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Voice > Vocal Rehabilitation > Flashcards

Vocal Rehabilitation Flashcards

0
Q

A combination of treatment modalities, such as: behavioral, pharmacological, and surgical interventions

A

Combined modality

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1
Q

Elimination of all vocal fold contact Does not aid in the process to reprogram the patient’s behaviors It is useful for the healing process, however studies suggest wound healing relies on vocal activity

A

Complete voice rest ( CVR)

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2
Q

Used to facilitate greater oral movements to improve oral resonance, reduce extrinsic laryngeal muscle tension, and reduce vocal strain

A

Chewing

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3
Q

What is the time commitment for Lee Silverman Voice Therapy?

A

4 times a week for 4 weeks for a 1 hour session

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4
Q

Clinicians use this technique to help patients reduce stress via relaxation exercises

A

Relaxation

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5
Q

Certification is required Goal: increase loudness by increasing effort and coordination during speech production. Relies on memory, learning and reliance on self- cuing and self- regulating Intensive protocol: 4 times a week for 4 weeks for a 1 hour session Used primarily in patients with Parkinson’s disease

A

Lee Silverman Voice Therapy

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6
Q

Clinicians realize that the support for voice production is sub glottal pressure. This technique teaches patients how to coordinate the inspiratory and expiratory phases of voice production, optimizing lung volumes for speech

A

Respiration training

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7
Q

When do you terminate therapy?

A
  • Resolution of the vocal pathology
  • Patient satisfaction with voice outcome
  • Reimbursement issues
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8
Q

Clinicians encourage patients to open their mouth to reduce dampening of sound production and increase oral resonance

A

Open mouth approach

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9
Q

The best research design for defining the effectiveness of a treatment is

A

Large randomized control trials

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10
Q

Vocal habits due to emotional, occupational, or social stresses. Serious cases, should be referred for a psychiatric evaluation. Voice pathologist can help the patient remediate the emotional disturbances associated with the onset or maintenance of the condition.

A

Psychogenic voice therapy

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11
Q

Clinicians advocate a good posture.chin position, head turning - unilateral tvf Paralysis by turning head to the affected side to aid in vocal fold addiction

A

Head positioning

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12
Q

Clinicians use a source of noise to induce the Lombard effect, which is known to elevate vocal loudness when noise is introduced to the patient via headphones. Voice clarity may be the result.

A

Masking

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13
Q

Uses multiple behavioral therapy orientations to address patient’s care

A

Eclectic therapy

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14
Q

The words used as stimuli run continuously together without changes in stress or prosody. The chant uses elevated pitches, sustained vowels, no syllable stress, and an elimination of hard glottal attacks. The chant is then modified to progress into conversational speech

A

Chant talk

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15
Q

Goal: eliminate any behaviors that cause trauma to the structural health and function of the vocal folds Focuses on patient education Used with another form of tx

A

Vocal hygiene

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16
Q

First session: collect patient case history data and educate patient about voice care Second session: introduce resonant voice basic training gesture (RV BTG)- simple sounds, words, phrases, chant, and regular conversation

A

Lessac-Madsen Resonant Voice Therapy protocol

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17
Q

Used to help patients with hyper or hypo functional voice disorders Developed by Joseph Stemple

A

Vocal Function exercises

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18
Q

Voice therapy for school aged children with voice disorders (4)

A
  • Largely focused on eliminating vocal behaviors that are not conducive to vocal health (do and do not)
  • Rarely successful
  • Combination of hygienic and physiologic models of voice therapy in order to address rehabilitation
  • Train child if make sounds more therapeutically
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19
Q

Clinicians use this technique to help patients generate a voice source that is optimal with regard to resonance. The direction to the patient is to “move” the voice from the back if the throat to the front of the mouth while feeling vibrations in the nasal cavity. Optimal coupling of the supra glottal and glottal cavities is necessary for best possible voice production

A

Focus

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20
Q

Direct exercises are used to activate the laryngeal muscle and work other subsystems, such as respiratory and sub glottal systems

A

Physiologic Voice Therapy

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21
Q

Feedback biological information to gain control of bodily processes that normally cannot be controlled voluntarily Ex. Electromyography Plethysmography

