Management of Laryngeal Impairment

Question 1

Extrinsic muscles of larynx innervated by:

Answer 1

CN V, VII, XI

Fixation, elevation & lowering position of the larynx

Question 2

Intrinsic muscles of larynx innervated by:

Answer 2

CN X

Adducting, abducting & elongating VFs

Question 3

Severe VF hypoadduction

Answer 3

Often exhibit reduced respiratory support, VPI and laryngeal weakness
Often in TBI w/ brainstem involvement

Question 4

Want to inventory _______________ associated w/ phonation

Answer 4

Non-speech reflex patterns

ex: laugh, cough, sigh, expressions of pain/discomfort

Question 5

If weak effort, can support exhalation by ____________

Answer 5

Abdominal pressing

Question 6

Ask family or carepartner to keep a journal outlining:

Answer 6

Voicing bevr
Consistency
Position
Stimulus
Length of phonation
Assistance or instruction provided

Question 7

Increasing loudness in hypoadduction to

Answer 7

Generate greater levels of subglottal air pressure

Initiate phonation at appropriate lung volumes or times in the respiratory cycle

Question 8

3 Strategies to Increase loudness

Answer 8

• Effortful closure techniques
• Head turn
• Balance subglottal air pressure with medial compression

Question 9

Surgical Intervention

Answer 9

Laryngoplasty
Teflon, collagen, autogenous fat injections
Re-innervation techniques

Question 10

Lee Silverman Voice Therapy (LSVT)

Answer 10

“Big and loud”

Focus on increasing vocal effort to enhance VF closure and loudness

Question 11

LSVT Steps

Answer 11

1. Increase loudness & decrease breathiness by increasing VF adduction
2. Improve intonation by increasing cricothyroid muscle activity
3. Improve voice quality by increasing stability of VF vibration

Question 12

LSVT Characteristics

Answer 12

• Intensive
• High effort
• Maximum duration of phonation at constant levels of loudness and steadiness
• Fundamental frequency range exercises
• Speak w/ same effort
• Increase accuracy in articulation
• Recalibration

Question 13

Positive prognostic indicators

Answer 13

• Classic Parkinson’s
• Hypoadducted VFs w/ anterior glottal gap
• Motivated and value speech
• Stimulable for louder voice
• Adequate cognition

Question 14

Prosthetic management for laryngeal impairment

Answer 14

Portible amplification

Question 15

Surgical procedures for laryngeal hypoadduction

Answer 15

Pallidotomy - lesion part of globus pallidus
Thalamotomy - for drug-resistant tremor
Deep brain stimulation

Question 16

Hyperadduction intervention

Answer 16

Behavioural intervention & balance
Sound level meter
Pharmalogical
Botox

Question 17

Hyperadduction Management Techniques

Answer 17

Breathy Onset
Yahn/sigh
Relaxation
Respiratory-laryngeal timing
Intelligibility drills