as possible
During VFE exercise 1, you should monitor for what 3 things and expect what 3 things?
1) tone focus
2) breathing, onset of tone
3) posture
1) poor control early on
2) voice breaks, wavering, breathiness
3) loss of focus
What is the rationale for VFE exercise for 1?
1) warming up the muscles
2) as pt works to increase duration, they are improving their ability to valve the exhaled air
What is VFE exercise goal 2?
“stretching” = glide from your lowest to highest note on the word “knoll”, “whoop”, a tongue trill, or lip trill with no voice breaks
What is the rational for VFE exercise 2?
1) stretches the VFs
2) slow, controlled contraction of the CT
What are 2 initial expectations for VFE exercise 2?
1) difficulty maintaining tone focus
2) voice breaks
What is VFE exercise 3 goal?
“contracting” = glide from a comfortable high note to your lowest note on the word “knoll”, “boom”, tongue trill, or lip trill with a goal of no voice breaks
What is the rational for VFE exercise 3?
slow, controlled contraction of the TA
What are 2 initial expectations of VFE exercise 3?
1) difficulty maintaining tone focus
2) voice breaks
What is VFE exercise 4 goal?
“power” = sustain the musical notes C-D-E-F-G for as long as possible on the word “old” without the /d/ (middle C for females, octave below for males) with the goal of efficient voice production flow rate
What are the 3 rationale for VFE exercise 4?
1) low-impact adductory strengthening
2) sustained contraction of adductors (IA, LCA)
3) sustained engagement of the TA and CT
How are VFE notes obtained?
matched to a pitch pipe, audio recorder, or keyboard/piano
VFE homework includes: (2)
1) daily record charted by pt
2) est. time to complete = 8-10 weeks
During the first few days of VFE, what might some pts experience?
minor laryngeal aching
All VFEs are done… (6)
1) 2x each, 2x per day
2) as softly as possible, but engaged
3) with monitoring for breaks, wavering, breathiness
4) with extreme care to use forward focus without tension
5) with care to use easy onset without breathiness
6) with appropriate breathing technique
How should you explain VFEs to pt.? (4)
1) admit it seems silly
2) compare to workout program (PT, weights, etc.)
3) stress necessity of systematic exercise
4) explain that times do not increase due to increased lung capacity
What are 4 VFE pt advantages?
1) easily understood/reasonable model
2) systemic, permits for plotting progress
3) pt must attend to the voice at least 2x a day
4) involves doing something positive vs. a “don’t do”
Approximately how many weeks do you do the full VFE progeam 2x each 2x a day for? 1x each 1x a day?
2
1
