Tx

Question 1

what are the five voice tx philosophies?

Answer 1

hygienic, symptomatic, psychogenic, physiologic, eclectic

Question 2

hygienic voice tx: concept, proponents, and weakness

Answer 2

c: voice px has a direct behavioral cause
p: eliminate-change bx and voice will improve
w: cause of voice px may not be the precipitating factor

Question 3

symptomatic voice tx: concept, proponents, and weakness

Answer 3

c: modify deviant vocal symptoms (breathiness, hard glottal attacks, etc.)
p: use voice tx facilitating techniques (yawn-sigh, chanting, etc.)
w: symptom(s) may not be the cause

Question 4

psychogenic voice tx: concept, proponents, and weakness

Answer 4

c: voice px is related to emotional-psychosocial px
p: treat the psychosocial px and voice will improve
w: psychosocial pas may be overstated

Question 5

physiologic voice tx: concept, proponents, and weakness

Answer 5

c: modify pt’s underlying physiological mechanisms (subsystems)
p: improve balance between respiration, phonation, and resonance (resonant voice, lee silverman, etc.)
w: does not account for bx

Question 6

eclectic voice tx: concept, proponents, and weakness

Answer 6

c: any combination of voice tx (hygienic, symptomatic, psychogenic, physiologic)
p: use what’s most effective
w: every pt is unique

Question 7

list the guidelines of voice tx

Answer 7

patient education; focus on kinesthetics of voice production; use audio-visual feedback; do not rush; model tx tasks; record-document ssns; provide specific home practice

Question 8

list contributing factors of prognosis

Answer 8

whether or not the pt: recognizes they have a px, is compliant to the tx plan, is willing to change-stop bus, has psychiatric pxs, is remediable, has appropriate expectations, is generally healthy

Question 9

name the symptomatic voice tx techniques

Answer 9

digital manipulation; yawn-sigh; chewing; easy onset / linking; tongue stretch / supraglottic relaxation; push-pull; chanting; breathing; altering habitual pitch-loudness

Question 10

symptomatic voice tx techniques are most commonly used to ___

Answer 10

decrease extralaryngeal-supraglottic muscle tension; decrease hard glottal attacks; increase glottic closure

Question 11

describe easy onset / linking

Answer 11

SYMPTOMATIC

trains continuous airflow to help eliminate glottal attacks as in “…i’ll-have-eggs-over-easy”

Question 12

describe yawn-sigh

Answer 12

SYMPTOMATIC

fake yawn then produce /h/ to lower larynx and release supraglottic squeezing as in opens mouth “…hi”

Question 13

describe chewing

Answer 13

SYMPTOMATIC

speaking while “chewing” to disengage laryngeal tension

Question 14

describe chanting

Answer 14

SYMPTOMATIC

trains continuous airflow to help eliminate glottal attacks as in “ninety-seven ninety-eight ninety-nine”

Question 15

describe digital manipulation

Answer 15

SYMPTOMATIC

palpate pt to assess for muscle tension (intrinsic, extrinsic, or both) and to massage pt

Question 16

anterior-posterior compression and false vocal fold medialization are indicative of ___

Answer 16

supraglottic squeezing, which is ALWAYS a sign of tension

Question 17

SYMPTOMATIC

yawns and “slurping spaghetti” : lowers larynx and opens supraglottic area :: silent laughter : ___

Answer 17

ABducts false vocal folds

Question 18

describe tongue stretches

Answer 18

SYMPTOMATIC

relaxes base of the tongue and opens supraglottic area

Question 19

the rag doll exercise is used to ___

Answer 19

decrease neck and shoulder tension and to train abdominal / lower back breathing

Question 20

name exercises that help to establish abdominal breathing

Answer 20

sitting and leaning with forearms on knees; standing with arms crossed overhead; pavone; sustained /f/; prone position

Question 21

describe pavone

Answer 21

start with arms down and palms facing inward, raise arms with palms facing forward, then continue raising arms with palms facing up

teaches abdominal breathing and ideal posture

Question 22

describe sustained /f/

Answer 22

posture /f/, breathe in, then exhale until completely out of breath

forces abdominal inhalation and has good feedback

Question 23

describe push-pull

Answer 23

pt pushes palms together and produces a short staccato vowel or /m/ initial cv syllable

increases vocal fold adduction; good for hypo functional pts and pts with vocal fold paralysis-paresis, bowing, presbylarynges, etc.

Question 24

name the physiologic voice tx techniques

Answer 24

vocal function exercises; lessac marsden resonant voice tx; accent method; flow phonation; lee silverman voice tx; semi-occluded vocal tract exercises

Question 25

physiologic voice tx improves ___

Answer 25

BALANCE amongst: respiratory support, laryngeal muscle strength; control-stamina; supraglottic modification of the laryngeal tone

Question 26

in physiologic voice tx, the cause of voice disturbance may be ___

Answer 26

mechanical, neurological, or psychological

Question 27

describe vocal function exercises

Answer 27

PHYSIOLOGIC warm up : sustained /i/ with frontal focus :: expansion : pitch glides up on /o, ol, nol/ :: contraction : pitch glides down on /o, ol, nol/ :: power : sustained phonation on five pitches rationale: recalibrates-strengthens larynx; improves glottic closure

Question 28

describe semi-occluded vocal tract exercises

Answer 28

PHYSIOLOGIC glides, revving, speech, and vowel prolongations using drinking straws rationale: necessitates a greater respiratory drive, increases vocal fold closure, lowers-relaxes larynx, and trains frontal focus

Question 29

describe resonant voice

Answer 29

PHYSIOLOGIC frontal tone placement of /m, n, j, r, z/ in syllables-words-sentences rationale: allows pt to appropriately increase loudness; decreases hyperfunction and decreases vocal fold medial compression

Question 30

describe accent method

Answer 30

PHYSIOLOGIC produced sustained consonants-vowels while rocking back and forth (ha, yay, hay, sa, who, fa, etc.) rationale: improves coordination between respiration and phonation; decreases medial compression and teaches flow phonation

Question 31

describe lee silverman

Answer 31

PHYSIOLOGIC sustained, loud phonation of (ahh); pitch glides up and down; targeting adequate loudness from phrases to spontaneous speech

Question 32

describe flow phonation

Answer 32

PHYSIOLOGIC | cup bubbles with and w/o voicing; blowing tissue paper (bernoulli effect) with and w/o voicing; gargling

Question 33

what is the best therapy task sequence (order)?

Answer 33

relaxation exercises, breathing exercises, voice exercises

Question 34

list the guidelines for vocal hygiene goals

Answer 34

identify vocal hygiene risks that are specific to the pt; no laundry lists; make sure the pt understands why

Question 35

describe post-surgical voice care

Answer 35

voice rest for 7 - 10 days; review pre-surgery recommendations (train adequate breath support; eliminate muscle tension; address vocal hygiene issues) after rest: begin glides and semi-occluded vocal tract exercises; train confidential voice; train resonant voice tx

Question 36

describe confidential voice

Answer 36

``` PHYSIOLOGIC breathy phonation (soft intensity speech with minimal voicing) to decrease medial compression and impact stress; use post surgery or after severe phono trauma ```

Question 37

hyperfunction vs hypofunction which one is facilitated by using a larger-diameter straw during semi-occluded vocal tract exercises?

Answer 37

hypofunction