quiz 6

Question 1

1.

vocal tremor

Answer 1

• tremor: spontaneous, rhythmic, oscillatory movements of the muscles of the hands, limbs, articulators

Question 2

kinds of tremors

Answer 2

• resting tremor
• volitional tremor
• postural tremor
• terminal tremor

Question 3

essential voice tremor

Answer 3

• primary voice symptom is regular modulations of frequency or loudness of the voice most evident on vowel prolongation (5-6Hz, 5dB)
• secondary voice symptom is strain, struggle, or harshness
• tremor in other body parts may accompany vocal tremor

Question 4

diagnosis of vocal tremor

Answer 4

• best diagnosed on sustained phonations, rather than conversational speech; perceived as more severe
• endoscopic exam will show structurally normal larynx with VF adjusting as per the frequency/loudness modulations
• flexible endoscopic exam will show corresponding “tremor” in velum, pharyngeal, tongue movements in tremulous synchrony

Question 5

management of vocal tremor

Answer 5

• voice therapy
• Botox injections

Question 6

role of voice therapy in vocal tremor

Answer 6

• reduce any compensatory vocal hyperfunction
• coordinate subsystems of voicing
• mask the tremor with strategies

Question 7

strategies to mask vocal tremor

Answer 7

• will not be able to make tremor go away, but can give helpful strategies
• reduced duration of voiced segments so tremor doesn’t have a chance to occur
• more frequent pauses

Question 8

role of Botox injections

Answer 8

• injected into oscillating muscles to reduce degree they involuntarily tremor
• important to determine muscles responsible for tremor

Question 9

why is Botox for vocal tremor more difficult than Botox for laryngeal dystonia

Answer 9

• in LD, the spasming muscles can most likely be isolated to one muscle “group,” such as adductor or abductor muscles
• with vocal tremor, it’s often multiple muscle groups spasming, making it difficult for laryngologist to figure out the best muscles to inject
• successful injection of VF will not cause other muscles to stop oscillating, so speech may continue to be affected following Botox injection
• can be helpful for tremor, but harder to administer than LD

Question 10

global cue ideas for vocal tremor

Answer 10

• something that cues patient to shorten duration of voiced segments and take more frequent pauses
• “speak staccato”

Question 11

speech characteristics in PD

Answer 11

• hypokinetic dysarthria
• reduced loudness
• breathy voice
• imprecise articulation
• monotone
• intermittent and rapid rushes of speech
• not a cause of muscle weakness, but in misperception of amount of effort necessary

Question 12

LSVT

Answer 12

• trains people with PD to use a normal loudness
• key element is “recalibration”
• global cue is GET LOUD, improving loudness of voice, articulation, intonation, and facial expression
• 60 min sessions, 4x/week, for 4 weeks
• homework is 1x/day for 10-15 minutes

Question 13

recalibration of LSVT

Answer 13

• purpose is to recalibrate those with PD to a normal loudness, so they get comfortable using that intensity in everyday speech without feeling like they’re being too loud

Question 14

Speak OUT and LOUD Crowd

Answer 14

• another voice program
• global cue is speak with intent, not get loud, aiming to avoid vocal hyperfunction sometimes seen with LSVT
• 40-45min sessions, 3x/week, for 4 weeks
• second part is Loud Crowd, a 1x/week maintenance group that works to maintain skills; promotes accountability, support, vocal practice, and encouragement

Question 15

global cues

Answer 15

• a word or short phrase that cues a patient to fix multiple behaviors in one cue; ex: get loud
• may be helpful to reduce number of corrections given to patient, can be carried over to caregivers to use after treatment/at home, promotes generalization