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SPH512 Part 2 - Voice and Fluency > Vocal Function Assessment - Functional Tasks > Flashcards

Vocal Function Assessment - Functional Tasks Flashcards

1
Q

Functional Voice Assessment Tasks - to:

A
  • Describe the voice
  • Establish a baseline for reporting
  • Identify + interpret abnormal voice for diagnosis
  • Suitability of client for therapy (stimulability)
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2
Q

What are the Functional Tasks used to assess function of the larynx and vocal tract?
These tasks are based on research literature and have documented norms (means, SDs) and have been used in disordered populations.

A
  • Contextual Speech –> (conversation, reading 2 examples) There are NORMS for F0 for The Rainbow Passage (Fairbanks, 1960) and The Grandfather Passage (Darley, Aronson + Brown, 1975)
  • Vowel prolongation (stability of tone) - Auditory-perceptual rating/ F0 (SD)
  • MPT - cue habitual pitch, 3x , report longest
  • s/z ratio - NORMS = ~1
  • Pitch range - Auditory-perceptual / Acoustic Analysis
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3
Q

Functional Tasks:

A
  1. Contextual speech (2 examples incl. Rainbow passage - Fairbanks, 1960) - F0 NORMS
  2. Vowel Prolongation (tone stability) - Auditory-perceptual / F0
  3. MPT
  4. s/z ratio - NORMS = ~1
  5. Pitch range - Auditory-perceptual / Acoustic analysis.
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4
Q

What would you do during the contextual speech part of the Functional Task?

A
  • RECORD -high quality equipment
  • Contextual sample 1 - conversation or CAPE-V “Tell me about your voice problem”.
  • Contextual sample 2 - The Rainbow Passage (Fairbanks, 1960) or Paediatric - describe a picture. Other languages, find the literature supported standard reading passage with normative values.
  • CAPE-V standard sentences.
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5
Q

What measure do we take of The Rainbow Passage / Contextual speech tasks, when doing acoustic analysis?

A

Fundamental Frequency (F0)

*Representative task - don’t model it

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6
Q

What Functional Task assesses whether the patient can stabilise their F0 and voice quality?

What measures do we take of this task?

A

*Prolonged Vowel (vowel on same pitch for 3-5 secs).

  • Auditory-perceptual rating (use CAPE-V rating protocol)
  • Acoustic Analysis - analyse standard deviation of F0

*Representative task - don’t model it

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7
Q

Which Functional Task assesses vocal fold closure on available air?

What are the normative values?

A

Maximum Phonation Time (MPT)

Females: 16+ seconds
Males: 20+ seconds

***less than 10 seconds RED FLAG for lack of vocal fold closure

*Representative task - don’t model it

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8
Q

How do you tell if it is lack of vocal fold closure, or compromised lung function responsible for short phonation time on MPT?

A

Compare s/z ratio task.

If both /s/ and /z/ are very short, probably poor lung capacity.

If very long /s/ and short /z/, poor vocal fold closure, so the MPT score was also due to poor vocal fold closure.

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9
Q

Which Functional Task evaluates the effect of voicing on airflow control?

A

s/z ratio. Should be the same (s/z ratio = 1)

Ratio greater than 1:4 is abnormal (Stemple et al., 2020. p. 155)

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10
Q

What is the purpose of the pitch range task (a functional task)?

A

To see how well the client can change their pitch, and how flexible their vocal folds are.
*Performative task - model this.

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11
Q

This functional task assesses how much airflow is needed to begin phonation (whether vocal folds are vibrating efficiently)

A

Dynamic Range task (softest possible phonation)

  • count 1-5 beginning softest voice, ending loudest voice. or extended ‘ahhh’ on softest possible voice
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12
Q

This functional task tests whether the client can adduct the vocal folds tightly and build enough subglottic pressure. It also enables observation of compensatory strategies to make a loud noise, if vocal folds are not tightly closing (what do you look for?)

A

Dynamic Range task (loudest possible phonation)

  • Shout “Hey!”
  • If vocal folds not closing tightly, but MPT is normal+ and shout is loud, look for evidence of strain/muscular constriction.
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13
Q

If a patient’s voice gets clearer as they get higher in their Pitch range task, what could that mean?

A

Soft, gelatinous nodules are being stretched, and interfering less with vocal fold function in the higher pitch ranges, but decrease VF closure and vibration in the relaxed VFs at the lower pitch ranges. May get rougher, breathier, go into fry…

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14
Q

How could you get a child to do MPT, without modeling it (it is a representative task).

