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SPH512 Part 2 - Voice and Fluency > Proms, Case Hx / Biomechanics > Flashcards

Proms, Case Hx / Biomechanics Flashcards

1
Q

What are the parts of the true vocal folds, according to Cover-body theory (Hirano, 1974)?

A

Body: Vocalis Muscle

Transition: Lamina Propria (Vocal ligament) - intermediate and deep layers.

Cover: Epithelium superficial layer lamina propria (responsible for mucosal wave).

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2
Q

Where do the false vocal folds attach?

A

Arytenoids and angle of thyroid cartilage.

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3
Q

What is also called Reinke’s space, and is responsible for the mucosal wave?

A

Superficial layer of the lamina propria.

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4
Q

Another name for the false vocal folds?

A

Ventricular folds

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5
Q

What are the ventricular (false vocal folds) made of?

A

Mostly glandular tissue with a bit of musculature. They sectrete mucus onto the vocal folds for lubrication, and are not (should not be!) involved in phonation.

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6
Q

What is the outer layer for skin on the vocal fold?

A

Stratified squamous epithelium

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7
Q

What is the ‘body’ of the vocal fold made up of?

A

Thyroaryteniod muscle

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8
Q

What is the ‘transition’ layer of the vocal fold made up of?

A

Vocal ligament, Deep and intermediate lamina propria

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9
Q

What are the 2 main adjustments of the larynx, changing the vocal fold mass, tension and length? (Thereby impacting pitch and loudness).

A

Medial compression
and
longitudinal tension

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10
Q
  1. Frequency of vocal fold vibration
  2. Pattern/mode of vibration
  3. Configuration of vocal tract
    affect both…?
A

Pitch

and

Quality

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11
Q

3 types of onset (of phonation)

A
  • Breath before tone
  • Simultaneous (easy) onset
  • Glottal stroke/attack
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12
Q

Vibratory cycle at conversational pitch/intensity: open vs closed phase

A

Open phase (50%)

Closed phase (13%)

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13
Q

Describe breath before tone onset

A

Breath goes through the glottis before vocal folds adduct. Can hear the breathy start (“Hoh no!”). Breathy tone, low volume.

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14
Q

Describe simultaneous (easy) onset

A

Vocal folds brought together at the same time as they produce sufficient airflow for them to start vibrating.
Sounds louder, with more sound in the tone (less breathy and whispered) than breath breath before tone.

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15
Q

Describe Glottal stroke

A

Vocal folds adduct completely before being blown appart to start vibration. Crisp start, sounds normal.

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16
Q

Describe glottal attack

A

Adduction is forceful and tight. Sounds like first phoneme is accented. Begins with force.

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17
Q

What is a glottal cycle?

A

Opening - closing - opening

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18
Q

How do we increase pitch?

A

Increase the length of the vocal folds (cricothyroid muscle), which decreases mass and increases tension. The increase in tension makes the vocal folds flutter open and closed more quickly.

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19
Q

Increase in length = decrease in mass = increase in tension = increase in pitch
mediated by which muscles?

A
  • Cricothyroid
  • Thyroarytenoid
  • Posterior Cricoarytenoid

–> extreme changes are facilitated by extrinsic muscles to stabilise the larynx

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20
Q

How to increase vocal intensity?

A

Increased closed phase + Increased medial compression = Increased resistence THEREFORE increased subglottal pressure needed to blow vocal folds appart

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21
Q

Why does pitch sometimes get louder when people raise their voices?

A

Vocal cord tension may be incidentally increased, when the closed phase and medial compression of vocal folds is increased.

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22
Q

Name 4 vocal registers:

A
  1. Glottal Fry
  2. Chest/modal voice.
  3. Head voice
  4. Falsetto (loft register)
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23
Q

Muscle and vocal fold action during Glottal Fry register:

A 
Thyroarytenoid activated (cricothyroid relaxed)
- vocal folds very short and flaccid, vibrating slowly.  Almost "slap" together. Lowest pitch register.
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24
Q

Muscle and vocal fold action during Chest/Modal voice register:

A 
Thyroarytenoid activated (crycothyroid relaxed)
Vocal folds slightly longer than vocal fry, with a shorter closed phase.  Commenest 'speaking voice' modality.  Can change pitch without changing vibration pattern,.
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25
Q

Muscle and vocal fold action during Head voice register:

A

Crycothyroid muscle activated. (Thyroarytenoid relaxes so it can be passively streched as thyroid cartilage tilts)
As vocal folds lengthen and begin to stretch, the vertical meeting area begins to thin. Cover becomes thinner and tenser. Closed phase less than in chest voice - not breathy, but less power/volume.

