Considerations in Voice Treatment (Ch. 3) Flashcards
normal voice
-clear quality
-pitch and loudness appropriate for:
age
sex
situation
-no effort, pain, strain, fatigue
-fulfills needs of individual:
occupational
social
emotional
perceptual terminology
pitch loudness quality resonance respiratory
dysphonia
impairment of the speaking or singing voice
pitch
too high/too low/pitch breaks
diplophonia: 2 pitches at same time
range: monopitch/uncontrolled
loudness
inadequate
excessive
monoloud
uncontrolled
quality
terms related to VF vibratory patterns: breathy: hypoadduction harsh/rough: irregular VF vibration hoarse: excessive noise strained: excessive laryngeal muscle effort strained/strangled: ditto voice arrests aphonia
resonance
hypernasality: problem with velopharyngeal function
hyponasality
nasal emission
cul de sac: muffled & low due to obstruction
respiratory
stridor: noisy inhalation or exhalation; airway obstruction
dyspnea: shortness of breath
acoustic terminology
fundamental frequency frequency variability maximum phonational frequency range intensity/amplitude intensity/amplitude variability dynamic level jitter shimmer harmonics-to-noise ratio noise-to-harmonics ratio signal-to-noise ratio
Fundamental Frequency (FO)
- acoustic correlate of pitch (Hz)
- rate at which VF vibrate
- Speaking FO = connected speech
Frequency Variability
expected in connected speech but not in sustained vowel
indicated with standard deviation (FOSD)
Maximum Phonational Frequency Range
complete range of FOs person can generate from lowest to highest, including pulse but exclusing falsetto
intensity and amplitude
- acoustic correlates of loudness
- dB for intensity; dB SPL for amplitude
- average intensity measure over utterance
- intensity variability measured over utterance
- dynamic range is tied to FO: can produce more intensity in middle range than at ends
periodicity
smoothness of mucosal wave
jitter
cycle-to-cycle frequency variations
shimmer
cycle-to-cycle amplitude variations (intensity)
Harmonics-to-Noise Ratio (HNR)
Noise-to-Harmonics Ratio (NHR)
Signal-to-Noise Ratio (SNR)
quantify ratio between periodic and aperiodic voice components
measured in dB
causes of voice disorders
multifactorial:
- structural/organic
- physical injury
- neuro problems
- lifestyle
- psych problems
- systemic disease
- meds
- respiratory problems
- idiopathic
voice team
ENT SLP Patients and family Others: audiologists therapists teacher nurse social worker allergist etc
primary prevention
eliminate or prevent onset of disorder by reducing susceptibility
- education of dangers
- education of good vocal technique
3 primary prevention activities for SLPs in schools
- info to parents and teachers re bad behaviors
- focus child’s attention to sounds in enviro
- explain function of larynx to teachers and kids
secondary prevention
early detection and treatment
-eliminates or slows progress
tertiary prevention
reducing the disability
restore as normal function as possible
International Classification of Functioning, Disability, and Health (ICF)
- body function & structures
- anatomical, physiological, psychological
- temp or permanent
- progressive/regressive/static
- intermittent/continuous
- slight/severe
* tx designed at level of quality of voice signal - activities and participation
- activity = execution of task
- participation = degree of involvement in life situation - treatment at level of social context of communication (make as functional as possible in life situation)
- enviro factors
effects of Rx on voice
xerostomia: dry mouth
-most common side effect in vocal tract
*Dry vocal tract requires higher PTP which can cause vocal fatigue.
Analgesics interfere with blood clot formation, can cause VF hemorrhage
Psychoactive drugs affect CNS, cause dysarthria
multicultural factors
how to become culturally competent:
- Become aware of differences.
- Obtain info regarding culture
- Develop pro skills to assess client’s values, beliefs, attitudes, perceptions
- Gain comfort in interacting with cultures
Evidence-Based Practice
Difficult to hold voice research to gold standard:
- Voice is so variable.
- Standards are variable. Patients may differ from those in study.
- Cognitive, communicative and behavioral impairments interact in complex ways.
- Treatments regimes may be too long or complex.