A

Use the acoustic image on the screen. “Can you make a blob with ‘ah’” “Can you make a longer blob?” “Can you make the longest blob in the world?”

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15
Q

What might reduced range on the Pitch range task mean?

A

VF mucosa is less flexible - it could be swollen or inflamed, for example, from LPR.

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16
Q

If the vocal fold vibration is inefficient, what might the MPT look like?

A

Shorter

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17
Q

What could Muscle Tension Dysphonia (MTD) do to the Maximum Phonation Time (MPT)?

A

Excessive muscle constriction could make MPT longer (but quality would be bad - would sound VERY STRAINED)

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18
Q

If the Dynamic Range Task for softest possible phonation indicates lack of efficiency, what could this indicate?

A

VF lesion
or
Swollen or inflamed vocal folds (LPR?)

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19
Q

What could a quality of strain in the voice indicate?

A

MTD

or Compensatory tension –> lesions, paresis, etc…

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20
Q

What could a quality of roughness in the voice indicate?

A

Irregular vibration of the vocal folds - perhaps a lesion causing irregular vibration.

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21
Q

What might a monotone on a pitch glide, and inadequate loudness (unrecognised) indicate?

A

Parkinsons

22
Q

VHI-10 (voice handicap index) score greater than what, is abnormal?

A

11

23
Q

RSI (Reflux Severity Index) score of what, indicates a 90% chance of having reflux?

A

15

24
Q

Tasks assessing other vocal functions:

A
  • Palpate the larynx (muscle tension, pain)
  • Feel movement of larynx
    • > Swallowing (raises)
    • > Yawning (lowers)
    • > Laryngeal movement on phonation
  • Velopharyngeal Port (say “ahhh” while blocking/unblocking nose -> sound change indicates not closing nasal cavity properly)
  • Sing “Happy Birthday”
  • Count 80-90 –> Vowel onset (observe onset of phonation)
  • Cough, Clear throat
  • OMA and Cranial Nerve Ax (Not ATM due to COVID)
  • Therapy trial (stimulability)
25
Q

What does the SLP need to do in a therapy trial?

A
  • Choose an appropriate technique to best help specific aspect of their vice that is disordered.
  • Use appropriate language
  • Have a task analysis, so if they can’t do the whole task, you can try them doing a part of the task (helps you know 1. where to start in therapy 2. how many steps you need to prepare)
  • Provided 2 feedback modalities -> How does it FEEL? How does it SOUND?
26
Q

During a therapy trial, remember…

A
  • Intructions from SLP will influence the outcome of the trial.
  • Know when to model, and when not to.
  • Note what you see the client do, and how you see them cope with the task (or tackle it).
  • RECORD how many attempts it takes them to achieve the task.
  • TAKE good quality audio-recording, for later acoustic analysis to confirm/clarify SLP’s auditory perceptions.
27
Q

The more I talk the worse my voice gets. But if I rest it, it seems to improve. What does this possibly indicate?

A

A FUNCTIONAL voice disorder –> if it is organic (e.g. something growing on the vocal folds) it won’t get any better with rest.

28
Q

Who does the SUBJECTIVE measure Ax of Visual imaging of the larynx?

A

Usually the ENT. They may sent the patient to you with the video, or report.

29
Q

Under what circumstances might visual imaging be done on a patient under general anaesthetic (direct laryngoscopy)?
What is the problem with this?

A
  • Children, or someone already having surgury

* Can’t see vocal fold vibration - people can’t phonate if asleep.

30
Q

If your patient was suspected to have some kind of vocal fold asymmetry or a change/varience in mucosal wave, what kind of visual imaging would you use?

A
  • Rigid
  • MUCH better light, magnification + resolution (more fibres)
  • Allows high speed laryngoscopy and stroboscopy
  • Vowel production ONLY
31
Q

When would you use a flexible nasendoscopy?

A

Want to see connected speech - lesion or some specific damage to the vocal folds better observed while in use
*CAN use connected speech, but poorer light, magnification, resolution

32
Q

View on laryngeal imaging?

A
  • Anterior –> Epiglottis
  • Posterior –> Arytenoids, wide opening
  • *IF posterior (arytenoids) at top of image, right VF is on LHS and vice versa
33
Q

What to look for in laryngeal imaging?

