Laryngeal Subsystem Flashcards
What are the two speech functions of the larynx
1) to control phonation - rapid, vibratory quasi periodic motions of the VF
2) To control articulation (phonetic distinction)
What are the 3 was the larynx controls articulation
- vowels vs (voiced/voiceless) consonants
- laryngeal devoicing gesture: consonants
- laryngeal height - vowels
High vowels have a ________ position of the larynx and low vowels have a ___________ position of the larynx
higher
lower
How does phonation occur?
VFs vibrate largely due to aerodynamic and elastic (passive) forces arising from small variations in the glottal area and pressure changes below and between VFs
Movement of VFs is determined by _________ laws coupled with ________ forces
aerodynamic
elastic
Aerodynamic laws affecting the VFs include what?
- the Bernoulli effect
- mass conservation laws
What muscles bring the vocal folds together
lateral cricoarytenoids
interarytenoids
What muscles open the VFs?
posterior cricoarytenoids
What muscles establish appropriate tension in the VFs?
cricothyroid and vocalis
Contraction of the CT and vocalis is the primary mechanism for what?
F0 control for purposes of prosodic variation
What are some characteristics we look at in F0?
- phonation frequency
- phonation variability
- period
T or F: F0 = pitch
false!
- F0 is what is produced
- pitch is the perceptual equivalent
When is phonation best measured?
In a simple/normal phonation like a sustained /a/
In a waveform analysis, consonants have _________ waves and vowels have _______ waves
aperiodic
semi-periodic
on a waveform each _______ is associated wit ha closure of the VFs
peak
Why is phonation important? (affects 3 things)
- prosody: intonation, stress, phrasal junctures
- speaker identification: sex, dialect, social status
- paralinguistic information (emotions)
-leads to complex effects of damage
Phonemic distinction aka ___________ affects intelligibility
articulation
On a spectrogram, complete closure of the VFs leads to a white space called a ________
closure interval
On a spectrogram, the voice onset after a closure interval is described as a ___
burst
Describe the laryngeal devoicing gesture (LDG)
- Voicelessness is produced by a particular gesture of the larynx and it is longer in duration and exremelty synchronized with an oral closure when the consonant is being produced
- the larynx produces a very large opening then closing gesture of the VFs and the duration of that gesture = onset of the closure interval, continues through the busrt in the VOT time and ends at the beginning of the next vowel
The LDG is the physiological implementation of _________
voicelessness
The LDG is ___________ with the oral constriction for voiceless consonants
synchronous
T or F the LDG is under voluntary control
False
What are the 4 types of phonatory impairments
- hypoadduction impairments
- hyperadduction impairments
- phonatory instability impairment
- phonoatory coordination impairment
Describe phonation in hypo adduction impairments. What are some causes?
- inadequate VF closure, reduced loudness, breathy or hoarse voice
- laryngeal paralysis, PD, TBI, bulbar palsy
Describe phonation in hyper adduction impairment. What are some examples
- harsh, pressed, strained-strangled voice
- pseudobulbar palsy, Huntington’s disease, CP, TBI
Describe phonation in phonatory instability impairment
- tremor, rough or hoarse voice quality, pitch breaks and glottal fry
Describe phonation in phonatory coordination impairment
-difficulty achieving voicing distinctions
What are the 2 general types of assessment tasks for assessing laryngeal function?
- Non-speech: cough, laugh, sigh (on command/ involuntary may be different). Determine if laryngeal vs. respiratory
- Phonation: steady pitch, raising and lowering pitch, voice quality judgements
What do we measure using instrumental assessment, acoustic analysis of F0
- jitter
- shimmer
- signal to noise ratio
What is important to remember during instrumental assessment - acoustic analysis of voice
- remember to elicit task consistently
- variability may be a feature of the disorder voice
Other than an acoustic analysis of voice, what else can we do with instrumental assessment
- visualization of VFs
- aerodynamic assessment to measure laryngeal resistance
According to Duff, why is management of respiratory/phonatory Fx often a priority?
Because improvement at this level is expected to generate improvements at other levels
What are the 5 types of respiratory treatments
1) postural adjustments
2) breathing augmentation (i.e. expiratory board)
3) Augmented feedback/biofeedback
4) At phrase level, linguistic approach (i.e. expanding breath group durations)
5) Inspiratory or expiratory strength training via a device
What are the two types of techniques for laryngeal hypoadduction?
- effort closure techniques
- surgical options
What are some effort closure techniques for laryngeal hypoadduction?
- clasping hands together and squeezing palms together as hard as possible
- interlacing hands and pulling outward
- Sitting in chair, grasping bottom with hands, pulling upward
What are the surgical treatment options for laryngeal hypoadduction?
- VF repositioning or medicalization laryngoplasty, thyroplasty or arytenoid adduction surgery
- VF injections
T or F: laryngeal hyper adduction can be a compensatory mechanism
True: it may occur as a compensatory mechanism for managing weakness at the respiratory or velopharyngeal level
What are some treatment options for laryngeal hyper adduction?
- Easy onset of phonation (yawn-sigh, chewing)
- Laryngeal massage, relaxation exercises
- Increase pitch, high lung volumes
- Surgical options: RLN resection (induced UL VF paralysis) or Botox
What are the results of the study by Maryn and colleagues on augmented feedback/biofeedback
Only 3/18 studies didn’t find support for using biofeedback in training voice
What are some examples of biofeedback in voice?