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26
Q

Muscle and vocal fold action during Falsetto (loft) register:

A

Cricothyroid muscle dominates (thyroarytenoid muscle passively relaxed).
Vocal folds very stretch and do not touch (just approximate) during the glottal cycle. Voice can be breathy and tight, without power.

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27
Q

We use Ax of signs and symptoms to decide if someone has a voice disorder…
but how do we measure signs and symtoms…?

A

Multi-Dimensional Assessment –> Assessment of

  • Body structure and Functions
  • Activity
  • Participation
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28
Q

There are 2 ways to measure patient symptoms (the patient’s complaints) in a way that enables a meaningful interpretation of them. What are they?

A
  1. Screening (examination of a group to seperate well persons from those who have an undiagnosed voice disorder, or who are at high risk)
  2. Patient Reported Outcome Measures (PROMs) /Quality of Life Evaluations (Designed to measure symptoms of impact of symptoms on someone who presents with an (already recognised) problem.
29
Q

List a paediatric voice screener:

A

Quick screen for Pediatric Voice Disorders (Lee, et al., 2004) - for children

30
Q

What kind of Ax is The Screening Index for Voice Disorder (SIVD) (Ghirardi, et al., 2013) and does it reliably separate well persons for those with an undiagnosed voice disorder, or those who are at high risk? What is the cut-off score?

A

Subjective measure - screener to identify if an adult is at risk of having a voice problem.

Yes.

Score 5 or more indicates risk of having a voice disorder.

31
Q

What kind of Ax is The Quick Screen for Pediatric Voice Disorders (Lee, et al., 2004) and does it reliably separate well persons for those with an undiagnosed voice disorder, or those who are at high risk?

A

Subjective Measure - screener for specific population (children).

No, it doesn’t have enough evidence to make a clear, definitive judgement about risk, but may be useful for guidance.

32
Q

List some Patient Reported Outcome Measures (PROMs) / Quality of Life Evaluations

A
  • Voice Handicap Index (VHI) (Rosen, et al., 2004)
  • Voice Related Quality of Life Index (V-RQOL) (Hogkiyan and Sethuraman, 1999)
  • Voice Activity and Participation Profile (Ma and Yiu, 2001)
  • Voice Disability and Coping Questionnaire (Epstein and Hirani, 2009)
  • Voice Symptom Scale (VoiSS) (Deary, et al., 2003)
33
Q

List some POPULATION SPECIFIC Patient Reported Outcome Measures (PROMs) / Quality of Life Evaluations

A
  • Pediatric Voice Handicap Index (Zur, et al., 2007)

* Singing Voice Handicap Index (SVHI-10) (Cohen et al., 2009)

34
Q

Which PROMs would you give a child’s Parent? (to fill in in parental proxy)

A

Pediatric Voice Handicap Index (pVHI) (Zur, et al., 2007)

35
Q

Which PROMs would you give a person with a voice disorder, in general? (Which is most-used in Australia?)

A

Voice Handicap Index (VHI-10) (Rosen, et al., 2004)

36
Q

Which quality of life evaluation would you give to a singer?

A

Singing Voice Handicap-10 (SVHI-10) (Cohen, et al., 2009)

**No cut-off data, so difficult to say there is definitely a disorder - more useful to measure progress in therapy.

37
Q

Normative Values for the Voice Handicap Index-10 (VHI-10)?

A

A VHI-10 score greater than 11 should be considered abnormal (Arffa et al., 2012)

38
Q

A RSI (Reflux Symptom Index) score of more than 13 is considered to be…? Anybody with a score of over 15 has a…?

A

Abnormal (Belafsky et al., 2002)

90% chance of having reflux

**Cate uses this as standard in her Ax battery, because she wants to pick up LPR if present as behavioural strategies very effective, effect on voice is large.

39
Q

Name a PROMs aimed at flagging likely LPR?

A

Reflux Symptom Index (RSI) (Belafsky et al., 2002)

40
Q

Name a PROMs aimed at measuring symptoms of cough.

A

Cough Severity Index (CSI) (Shembel et al., 2014)

41
Q

What are PROMs for?

A

Designed to measure symptoms or impact of symptoms for someone who presents with a problem.

