Perceptual Assessments

Question 0

Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

Answer 0

• Developed by ASHA
• Intended to be used in conjunction with other testing
• Method:
  
  • 2 vowel sounds
  • 6 phonetically loaded sentences (assesses the influence of phonetic demands on voice quality)
  • Running speech (assesses voice in natural context)
• Scoring:
  
  • 100mm visual analogue scale
  • Overall severity, roughness, breathiness, strain, pitch, & loudness
  • Mild, moderate, & severe
  • Consistent or intermittent
  • Blank lines to rate other factors (e.g. tremor, diplophonia)

Question 1

Types of perceptual voice assessment (3)

Answer 1

• The Sound Judgement (Oates & Russell, 2003)
• The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) (ASHA, 2006)
• The Voice Handicap Index (VHI) (Jacobson et al., 1997)

Question 2

Voice Handicap Index (VHI)

Answer 2

• Assesses patient’s perception of the relative impact of his/her voice disorder on daily activities
• Functional, physical and emotional sub-scales rated using a 5 point scale
  
  • 0 = never
  • 1 = almost never
  • 2 = sometimes
  • 3 = almost always
  • 4 = always

Question 3

Perceptual assessment of pitch

Answer 3

• Perception of how high or low a voice is
• Determined by speed of vibration of vocal folds
  
  • High pitch: fast rate of vibration
  • Low pitch: slow rate of vibration
• Variations in pitch (intonation)
• Variations: monotone or excessive variability

Question 4

Perceptual assessment of loudness

Answer 4

• Perception of how loud or soft voice is
• Determined by interaction between subglottal pressure & degree of adduction of vocal folds
• Soft voice: Subglottal pressure & inadequate adduction of vocal folds

Question 5

Perceptual assessment of quality

Answer 5

• How clear a voice sounds
• Rated according to the following:
  
  • Breathy
  • Strained
  • Rough
  • Glottal fry
  • Tremor
  • Pitch breaks
  • Phonation breaks
  • Voice arrests
  • Diplophonia
  • Falsetto

Question 6

Breathy

Answer 6

• Audible air escaping during phonation
• Due to incomplete adduction of vocal folds
• Breathy + strained = whispery
• Breathy + strained + rough = hoarse

Question 7

Strained

Answer 7

• Sounds like excessive vocal effort
• Due to increased laryngeal muscle tension & constriction
• True vocal folds and/or false vocal folds
• Strained + breathy = whispery
• Strained + rough = harsh
• Strained + breathy + rough = hoarse

Question 8

Rough

Answer 8

• Lack of clarity
• Due to irregular vibration of vocal folds
• Rough + strained = harsh
• Rough + breathy + strained = hoarse

Question 9

Glottal fry

Answer 9

• Rapid series of low-pitched “pops” or “taps”
• Creaky quality
• Physiological bases: complex, not well understood
• Due to:
  
  • Longer than normal closed phase of vocal fold vibration
  • Low frequency of vocal fold vibration
  • Tightly adducted vocal fold with free edges (flaccid/slack)
  • Low subglottal pressure

Question 10

Falsetto

Answer 10

• High pitched
• Thin, light quality, impression of immaturity
• Excess air escapes at times
• Due to:
  
  • High frequency of vocal fold vibration
  • Thinning of vocal fold edge
  • Incomplete closure along length of vocal folds

Question 11

Pitch breaks

Answer 11

• Sudden, short, unexpected & uncontrolled changes in pitch (increase or decrease)
• Physiology not understood

Question 12

Diplophonia

Answer 12

• Perception of 2 pitches occurring simultaneously in the voice
• Physiology not understood

Question 13

Phonation breaks

Answer 13

• Sudden, short, unexpected & uncontrolled breaks in voice
• Short duration
• Moment of turbulent air escaping with no voice
• Due to: Sudden cessation of vibration of vocal folds

Question 14

Voice arrests

Answer 14

• Voice stoppages
• Due to uncontrolled adduction of vocal folds
• Specific characteristic of spasmodic dysphonia
• Voice sounds strained & strangled