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Voice Disorders > Lecture 3 - 9/17 > Flashcards

Lecture 3 - 9/17 Flashcards

1
Q

Freedome to Act - Energetic Rest

A

The body is ready without strain or stiffness. A state of being between the two extremes (lax and stiff).

We apply this concept to

  • Respiration
  • Phonation
  • Resonation/Articulation
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2
Q

Tools to decrease the expiratory drive and medial compression of the VF’s

A

confidential voice
back pressure
resonant phonation
voiceless initiation of syllables

Clinician Answers: “Why Do I need to Do this?”

  • Contributes to the partnership you hope to build during this process
  • Clarifies the purpose of procedures
  • Facilitates adherence to practice & other recommendations
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3
Q

Neurological control of respiration

A

respiratory center in reticular activating system regulates concentration of Co2 and oxygen

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4
Q

Active part of respiration

A
  1. Inhalatory to expand and elevate the chest wall
    -Diaphragm and External Intercostals
  2. Exhalatory to collapse the chest wall during forced exhalation
    Abdominal musculature, transversus abdominis, external
    & internal obliques, & rectus abdominis
  3. Checking action to control speed of exhalation
    External intercostal muscles
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5
Q

Passive non muscular forces in respiration

A
  1. Elasticity
  2. Gravity
  3. Pleural linkage
    Oppositional relationship between lungs (to shrink &
    collapse) & chest wall (to expand)
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6
Q

INNERVATION

A

Innervation for inhalation:
T1-T12 – Spinal intercostal muscles
C2-3, C5-8, CN XI – Posterior neck muscles
C3-5 Phrenic nerve – Diaphragm

Innervation for exhalation:
T1-T12 – Spinal intercostal muscles

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7
Q

Newborn Respiration Stages

A

Newborn Stage 1 – Lasts a few minutes following birth
Establishment of postnatal respiration
Newborn Stage 2 - Lasts several hours to a day or more
All parts of chest & abdomen expand & contract
together (synchronous)
Newborn Stage 3 - Lasts several days or weeks
Rapidly fluctuating rates, variable rhythms, and a wide
variety of respiratory patterns
Newborn Stage 4 - Begins several weeks after birth
Stable rhythms & respiratory patterns as chest &
abdomen expand & contract
Newborn Stage 5 - Around 8 months -
Rhythmic diaphragmatic & thoracic movements are
established

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8
Q

Childhood Respiration

A

Age 7

Thoracic breathing predominates

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9
Q

Adult Respiration

A

Age 20-21
Adult vital capacity has developed

Aging Of Lungs - 80+ years
     -May have increased compliance in lungs & increased 
      stiffness of chest wall  
     -Decreased vital capacity
     -Reduced voice loudness
     -Limited pitch range
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10
Q

Passive

A

Non-muscular Forces

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11
Q

Active

A

Muscular Forces

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12
Q

Pleural Linkage

A
  • Thin, airtight membrane (visceral pleura) envelopes lungs, & a similar membrane (parietal pleura) lines inside of chest
  • Intrapleural fluid binds chest wall to lungs via negative pressure
  • Midrange of vital capacity where freedom to act is greatest
  • The pull from elastic recoil of pulmonary-chestwall unit reduces need for muscular activity during quiet breathing
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13
Q

Vital Capacities: Speech Range

A

During speech, we stay within the middle portion of this range where the passive respiratory forces are minimal (freedom to act).

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14
Q

Breathing when you yell is like….