42
Q

This PROMs is a very specifically designed too according to definitions of activity and participation from the ICF. It is very useful for professional voice users to assess impact of their disorders on activites and participation, and also for patients involved in workers comp and medico-legal cases…

A

Voice Activity and Participation Profile (VAPP) (Ma and Yiu, 2001)

**Can also compare scores to research data.

43
Q

Which PROMs measures patient reported symptoms of kinaesthetic/physical sensations related to the voice disorder?

A

Vocal Tract Discomfort Scale (VTD) (Mathieson et al., 2009)

44
Q

What is the Cough Severity Index (CSI) (Shembel et al., 2014) useful for?

A

Numerical values allow us to interpret results. 2 standard deviations above mean are symptomatic for cough. Can provide a baseline to see if cough symptoms improve through therapy/behaviour strategies.

45
Q

3 Questions to ask when considering which PROMs to use:

A
  • What do they assess (all parts of ICF, only body functions and structure? Only participation?)
  • Is it for a specific population?
  • Does the tool have cut-off scores or norms?
46
Q

Do we collect PROMs before or after the case history interview? Why?

A

Collect PROMs BEFORE doing the Case Hx –> inform more targeted case history questions.

47
Q

Information to collect during case history interview:

A 
Demographic
Symptoms
Onset of disorder
Variability
Triggers
Medical History
Social History
Psychological/Emotional History
Occupation
Needs and uses of voice.
48
Q

Case History:

Onset –>

  1. When?
  2. Sudden or gradual?
A

See Baker for onset of different voice disorders.

49
Q

Case History:

Variability?

A

Is the voice problem stable, or does it fluctuate?
Is it better/worse with rest/use?
Do any medical conditions or other factors make it worse?

50
Q

Case History:

Triggers

A

Anything make your voice worse? Or Better?

What have you tried for your voice? Did it work?

51
Q

Case History:

Medical History

A

Need to be very detailed so we can understand if the voice problem is a symptom of another medical problem or if it is stand alone.

52
Q

Case History:

Occupational

A

How do you use your voice on in your job? In what environment? For what hours? Do you like your job? Is it stressful?

53
Q

Case History:

Needs and Uses

A

What do you need/use your voice for? (is vocal function a causal factor?) AND what impact is current disordered vocal function having on activities and participation?

54
Q

Questions to answer by the end of the case history interview:

A
  • Does a problem exist?
  • What is it’s severity?
  • What impact does the problem have on QoL?
  • What is the etiology of the problem?
  • What is the likelihood and motivation for change?
  • What is therapy likely to accomplish?
  • Is there a need for further referral?
  • Recommendations for therapy?
55
Q

Voice Related Quality of Life Index (V-RQOL)

What are scores indicative of disorder?

(Hogikayn and Sethuraman, 1999)

A

PROMs.
Describes the voice and the impact it has on one’s quality of life.

V-RQOL Physical Functioning ≤ 52.
V-RQOL Social-Emotional ≤ 56.
V-RQOL Total ≤ 54.

(Hogikayn and Sethuraman, 1999)

56
Q

Voice Activity and Participation Profile (VAPP)

What does this assess?

(Ma and Yiu, 2001)

A

PROMs.
Describes the voice problem and the effect it has on one’s life.

(Ma and Yiu, 2001)

57
Q

Voice Disability and Coping Questionnaire

Epstein et al., 2009

A

PROMs.
Describes the voice problem and the ways the person copes with the impact it has on their life.

(Epstein et al., 2009)

58
Q

Pediatric Voice Handicap Index (pVHI)

Zur et al., 2007

A

PROMs.
Describes the voice and the effect it has on a child’s life.

(Zur et al., 2007)

59
Q

Singing Voice Handicap Index (SVHI-10)

Cohen et al., 2009

A

PROMs.
Describes the voice and the effect of singing on one’s life.

(Cohen et al., 2009)

60
Q

Voice Symptom Scale (VoiSS)

Deary et al., 2003

A

PROMs.
Patient describes their voice and the effects of their voice on their lives.

(Deary et al., 2003)

61
Q

Reflux Symptom Index (RSI)

Belafsky et al., 2002

A

PROMs.
Examines symptoms commonly experienced in patients with silen reflux.

A score of 15 or more means that you have a 90% chance of having reflux, especially airway reflux.

(Belafsky et al., 2002)

62
Q

Cough Severity Index (CSI)

Pros of using this?

(Shembel et al., 2013)

A

PROMs.
Examines symptoms commonly experienced in patients with coughing difficulties.

