VD Test One Voice Assessments Flashcards
What does the American-Speech-Language Hearing Association (ASHA) Preferred Practice Patterns for the Profession of Speech-Language Pathology state:
All patients/clients with voice disorders must be examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician’s examination may occur before or after the voice evaluation by the clinician (p.99).
List the components of the Voice Evaluation (4).
- Background and history.
- Patient interview.
- Non-instrumental assessment.
- Instrumental assessment.
Name 2 components of a background and case history.
- Reasons for referral.
2. Medical record review.
Name 4 components to look at when looking at background and case history.
- Medical status
- Education
- Occupation and vocations
- Cultural and linguistic background
When can dysphonia occur?
Intermittently
OR
in a specific-situation
When can a voice problem begin? And what might be the associated conditions or circumstances in which a voice problem might begin.
- Dysphonia can be “sudden onset dysphonia”
- “Sudden-onset dysphonia” might suggest a different etiology than slowly developing dysphonia.
What should you elicit from the patient when considering the what, how, and why of voice problems?
The patient’s thoughts about possible causes.
What are 2 questions you should ask yourself when considering the variability and consistency of a voice problem?
Has the voiced changed since the onset of problem, and how?
How does the voice change throughout the day, or under different conditions?
Where do you gather information about voice usage (2)?
- From interview with patient or family members.
2. From questionnaire filled out by patient prior to evaluation.
When considering description of voice usage what is important to focus on?
Potential vocal abuse/misuse/overuse.
When conducting a psychological screening, you will find that voice difficulties are often symptomatic of the inability to have?
Satisfactory interpersonal relationships.
During a psychological screening what should you look for signs of?
stress and anxiety
What are 2 components you should evaluate during psychological screening.
- coping mechanisms
2. social network
When conducting a non-instrumental assessment, what is being evaluated (2 things) with behavioral observation and screening?
- hearing
2. vision
List 2 examples of assessing without instruments.
- Auditory perceptual judgments.
2. Voice-related quality of life.
What does an auditory-perceptual assessment assess (6)?
- Pitch
- Loudness
- Voice quality
- Respiratory-phonatary control
- Resonance (oral and nasal)
- Overall severity
What is shimmer?
Short term variability in the amplitude.
What is jitter?
Short term variability in fundamental frequency.
What does abnormal voice quality define?
The presence or absence of a voice disorder clinically.
How are persons with an abnormal voice quality perceived?
More negatively than normal peers.
List the 4 distinct vocal qualities.
- Breathy
- Harsh-rough
- Hoarse
- Strained
Define “breathy”
- Perceived as “whispery” or “airy”
- Associated with hypo-adduction (VFs don’t close enough)
Define “harsh-rough”
- Perceived as “raspy”
- Associated with hyper-adduction
Define “hoarse”
- Simultaneously “breathy” and “harsh-rough”
- Associated with compensatory hyper-adduction
Strained
- Perceived as “choked” and or/effortful
- Associated with hyper-adduction
Define:
G = Grade
Overall severity or abnormality of the dysphonia
Define:
R = roughness
Psychoacoustic impression of irregular vocal fold vibration, represented by fluctuations in pitch and loudness
Define:
B = breathiness
Psychoacoustic impression of air leakage through the glottis, represented by presence of white noise
Define:
A = asthenia
Psychoacoustic impression of weak voice, lacking higher harmonics and showing instability in pitch and loudenss
Define:
S = strain
Psychoacoustic impression of effort and hyperfunction, excessive noise and elevated pitch
What does CAPE-V stand for?
The Consensus Auditory-Perceptual Evaluation of Voice
What organization developed the Cape-V?
ASHA SID 3: Voice and Voice Disorders (2002)
What technique does the CAPE-V use?
The Visual Analog Scaling technique
How does one score the CAPE-V?
- Rater places a tick mark along each line.
- Far left = normal
- Far right = most deviant from normal
- Then the tick mark location is measured and written in column on the right
- There are 2 unlabeled lines, to add features not listed
On the CAPE V, what does “C” stand for?
- consistent presence of a particular voice attribute
- the attribute was continuously present
On the CAPE V, what does “I” stand for?
- intermittent presence of a particular voice attribute
- indicates that the attribute occurred inconsistently within or across tasks
On the CAPE V, what does overall mean?
integrated impression of voice deviance
On the CAPE V, what does roughness mean?
perceived irregularity in the voicing source
On the Cape V, what does breathiness mean?
audible air escape in the voice
On the Cape V, what does strain mean?
perception of excessive vocal effort (hyperfunction)
On the Cape V, what does pitch mean?
perceptual correlate of fundamental frequency
On the CAPE V, what does loudness mean?
perceptual correlate of sound intensity
When considering voice related quality of life, what should you consider for your patient?
The impact dysphonia has on the quality of life. Including the individual’s perception of his or her illness.
What is the voice handicap index?