A

Biofeedback techniques

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22
Q

Used to help adolescent and adult voice patients with hypo and hyper functional voice disorders Target: for the patient to use the least amount of respiratory effort and impact stress on the vocal folds 30 to 45 minute sessions once or twice a week for 4 to 8 weeks

A

Lessac-Madsen Resonant Voice Therapy

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23
Q

Clinicians use this analysis to help the patient identify the most stressful or anxiety provoking events, comparing situations that create a good voice or a worse voice. Basically, a deconditioning approach is used to help the patient learn relaxation strategies to reduce the stressful or anxious response

A

Hierarchy analysis

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24
Q

Largely focused on eliminating vocal behaviors that are not conducive to vocal health (do and do not) Rarely successful Combination of hygienic and physiologic models of voice therapy in order to address rehabilitation Train child if make sounds more therapeutically

A

Voice therapy for school aged children with voice disorders

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25
Q

Who is the primary population Lee Silverman Voice Therapy is used with?

A

Patients with Parkinson’s Disease

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26
Q

Voice therapy techniques should be based on what?

A

Empirical evidence for their use and effectiveness

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27
Q

Clinicians strive to reduce this in cases of hyper functional voice disorders. It can be used as a relaxing technique apparently because the vocal folds are vibrating in a more lax state when a low fundamental frequency is produced

A

Glottal fry

28
Q

Clinicians use this technique for patients who are unable to produce any voice often due to excessive vocal strain. Vegetative tasks or others can be used to help facilitate any sound production

A

redirected phonation

29
Q

Clinicians help the patient identify the behaviors that are causing harmful effects on laryngeal structure or function

A

Elimination of abuses (phono trauma)

30
Q

Clinician provides a recorded sample of the patient’s voice for them to judge correct vs. incorrect production

A

Auditory feedback

31
Q

What is the goal of Lee Silverman Voice Therapy?

A

Increase loudness by incresasing effort and coordination during speech production.

32
Q

Do you need to be certified to officially use Lee Silverman Voice Therapy?

A

Yes

33
Q

Clinicians use a modified approach to Aronson’s technique of circumlaryngeal therapy whereby the larynx is gently massaged to reduce the extrinsic laryngeal muscle tension and a lower laryngeal position

A

Laryngeal massage

34
Q
  • Vocal warm up
  • Pitch glides
  • Prolonged phonation of /o/ at selected pitches
A

Vocal function exercises protocol

35
Q

3 types of interventions

A
  • Behavioral
  • Medical
  • Surgical
36
Q

Clinicians use pitch inflections for patients with monotone voice to help activate the cricothyroid muscle

A

Pitch inflections

37
Q

Psychogenic voice therapy (3)

A
  • Vocal habits due to emotional, occupational, or social stresses.
  • Serious cases, should be referred for a psychiatric evaluation.
  • Voice pathologist can help the patient remediate the emotional disturbances associated with the onset or maintenance of the condition.
38
Q

Clinicians work to minimize extreme cases of hyper function by posturing the tongue in the position for vowel production of /i/. The high tongue position helps to reduce pharyngeal squeezing and is often used in cases of ventricular hyper function/phonation.

A

Tongue protrusion /i/

39
Q

Aim: to retain psychiatric symptoms without needing to use this pathology as a coping syndrome

A

Paradoxical vocal fold dysfunction: psychotherapy approach

40
Q

Clinicians use this technique to aid patients in identifying incorrect and correct voice productions through visuals

A

Visual feedback

41
Q

What is the goal of voice therapy? (4)

A
  • Restore best voice possible
  • Focus on functional outcomes
  • Reeducate patient on how to use their voice effectively and efficiently
  • Eliminate the reformation of the voice disorder/pathology
42
Q

Clinicians use voice production on inspiration rather than expiration to help modify ventricular phonation for those who are unable to resist voice change when using expiration

A

Inhalation phonation

43
Q

Clinician responsibility (6)

A
  • Knowledge and skill of normal and disordered voice production
  • Knowledge and skill of therapeutic process
  • Compassion, understanding, and empathy
  • Superb listening skills
  • Counseling skills
  • The ability to inspire action for change
44
Q

Lessac-Madsen Resonant Voice Therapy- Who?

