Hypertension and Muscle Dysphonia Flashcards
medial compression
the force that 1 vf exerts on the other
perfect amount of medial compression
enough to hold the air under the vfs but also be set into motion with the least amount of effort
hypofunction
- vfs are blown apart and don’t provide enough resistance
- breathy quality
- decreased utterance lenght
hyperfunction
- vfs are offering too much resistance to the outgoing airstream
- takes a lot of effort
- once there is vibration, it is very tense resulting in strained or stangled vocal quality
- wastage of air
terminology for voice disorders
different people will use different words for the same thing
SLP rules with hypertension
all voice disorders must have a doctoral diagnosis before treatment, and you cannot make the medical diagnosis
hoarseness of more than 2 weeks
- they need to go see a doctor
- could be a sign of neuromuscular disorder (thyroid disorder)
- could be nodules, polyps, chronic laryngitis, cancer
ulcer for more than 2 weeks
they need to go see a doctor
2 types of dysphonia
- primary MTD
- secondary MTD
primary MTD
- functional disorder
- there is nothing wrong with the vfs (anatomically typical), but patient uses hyperfunctional voice habitually
- can unintentionally become a habit because of work and psychological effects
- we have to break that phonatory set so that they can habituate a new phonatory set
secondary MTD
- a compensatory strategy for some organic problem
- if the vfs are atypical, phonation is going to be atypical
2 step therapy approach for secondary MTD
- set the stage for the vf anatomy to normalize
- habituate a less effortful pattern
signs during diagnostic and what to do
- giving client a hearing test
- if they have habituated the pattern, you need to help them break that habit
- perceptual evaluation
- CAPE-V
- looking component during evaluation
- when running out of air, patient will squeeze causing tension
- patient’s neck
giving client a hearing test
- sometimes it might just be poor hearing
- not closing the feedback loop
- getting louder so that they can hear themselves
perceptual evaluation
- listen for typical to somewhat elevated pitch
- listen for typical to elevated loudness
- listen for quality: harsh, tense, strained, strangled
looking component during evaluation
- posture
- tense or relaxed when standing
- tense or relaxed when sitting
- if body is tense, so will larynx
looking component during evaluation: watch breathing
- may find inefficient breathing
- clavicure breathing
- also means inefficient breath support
- common for gasping or big breaths to occur if patient uses inefficient breathing techniques
the patient’s neck
- we do not touch the neck, we palpate the neck
- feeling with fingertips
- when palpating, looking for areas of nodularity
neck: feeling with fingertips
- muscles on the sides of the neck (do they have a little give or are they rigid)
- move the larynx
- check the position by finding the gap between superior horn and greater horn (if gap is not found, larynx is elevated)
asking the patient questions
- if they don’t answer them in some manner
- could report that talking is an effort and get tired the longer that they talk
- asking patient about vocal fatigue
- any pain, tightness, or earache?
- any tension in your upper shoulders or upper chest?
- if it feels like there’s something in your throat
asking patient about vocal fatigue
- detrioration in vocal quality as the day goes on
- better voice in the morning than later in the day
any pain, tightness, or earache?
muscle insertion
any tension in your upper shoulders or upper chest?
muscle insertion
if it feels like there’s something in your throat
globus sensation, which is a nervous lamp in your throat
holistic approach to therapy
- using many different facets
- direct intervention to break habits
- environmental and lifestyle modifications
holistic approach to therapy: physiologic aspects
treat vfs like a muscle
holistic approach to therapy: psychodynamic approach
always a psychosocial component
holistic approach to therapy: facilatory techniques
- facilitate voice production in a healthy manner
- how to promote voice that is less effortful and free of tension
- your client will only be as good at your techniques as your explaining, modeling, and coaching
- confidential voice
confidential voice
- train your patient to use a breathy, low volume of voice
- talk like there’s a baby in the room and you don’t want to wake them
- talk to somebody like you’re standing 2-3ft from them
- do not let the patient whisper
- all about the airflow with relaxed vfs
- can’t go to this immediately, vfs must be loosened up
can’t go into confidential voice immediately, vfs must be loosened up
- helps lower larynx
- use the entire vocal tract
- spread the voice out
- hear an improved quality
lips trills
- train the person to make full use out of the resonatory tract and get the full voice out of the throat
- warm-up and habit breaker for the session
- break the habit of laryngeal only voice
- articulators have to be properly relaxed
- using hands to help motor learning
lip trills: using hands to help motor learning
learning a skill by pairing it with a motor skill
easy onset
- direct technique to promote a less effortful technique
- purpose is to start phonation off with a breathy attack
easy onest: steps
- start air flowing through the vfs before phonation
- overtly pairing it with the /h/ and a vowel
- as developed, slowly fade the /h/
- habit breaker and trainer
- make sure patient isn’t forcing the /h/
yawn/sigh technique
- start utterance with a yawn, which opens up the vocal tract and relaxes it
- then sigh the utterance out
- 1 continuous movement
yawn/sigh technique could pair with ___ ___ and ___ ___
easy onset, continuous voicing
how does the yawn/sigh technique pair with easy onset and continuous voicing?
yawn in and /h/ out during the sigh
continuous voicing
keep voicing going throughout the entire utterance
chant talking
- start phonating and don’t stop
- mouth is open a little bit more
- expands the resonatory system, which facilitates production of lower pitch and larynx drops
- analogous to the continuous voicing
chewing
- opens up the vocal tract while also dropping the larynx
- not a facilitator, but good for starting the session
- once movement is established, add the voice
chewing: description
want to phonate as if you were chewing 3 saltines between your back molers
humming
- opens up the entire vocal tract
- warm-up
- brings voice into a forward focus
humming: brings voice into a forward focus
voice not in the throat but the entire vocal tract including the areas in your head
straw technique/semi-occluded phonation
- start of the session
- puts voice in the frontal focus
- almost like playing a kazoo
circumlaryngeal massage: step 1
- locate the hyoid bone
- then gently move the hyoid bone side to side
circumlaryngeal massage: step 2
pressure in a circular motion
circumlaryngeal massage: step 3
- move to the thyroid cartilage
- once located, put fingers across both sides and provide a low pressure massage downward
circumlaryngeal massage: step 4
- gently wiggle thyroid cartilage from side to side
- clicking is normal
circumlaryngeal massage: step 5
- small circular motions on the side of thyroid cartilage
- can gently hum or remain silent
when completing the circumlaryngeal massage, apply
small amount of pressure with thumb and fore finger
CM technique is not for SLP to perform on patient…
SLP teaches patient how to perform on themselves
dynamic stretching is a good substitute for
circumlaryngeal massage
dynamic stretching: step 1
grab onto the top of the shoulder and circle the shoulder around backward, then do the other side
dynamic stretching: step 2
- interlace hands with thumb hanging down and place behind the neck digging thumbs underneath the skull
- then nod your head up and down gently on the axis vertebrae
- then also side to side
dynamic stretching: step 3
circles on the jaw up and back and near the cheek bones
dynamic stretching: step 4
- brings fingers up to temples up and backward and do circular motion
- hands: 1 on top of the scalp, other behind
- then circle scalp on the skull
with dynamic stretching, you do not have to
complete the entire sequence
may not be good as a primary relaxer because
it tenses other muscles
relaxation (tense and then relax)
- start with the bigger muscles and end with the smaller muscles
- if unable to visualize, may not be a good technique
