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Motor Speech > Laryngeal Subsystem > Flashcards

Laryngeal Subsystem Flashcards

1
Q

What are the two speech functions of the larynx

A

1) to control phonation - rapid, vibratory quasi periodic motions of the VF
2) To control articulation (phonetic distinction)

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2
Q

What are the 3 was the larynx controls articulation

A
  • vowels vs (voiced/voiceless) consonants
  • laryngeal devoicing gesture: consonants
  • laryngeal height - vowels
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3
Q

High vowels have a ________ position of the larynx and low vowels have a ___________ position of the larynx

A

higher

lower

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4
Q

How does phonation occur?

A

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

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5
Q

Movement of VFs is determined by _________ laws coupled with ________ forces

A

aerodynamic

elastic

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6
Q

Aerodynamic laws affecting the VFs include what?

A
  • the Bernoulli effect

- mass conservation laws

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7
Q

What muscles bring the vocal folds together

A

lateral cricoarytenoids

interarytenoids

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8
Q

What muscles open the VFs?

A

posterior cricoarytenoids

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9
Q

What muscles establish appropriate tension in the VFs?

A

cricothyroid and vocalis

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10
Q

Contraction of the CT and vocalis is the primary mechanism for what?

A

F0 control for purposes of prosodic variation

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11
Q

What are some characteristics we look at in F0?

A
  • phonation frequency
  • phonation variability
  • period
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12
Q

T or F: F0 = pitch

A

false!

  • F0 is what is produced
  • pitch is the perceptual equivalent
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13
Q

When is phonation best measured?

A

In a simple/normal phonation like a sustained /a/

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14
Q

In a waveform analysis, consonants have _________ waves and vowels have _______ waves

A

aperiodic

semi-periodic

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15
Q

on a waveform each _______ is associated wit ha closure of the VFs

A

peak

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16
Q

Why is phonation important? (affects 3 things)

A
  • prosody: intonation, stress, phrasal junctures
  • speaker identification: sex, dialect, social status
  • paralinguistic information (emotions)

-leads to complex effects of damage

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17
Q

Phonemic distinction aka ___________ affects intelligibility

A

articulation

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18
Q

On a spectrogram, complete closure of the VFs leads to a white space called a ________

A

closure interval

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19
Q

On a spectrogram, the voice onset after a closure interval is described as a ___

A

burst

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20
Q

Describe the laryngeal devoicing gesture (LDG)

A
  • 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
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21
Q

The LDG is the physiological implementation of _________

A

voicelessness

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22
Q

The LDG is ___________ with the oral constriction for voiceless consonants

A

synchronous

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23
Q

T or F the LDG is under voluntary control

A

False

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24
Q

What are the 4 types of phonatory impairments

A
  • hypoadduction impairments
  • hyperadduction impairments
  • phonatory instability impairment
  • phonoatory coordination impairment
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25
Q

Describe phonation in hypo adduction impairments. What are some causes?

A
  • inadequate VF closure, reduced loudness, breathy or hoarse voice
  • laryngeal paralysis, PD, TBI, bulbar palsy
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26
Q

Describe phonation in hyper adduction impairment. What are some examples

A
  • harsh, pressed, strained-strangled voice

- pseudobulbar palsy, Huntington’s disease, CP, TBI

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27
Q

Describe phonation in phonatory instability impairment

A
  • tremor, rough or hoarse voice quality, pitch breaks and glottal fry
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28
Q

Describe phonation in phonatory coordination impairment

A

-difficulty achieving voicing distinctions

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29
Q

What are the 2 general types of assessment tasks for assessing laryngeal function?

A
  • 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
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30
Q

What do we measure using instrumental assessment, acoustic analysis of F0

A
  • jitter
  • shimmer
  • signal to noise ratio
31
Q

What is important to remember during instrumental assessment - acoustic analysis of voice

A
  • remember to elicit task consistently

- variability may be a feature of the disorder voice

32
Q

Other than an acoustic analysis of voice, what else can we do with instrumental assessment

A
  • visualization of VFs

- aerodynamic assessment to measure laryngeal resistance

33
Q

According to Duff, why is management of respiratory/phonatory Fx often a priority?

A

Because improvement at this level is expected to generate improvements at other levels

34
Q

What are the 5 types of respiratory treatments

A

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

35
Q

What are the two types of techniques for laryngeal hypoadduction?

A
  • effort closure techniques

- surgical options

36
Q

What are some effort closure techniques for laryngeal hypoadduction?

A
  • 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
37
Q

What are the surgical treatment options for laryngeal hypoadduction?

A
  • VF repositioning or medicalization laryngoplasty, thyroplasty or arytenoid adduction surgery
  • VF injections
38
Q

T or F: laryngeal hyper adduction can be a compensatory mechanism

A

True: it may occur as a compensatory mechanism for managing weakness at the respiratory or velopharyngeal level

39
Q

What are some treatment options for laryngeal hyper adduction?