- microphone
- surface EMG
- Fibroscopic laryngoscopy
- Visipitch
- Speech Viewer
What are some prosthetics techniques for reduced loudness? Who benefits from them>
- Voice amplifiers
- Speech enhancers
-Individuals with CP, MS, TBI, Myasthenia graves, vent/trach, spasmodic dysphonia, stroke, PD or paralyzed vocal cords
VERY IMPORTANT - how is the laryngeal subsystem connected to the respiratory system?
Subglottal pressure drives the phonatory system
When considering respiration and phonation, what are so-called ‘pieces of the puzzle?
-VF function
-Respiratory support
-apraxia
dysarthria
What are Katia Simics 11 non-speech skills that are important to assess when looking at respiration and phonation?
- resting breath
- deep breathing
- spontaneous cough
- elicited cough
- spontaneous laughing/crying
- elicited laughing
- pain response
- yawn/sigh
- pushing/pulling exercise
- sustained voicing
- breath groups
What, why and how of resting breathing
-Is resting breathing normal?
-Do they
have open mouth posture?
-How is their secretion management?
What, why and how of deep breathing
- Can they inhale on command?
- Look for chest rising and belly expanding.
- Look for nostril flair.
What, why and how of spontaneous cough
- Is any audible vocalization during cough? (right place & right time observation or parent/client/caregiver report, it is unsafe to elicit a cough)
- Note that clients with trachs can have voicing around the trach, but may not be able to show voicing if the trach tube is very large.
What, why and how of elicited cough
- Ask them to cough on command.
- Make sure that you also discuss vocal hygiene here as you don’t want the clients to start excessive coughing which can be hard on the tissues.
What, why and how of spontaneous laughing/crying
-Does the client demonstrate spontaneous laughing or crying and is there voicing during these moments?
What, why and how of elicited laughing
- Get to know the client and find out what makes them laugh.
- Attempt to elicit laughter. Can be very challenging and takes creativity.
- Collaboration with the Therapeutic Clowns.
What, why and how of pain response
- How does the client respond to pain?
- Are there vocalizations (moaning) that occur (observe during a physiotherapy session or may need to rely on report from parent/client/caregiver)
What, why and how of yawn/sigh
-Can they take control of this more spontaneous movement to create controlled voicing?
What, why and how of pushing/pulling exercises
-Do they have the ability to control focal fold adduction through the more spontaneous movements when we push/pull?
What, why and how of sustained voicing
- Can they vocalize and sustain voicing for at least 3 seconds?
- Ask them to inhale and then vocalize on exhalation. -Consider use of biofeedback here.
What, why and how of breath groups
- When they have reached a multiword utterance level: can they control breathing to increase number of words per breath clearly.
- Video feedback may be helpful here.
What might be indicated if there is a disconnect between spontaneous and elicited laughing
-may indicate motor planning difficulties if they laugh spontaneously but can’t laugh on command
What is the goal of LSVT/ LOUD?
Achieve better speech with increased loudness through reorganization of neural control processes
What are the 5 characteristics of LSVT?
- voice focus
- single focus
- high phonatory and physical effort
- sensory calibration/perception
- quantification
Describe Voice focus of LSVT
Think Loud is used as the system trigger for improving vocal effort
Describe the single focus of LSVT
Global parameter that seems to engage multiple speech systems
Describe the high phonatory and physical effort of LSVT
Increased effort is needed to override rigidity and hypokinesia
Describe the sensory calibration/perception of LSVT
Speaker learns to identify the appropriate amount of effort and loudness in speech
Describe quanitification in LSVT
Quantified feedback by the clinician is key to motivating speakers
Describe the treatment protocol in LSVT?
- intensive treatment: daily practice
- Treatment is administered 4x a week for 16 sessions in one month
- web based delivery
T or F: LSVT is the most evidence-based program for improving speech in individuals with PD
True
Based on the discussion in class, what are the positives of LSVT?
- Draws on the principles of neuroplasticity
- One focus: loudness
- Effects on varying factors: articulation, voice quality, oral motor effects including swallowing and facial expression
- Accessible delivery, computer and web based
- Perceptual component helps them be more aware of their movements and speech (visual feedback very helpful)
- Has also been found to be effective in individuals with cerebellar ataxia, MS, stroke and aging voice. And CP and down syndrome in children
Based on the discussion in class, what are the negatives of LSVT/
- Can’t deliver LSVT in a group setting, draining on resources
- Task specificity? How does training loud voice lead to increases in swallowing?
- Cited animal models and made correlations for gross motor neuroplasticity and human speech. But we can’t really compare them.
- Both authors have conflict of interest
- It can’t fix everything. How can talking louder help with incoordination. LSVT could help but it can’t really help with prosody. Spastic dysarthria shouldn’t really be helped with increased loudness.
- Yana says it doesn’t make sense based on the disease
LSVT research found that the therapy only makes changes in which factors?
- SPL
- F0 variability
- loudness
- Sickness impact profile (subjective)
The Cochrane review of LSVT found what
methodological quality is poor
What are the 3 hypotheses for how LSVT works
1) increase in muscular activation
2) improving the voice source and thus improving the signal quality (SNR)
3) recalibrating sensorimotor processes?
What are the conclusions about LSVT?
The following things are NOT CLEAR:
- why it works
- who it works for in PD
- why it works for other disorders
- its effect on speech intelligibility
- if it is better/different than other therapies
List 2 other behavioural treatments for PD
- respiratory, coordination and voice control training, with emphasis on prosody
- prosody based therapy
Linguistic manipulations emphasize _______
feedback