A
  • Movement
  • Form
  • Colour
  • Vocal fold edge
  • Symmetry
  • Length
  • Tension
  • Closure on phonation

OF: True vocal folds, False vocal folds, Supraglottic structures

34
Q

What to describe (about the larynx) in a videostroboscopic examination of the larynx?

Use a rating tool.

A
  • Glottic closure
  • Vocal fold edge
  • Presence/size of mucosal wave
  • Symmetry of the larynx
  • Symmetry of arytenoid movement/VF closure
  • Supraglottic activity
35
Q

If the arytenoids are not vertically matched, what might that mean?

A

One is dislocated OR superior laryngeal paresis

36
Q

Name an laryngeal image analysis tool recommened for paresis or sulcis vocalis? Enables analysis of high speed digital imaging and can be used for further analysis of vocal fold vibration (glottal area waveform, closed/ope quotient, speed index, spectral analysis)

A

Videokymography

37
Q

NORMs for Harmonics to noise ratio?

A

20dB is cut-off for ‘normal’

25dB or more is the norm for perceptual clarity - voices at this level sound clear.

38
Q

Which functional tasks should be done and recorded with the client at each session? Why?

A

*2 connected speech samples - conversation, The Rainbow Passage (Fairbanks, 1960) [NORMS]
*CAPE-V phrases
Prolonged V ‘ah’ ~5 seconds, 3 times (to do HNR if required)
–> show improvement to client, track improvement to inform therapy + decide on discharge

39
Q

Why do we do vowel onset sentences (some CAPE-V phrases and counting 80-90)?

A

To see what kind of onset the client is using - to see how the coordinate their vocal fold closure and beginning phonation

40
Q

Harmonics to Noise ratio (HNR) is only ever take on a…
Why?

*HNR gives harmonic signal energy to noise energy –> 25+ = clear 20+ = normal, below 20 is rough

A

prolonged vowel (so MPT, ideally)

Because you can’t have much change in pitch, or PRAAT can’t analyse HNR –> pitch needs to be as stable as possible

41
Q

How to tell the difference between asthma and paradoxical vocal fold motion.

A

Asthma - problem breathing out. Wheezy exhale.

Paradoxical VF motion - problem breathing in. Stridor.

42
Q

Functional task - palpating larynx during phonation. How to test?

A

Get them to count. Keep to one pitch only (IMPORTANT - we don’t want larynx to raise because of pitch raise, or to tilt). Larynx should pull up during phonation, and go down at rest, so make sure they PAUSE between numbers to feel this.

43
Q

Why is singing Happy Birthday (or for singers, their own choice) part of functional assessment?

A
  • Spasmodic dysphonia not present during singing - diff. part of the brain.
  • We want to see what they do with their voice when singing, esp. professional voice users.
44
Q

Why test cough and throat clear on the functional tasks?

A

Want to see if the CAN get laryngeal closure. Do they have a protective cough? Can they protect their airway?

45
Q

Why do we do a therapy trial during assessment?

A

To see if the client is a suitable candidate for therapy. Do they have the ability to make a change to their voice? Can they make it clearer? (This will provided evidence to differential diagnosis - - is it an organic or fuctional voice disorder? MTD type 1 SHOULD improve in therapy trials)
**SLP doesn’t diagnose voice disorders.

46
Q

List 10 parts to a Functional Voice Assessment:

A
  1. Conversation + Reading The Rainbow Passage
  2. Vowel onset phrases, Count 80-90
  3. MPT
  4. S/Z Ratio
  5. Dynamic Range (soft vs loud)
  6. Pitch Range
  7. Palpating larynx - yawn, swallow, count
  8. Singing
  9. Cough/throat clear
  10. Therapy Trial
47
Q

Why do acoustic analysis, when auditory-perceptual judgement is the gold standard?

A

Acoustic analysis supports our understanding/interpretation of auditory-perceptual judgements. ALSO perceptual judgements don’t have NORMS (mildly rough) but acoustic analysis does (HNR 20+ = normal, 25+ = clear, F0)

48
Q

During acoustic analysis, what functional task do you use to get a F0 reading? Why?

A

Reading of The Rainbow Passage.

Because most F0 NORMS in the literature are based on reading.

49
Q

During acoustic analysis, what functional task do you use to get a pitch range reading?

A

Pitch range task

50
Q

What might the SD of F0 on the MPT task mean?

A

Indicates the amount of deviation from F0 across the MPT task, so if SD is large, the patient may be having trouble maintaining a stable pitch.

SPH512 Part 2 - Voice and Fluency (7 decks)

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