A
  • 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
40
Q

What are the results of the study by Maryn and colleagues on augmented feedback/biofeedback

A

Only 3/18 studies didn’t find support for using biofeedback in training voice

41
Q

What are some examples of biofeedback in voice?

A
  • microphone
  • surface EMG
  • Fibroscopic laryngoscopy
  • Visipitch
  • Speech Viewer
42
Q

What are some prosthetics techniques for reduced loudness? Who benefits from them>

A
  • Voice amplifiers
  • Speech enhancers

-Individuals with CP, MS, TBI, Myasthenia graves, vent/trach, spasmodic dysphonia, stroke, PD or paralyzed vocal cords

43
Q

VERY IMPORTANT - how is the laryngeal subsystem connected to the respiratory system?

A

Subglottal pressure drives the phonatory system

44
Q

When considering respiration and phonation, what are so-called ‘pieces of the puzzle?

A

-VF function
-Respiratory support
-apraxia
dysarthria

45
Q

What are Katia Simics 11 non-speech skills that are important to assess when looking at respiration and phonation?

A
  • resting breath
  • deep breathing
  • spontaneous cough
  • elicited cough
  • spontaneous laughing/crying
  • elicited laughing
  • pain response
  • yawn/sigh
  • pushing/pulling exercise
  • sustained voicing
  • breath groups
46
Q

What, why and how of resting breathing

A

-Is resting breathing normal?
-Do they
have open mouth posture?
-How is their secretion management?

47
Q

What, why and how of deep breathing

A
  • Can they inhale on command?
  • Look for chest rising and belly expanding.
  • Look for nostril flair.
48
Q

What, why and how of spontaneous cough

A
  • 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.
49
Q

What, why and how of elicited cough

A
  • 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.
50
Q

What, why and how of spontaneous laughing/crying

A

-Does the client demonstrate spontaneous laughing or crying and is there voicing during these moments?

51
Q

What, why and how of elicited laughing

A
  • 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.
52
Q

What, why and how of pain response

A
  • 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)
53
Q

What, why and how of yawn/sigh

A

-Can they take control of this more spontaneous movement to create controlled voicing?

54
Q

What, why and how of pushing/pulling exercises

A

-Do they have the ability to control focal fold adduction through the more spontaneous movements when we push/pull?

55
Q

What, why and how of sustained voicing

A
  • 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.
56
Q

What, why and how of breath groups

A
  • 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.
57
Q

What might be indicated if there is a disconnect between spontaneous and elicited laughing

A

-may indicate motor planning difficulties if they laugh spontaneously but can’t laugh on command

58
Q

What is the goal of LSVT/ LOUD?

A

Achieve better speech with increased loudness through reorganization of neural control processes

59
Q

What are the 5 characteristics of LSVT?

A
  • voice focus
  • single focus
  • high phonatory and physical effort
  • sensory calibration/perception
  • quantification
60
Q

Describe Voice focus of LSVT

A

Think Loud is used as the system trigger for improving vocal effort

61
Q

Describe the single focus of LSVT

A

Global parameter that seems to engage multiple speech systems

62
Q

Describe the high phonatory and physical effort of LSVT

A

Increased effort is needed to override rigidity and hypokinesia

63
Q

Describe the sensory calibration/perception of LSVT

A

Speaker learns to identify the appropriate amount of effort and loudness in speech

64
Q

Describe quanitification in LSVT

A

Quantified feedback by the clinician is key to motivating speakers

65
Q

Describe the treatment protocol in LSVT?

A
  • intensive treatment: daily practice
  • Treatment is administered 4x a week for 16 sessions in one month
  • web based delivery
66
Q

T or F: LSVT is the most evidence-based program for improving speech in individuals with PD

A

True

67
Q

Based on the discussion in class, what are the positives of LSVT?

A
  • 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
68
Q

Based on the discussion in class, what are the negatives of LSVT/

A
  • 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
69
Q

LSVT research found that the therapy only makes changes in which factors?

A
  • SPL
  • F0 variability
  • loudness
  • Sickness impact profile (subjective)
70
Q

The Cochrane review of LSVT found what

A

methodological quality is poor

71
Q

What are the 3 hypotheses for how LSVT works

A

1) increase in muscular activation
2) improving the voice source and thus improving the signal quality (SNR)
3) recalibrating sensorimotor processes?

72
Q

What are the conclusions about LSVT?

A

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
73
Q

List 2 other behavioural treatments for PD

A
  • respiratory, coordination and voice control training, with emphasis on prosody
  • prosody based therapy
74
Q

Linguistic manipulations emphasize _______

A

feedback

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