A

Vary the size & speed of your inhalation

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15
Q

Observing Respiratory Systems (7)

A
  1. Adequacy of breath (SOB)
  2. Changes in movements of thorax
  3. Coordination between respiration & phonation
  4. Control for different voice tasks
  5. Changes in loudness
  6. Smoothness of loudness during speech & maximum phonation task
  7. “Sometimes when I talk it feels like I don’t have enough air.” (What patient feels/says)
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16
Q

Respirations and Capacities:

A

Total Lung Volume (TLC) – All air in lungs ~6,000 mL

Vital Capacity (VC) – Total amount of air that can be expired ~4000 mL

Tidal Volume (TV) – Midrange of vital capacity (35-60% VC) ~500mL

Inspiratory Reserve (IR) – Air forcibly inhaled after quiet inspiration (60-100% VC) 2500+ mL

Expiratory Reserve (ER)– Air forcibly exhaled after quiet expiration (0-34% VC) 900+ mL

                     (FROM GILL'S CLASS) mL                   MALE                           FEMALE

Tidal(TV) 660 590
TLC 6600 4600
IRV 3100 1900
ERV 1400 950
RV 2100 1500

17
Q

Breathing for Speech

A

Usually stays in 38%-60% VC Range
-Middle of range of motion
-Greatest degrees of freedom & freedom to act
-Least amount of work
-Feels easy
-Range is similar to quiet tidal breathing
-Allows for vocal adjustments – To speak past your
customary breath groups, take a bigger breath
—–
Passive expiratory forces become insufficient to sustain phonation as you approach & go below resting expiratory level (38% vital capacity)
—-
Use inspiratory checking to maintain phonation (activation of the inspiratory muscles to resist the passive elastic forces)

18
Q

Problems w/ Respiratory Functions Can Lead to…

A
  • Shortened phrase length
  • Reduced loudness
  • Changes in phrasing
  • Increased vocal effort
  • Decreased desire to speak
19
Q

Pulmonary Function Testing (7 types)

A
  1. Manometer
  2. Catheter in mouth & nose
  3. Whole body plethysmograph
  4. Pneumotachometer
  5. Rothenberg mask with air chamber
  6. Spirometer (SpiroPet)
  7. Stopwatch (Maximum Phonation Time)
20
Q

SpiroPet

A
  • Measures vital capacity in cubic centimeters (cc) of air
  • Compares to normative data based on age & sex
  • Refer to pulmonologist when mean vital capacity is below 70% of expected value
21
Q

Max Phonation Time Norms: (neutral vowel /a/ maybe)

A 
Maximum Phonation Time Norms:
Children ~ 10 seconds
Adults ~ 20 seconds
Females ~ 25.7 seconds
Males ~ 34.6 seconds 
Duration too short suggests…
Respiratory problem
Lack of checking action
Glottal insufficiency
Velopharyngeal insufficiency
Errors in data collection
Duration excessively long suggests…
Singer
Pressed phonation
Hyperadduction of VFs
Errors in data collection
22
Q

Calculate Phonation Quotient Equation and Norms

A 
Phonation quotient = 
Vital Capacity ÷ Maximum Phonation Time
-----
Phonation Quotient Norms	
Range 100-200 cc/sec
Phonation quotient too low suggests…
Lack of checking action
Glottal insufficiency
Velopharyngeal insufficiency
Errors in data collection
Phonation quotient excessively high suggests…
Singer
Pressed phonation
Hyperadduction of VFs
Errors in data collection
23
Q

Objective Measurement of Sustained /s/ & /z/

A 
Norms for sustained /s/ & /z/
Normal /s/ for child is 9 sec
Normal /z/ for child is 11 sec
Normal /s/ for adult is 16 seconds
Normal /z/ for adult is 19 seconds (why longer?)

Short duration for both (s & z) suggests…
Respiratory problems
Lack of checking action
Errors in data collection

Excessively long duration for both (s & z) suggests…
Singer
Errors in data collection

24
Q

Objective Measurement of s/z

A

Norms for s/z ratio
Normal range is slightly less than 1 (between .7 & .99)

Less than .7 suggests…
Increased medial compression 
Excessive stiffness of VFs 
Constriction in vocal tract (e.g., ventricular VFs, epilarynx)
Inappropriately loud voice
Pressed phonation
Errors in data collection
Greater than 1 suggests…
VF involvement (the /s/ is normal & /z/ is leaky)
Glottal insufficiency
Velopharyngeal insufficiency
Errors in data collection

Voice Disorders (8 decks)

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