Module 4

Question 1

What do voice problems come from? What does therapy aim to do?

Answer 1

Disordered vocal fold activity. Therapy aims to improve vocal fold movements. Detailed activity about movement of larynx helps with assessment/treatment.

Question 2

What do Doctor examine larynx with?

Answer 2

Laryngeal mirror- low level detail. Must pull on tongue to tug on epiglottis. Can see if structures growth and movement.

Question 3

For more detailed voice work, ENT /SLP will use

Answer 3

Rigid scope exam- shows on screen.
Flexible scope exam- through nasal cavity to shine down on larynx from above so people can articulate normally. Usually used in medical setting.

Question 4

What is high speed filming?

Answer 4

Standard vhs is 30 frames/s
Not clinically practical because of expense and complexity
Was used in pioneering work on physiology
Massive amounts of data-timing issues

Question 5

What is stroboscopy?

Answer 5

Capitalizes on optical illusion- each illumination is a snapshot, and paste the snapshots together in succession for a “movie”
30 frames/s, folds may oscillate 200x/s

Question 6

What is very important in stroboscopy?

Answer 6

TIMING. If you want a frozen image, flash occurs at same point in each cycle
If you want slow motion, flashes slightly delayed in successive cycles.

Question 7

How do we program when to flash during stroboscopy?

Answer 7

Throat microphone helps to know fundamental f to know where vocal folds will be.

Question 8

What are strobe limitations?

Answer 8

True vocal fold is not seen. F0 must be steady as flashes can’t synchronize if erratic. Severe dysphonia may not be possible.

Question 9

What is an electroglottograph? When is there more current? Less?

Answer 9

Placed on larynx on surface of neck, current passes from one side to another. Gives a waveform that shows us movement. More current when folds together, less when apart.

Question 10

In an open phase, where does the egg signal go?

Answer 10

Indirect path around folds. When closed, can go straight through and be stronger.

Question 11

What does the signal coming from an egg represent? What is important?

Answer 11

Not sound pressure, glottal width, or opening/closing. Represents vocal fold contact area! Changes in vocal fold contact are important.

Question 12

When does signal strength grow rapidly?

Answer 12

When folds close. Signal strength greatest when fully closed.

Question 13

What are advantages of egg?

Answer 13

Noninvasive, safe, easy

Question 14

What is vocal perturbation?

Answer 14

Voice perturbed away from periodic repitition

Question 15

What is jitter?

Answer 15

Random cycle to cycle differences in duration (f)

Question 16

What is shimmer?

Answer 16

Random cycle to cycle amplitude differences

Question 17

What kind of voice will have higher perturbation? How much perturbation do normal voices have?

Answer 17

Hoarse. Will have jitter and shimmer. Minimal -not natural to have none.

Question 18

How do you define perturbation in the clinic?

Answer 18

Number won’t give diagnosis- use your ears to see if there’s a problem- track progress over time with numbers.

Question 19

What causes perturbation?

Answer 19

Neurological- Muscle contraction is inherently un smooth, motor neurons take turns firing, overall contraction is the net effect of many minuscule twitches.
Air flow can be turbulent.
Pathological-vocal fold tissue changes- l/r asymmetry, mass lesions, vocal fold swelling, tension abnormalities

Question 20

How do we look at perturbation in a client?

Answer 20

Use sustained vowels, avoid onsets, offsets. Comfortable intensity level, record live to computer, compare like with like (same vowel/same conditions)

Question 21

What is tremor?

Answer 21

Tremor- rythmic change in F0 and amplitude. Much slower than cycle to cycle perturbation

Question 22

What is FM vs Am

Answer 22

Frequency modulation, amplitude modulation- pattern of gradual increase or decrease in F0 spread across many cycles

Question 23

What goes up with intensity?

Answer 23

F0

Question 24

In a person with tremor, TA increases SO

Answer 24

Vocal folds increase activation which reduces airflow

Question 25

How do we quantify tremor?

Answer 25

How rapid? 5 to 7 hz

How extreme? % fluctuation around mean

How steady? Periodicity can be expressed as %

Question 26

Why do we use our voice?

Answer 26

Efficient communication, artistic tool, subtle shades of emotion