- A 30 item scale which contains one total score and three subscales: functional, physical, emotional.
- Uses an equal-appearing interval scale.
Name an example for a visual examination of the larynx.
- stroboscopy
List 3 instrument assessments for the the voice.
- acoustic analysis
- aerodynamic analysis
- phonatory respiratory efficiency analysis
Name 2 examples of acoustic analysis.
- frequency related measures
2. intensity related measures
What factors determine fundamental frequency?
- Vocal fold length
- vocal fold mass (thickness)
- tension
What is the average fundamental frequency?
the average rate of vibration of the vocal folds expressed in Hz
Name 3 examples of speaking tasks in assessment.
- isolated vowels
- reading
- connected speech
What does an individual’s habitual pitch depend on?
age and gender
What is the average Fo for children?
350 - 400 Hz
What is the average Fo for an adult male?
120 Hz
What is the average Fo for an adult female?
240 - 260 Hz
What published “norm” information should a clinician use when making clinical judgements about voice?
Average Fo and Speaking Fundamental Frequency
What is the frequency range for males 17 - 26?
80 - 764 Hz
What is the frequency range for males 68 - 89?
85 - 394 Hz
What is the frequency range for females 18 - 38?
140 - 1122 Hz
What is the frequency range for females 35 - 70?
136 - 803 Hz
What does frequency range vary by?
training
What does vocal intensity correspond with?
acoustic power of the speaker (auditory perception of loudness)
What is habitual loudness?
The average loudness level used by the speaker for the majority of his or her vocalizations.
How is average/habitual intensity measured?
sound level meter
What is intensity variability?
the range of intensities used in connected speech
Normal voices have some intensity variability, how is this perceived by the listener?
Perceived by the listener as acceptable changes in intonation.
In some dysphonic speakers what can happen to intensity?
Intensity can be either more or less variable than expected or tolerated by the listener.
What can a dysphonic speakers’ loudness be perceived as?
Monoloudness because intensity can be either more or less variable than expected or tolerated by the listener.
How is intensity variability measured?
in terms of the standard deviation (SD) from the average intensity
What is the intensity level SD for a neutral, unemotional sentence
around 10dB
What is vocal perturbation?
cycle to cycle variability in the vocal signal
What is vocal perturbation aimed at?
identifying the short term, cycle to cycle non-volitional variablity
What is typically extracted from connected speech for assessment since vocal perturbation is aimed at identifying the short term, cycle to cycle non-volitional variability?
sustained vowels or steady state portions of vowels
What are the 2 vocal perturbation measures commonly obtained?
jitter and shimmer
What is jitter?
the short term variability in fundamental frequency
What is shimmer?
the short term variability in the amplitude
What do lung volumes refer to?
the amount of air in the lungs at a given point in time and how much air is used for various purposes, including speech
What do lung capacities combine?
various lung volumes
Various air pressures are needed for speech. List all 3 kinds.
- pressure inside the lungs
- pressure below the vocal folds
- pressure inside the oral cavity
What unit is used to measure air pressure?
Units of cmH20
What is a possible total pressure that a person can generate?
over 50 cmH20
What amount of air pressure is needed for conversational speech?
5 - 10 cm H20
How is subglottal pressure estimated?
indirectly by measuring oral pressure during production of the closed portion of /pa/
What is laryngeal airflow?
the volume of air passing through the glottis in a fixed period of time
How is laryngeal airflow typically measured?
cubic centimeters (cc) or millimeters per second (mL)
What is laryngeal/glottal resistance?
a measure derived from peak intraoral pressure and peak airflow during production of /pa/ repeated at a rate of approximately 1.5 syllables/second
What is estimated from the /p/ portion of the syllable?
peak intraoral pressure
What is estimated from the /a/ portion of the syllable?
peak airflow
Assessment of laryngeal/glottal resistance helps compare what 2 types of voices?
breathy vs. strain strangled voice
What is the durational measure: MPD?
Maximum Phonation Duration
What is the durational measure: MPT?
Maximum Phonation Time
Name an example of a durational measure.
s/z ratio
What is maximum phonation time?
- an indirect index of laryngeal airflow
- it is the greatest length of time over which the /a/ vowel can be sustained at the patient’s most comfortable pitch and loudness following a maximal inhalation
How many MPT trials are conducted? Which one is reported?
3 and the longest
Name another indirect index of laryngeal airflow except for MPT?
s/z ratio
How do you obtain an s/z ratio?
the clinician asks the patient to first sustain the /s/ as long as possible, and then to sustain the /z/ as long as possible, each at a normal pitch and loudness following a maximal inhalation
What does the clinician usually do during the s/z ratio assessment? How is it measured?
- clinician provides verbal encouragement
- the longest /s/ and longest /z/ from one of the three alternating /s, z/ trials is used to calculate the ratio
What does the s/z ration of a normal subject approximate?
1.0 (60 secs) check this!
A high s/z ratio is……?
above 1.4