Short, simple instrument that can be used in the clinical setting to quantify a patient’s symptoms of chronic cough of upper airway origin. Statistically reliable, valid and clinically relevant and can be used to measure treatment outcomes for chronic cough. Level of evidence: 2c

(Shembel et al., 2013)

63
Q

How long does a cough last before it is considered ‘chronic’? What are some other criteria for the ‘chronic’ label?

A

8 weeks.
May have been originally caused by URTI but now no obvious etiology. No longer an effective protective reflex. Refractory to traditional medical treatment.

(Shembel et al., 2013)

64
Q

Belinda - Pre-filled Client Questionnaire - excluding medical history and lifestyle factors

A
  • Demographic Info, family, referral info
  • Describe current condition of your voice?
  • How long voice like this?
  • Who noticed?
  • Do you know what caused it?
  • Onset - gradual / sudden?
  • Course? -worse?/better?/same?
  • Voice worse at what time? - morning? Later in the day after use?
  • Use? Speak extensively - At work? Socially?
  • Number of hours?
  • Voice use and symptoms? (yelling, throat clearing, bad breath, feel tired, dehydrated/thirsty, bitter/acid taste or hoarseness in morning?, whispering?, sore throat?, heartburn? chronic fatigue/insomnia?, chest cough?)
  • Symptoms? (hoarseness, Vocal fatigue? Volume trouble? - loud/soft difficulties?, Loss of pitch range? (low? high?), Long time to warm up voice? Breathiness? Tickling/choking sensation when speaking? Pain when speaking?, Loss of voice? Other?)
  • Capacities in which you have ever used your voice professionally?
  • Training for speaking or singing voice?
  • Do you warm up your voice before using?
  • Workers compensation claim?
  • Medical history (extensive - not included)
65
Q

Belinda - pre-filled Client Questionnaire - Medical history

A

*Ever had (thyroid problems?, Frequent bad headaches?, Asthma?, Chronic Fatigue syndrome?, High blood pressure?, arthritis?, lung/breathing problems?, Cleft palate?, ulcers?, Glandular fever? Cancer?
*Ever had any operations? (tonsillectomy? Heart surgury? Appendectomy? Other?)
*Ever injured head or neck?
*Ever had X-ray treatment to head and neck?
*Other serious accidents? with/without head injury, loss of consciousness, whiplash?
*List all current medications (including birth control, vitamins)
*Allergy evaluation? (details of allergies?)
*Ever consulted a psychiatrist or psychologist? Currently?
*Have a cold now? Recently? (when?)
*Pregnant? Currently menstruating?/ovulating? Regualar periods? Hysterectomy? (ovaries removed?) Reached puberty when? Menopause? Voice break?
*Suffered from the following in the last 12 months? (provide details) Cough? Bronchitis? Sinusitis? Colds/flu?
Asthma? Gastric Reflux?

66
Q

Belinda - pre-filled Cient Questionnaire - Lifestyle

A
  • How much sleep do you get on average per night?
  • Do you exercise regularly?
  • Do you drink… (Coffee? Tea? Cola? - Quantity?
  • Do you drink alcohol? (Frequency, quanitity)
  • Do you /have you ever smoked? Quantity? Duration? Quit date?
  • Recreational Drugs? What?
  • Heightened emotional situations in last 3 months? Details?
  • Current stress?
  • Current workload?
  • Do you live/work around.. (extreme dryness? Smoke/fumes?
  • Do you (Work late shift? Eat late at night?)
  • Have you (ever used antacids? Traveled recently?)
67
Q

Luke (7;4) - pre-filled Cient Questionnaire

A
  • Demographic incl. other health professionals, family structure, other languages used
  • Describe communication difficulties.
  • Who referred, and why?
  • Previously seen an SLP?
  • Other concerns? (developmental)
  • Communication difficulties/disabilities in family?
  • Pregnancy/birth history? Breast/bottle? Feeding? Fussy eater? Chewing/swallowing? Thumb/dummy? Dental?
  • Medical history
  • Hearing tested?
  • Other behavioural/developmental issues? Milestones? Toilet training?
  • Speech/language development and milestones. Current developmental level. Stuttering? Voice?
  • Social development? Playmates? Interests/activities?
  • Medications?
68
Q

Which PROMs was Luke’s mother given to fill out?

A

Paediatric Voice Handicap Index (PVHI)

Zur et al., 2007

SPH512 Part 2 - Voice and Fluency (7 decks)

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