A
  • Used to help adolescent and adult voice patients with hypo and hyper functional voice disorders
45
Q

What are the five fundamental concepts that the LSVT program is based on

A
  • Thinking loud
  • High speed effort
  • Intensive treatment
  • Recalibrating loudness level
  • Quantifying improvements
46
Q

Vocal function exercises Lessac-Madsen Resonant Voice Therapy Lee Silverman Voice Therapy Inspiratory and expiratory muscle strength training

A

Examples of physiologic voice therapies

47
Q

Clinician use physical pressure on the thyroid cartilage to help reduce extrinsic muscle contraction that is minimizing laryngeal movement

A

Digital manipulation

48
Q

Clinician helps a patient with consequences of a voice disorder, helping the patient explore the many intrinsic or extrinsic factors that relate to the condition and/or referring the patient for help with psychological issues when those issues go beyond the scope if practice for the voice pathologist

A

Counseling

49
Q

Clinicians use words predominated by nasals and glides as therapy stimuli for those with hyper functional voice production as it relaxes the articulators and optimizes nasal resonance.

A

Nasal /glide stimulation

50
Q

The purpose is to improve vocal fold adduction, vocal registration, and epilarynx tube narrowing in order it achieve the best acoustic power transfer from the glottis to the lips Lip trills, bilabial fricatives, humming, and phonation into tubes or straws

A

Semi occluded vocal tract

51
Q

Clinician educates the patient about how vocal loudness impacts vocal fold vibration and modifies vocal loudness based on the physical condition of the vocal folds.

A

Change of loudness

52
Q

How does a voice therapy session begin? (7)

A
  • Describe normal anatomy and physiology,
  • etiologic factors,
  • correlate etiology and vocal symptoms,
  • impact on vocal function
  • Measure motivation for therapy
  • Discuss a timeline
  • Home practice materials
53
Q

Who would you use Chant talk with?

A

Clinician uses this technique with hyper functional voice disorders.

54
Q

Focus (3)

A
  • Clinicians use this technique to help patients generate a voice source that is optimal with regard to resonance.
  • The direction to the patient is to “move” the voice from the back if the throat to the front of the mouth while feeling vibrations in the nasal cavity.
  • Optimal coupling of the supra glottal and glottal cavities is necessary for best possible voice production
55
Q

Counseling

A

Clinician helps a patient with consequences of a voice disorder, helping the patient explore the many intrinsic or extrinsic factors that relate to the condition and/or referring the patient for help with psychological issues when those issues go beyond the scope of practice for the voice pathologist

56
Q

Open mouth approach

A

Clinicians encourage patients to open their mouth to reduce dampening of sound production and increase oral resonance

57
Q

Clinicians use this technique in cases of hyper functional voice disorders by lowering the position of the larynx, widening the pharynx, moving the tongue forward, and reducing extrinsic laryngeal muscle tension

A

Yawn-Sigh

58
Q

Based on the notion that strength of skeletal muscles, such as limb muscles, occurs fairly rapidly due to neural mechanisms and eventual muscle hyper trophy as training processes Technique: use a pressure threshold device to blow forcefully through Patients: pediatrics and adults with hypo functional, hyper function, and neurogenic populations

A

Expiratory muscle strength training

59
Q

Clinicians most clearly understand that there is no such thing as the concept of “optimal pitch.” however, slight alterations in vocal pitch may be necessary to ensure that the patient is not straining the vocal folds behind their normal anatomic range

A

Establishing a new pitch

60
Q

Elimination of excessive voice use, using the voice only when absolutely necessary and in a therapeutic manner Duration should be patient specific

A

Modified voice rest (MVR)

61
Q

What is the voice clinician’s role in psychogenic voice disorders?

A

Discern whether the voice symptoms are due to structural, physiologic, neurophysiologic reasons, and if not, work toward helping the patient remediate the emotional disturbances associated with the onset or maintenance of the condition.

62
Q

Adductor spasmodic dysphonia treatment options (5)

A
  • Surgical
  • Chemodenervation
  • Alternative
  • Behavioral
  • Combined modality approaches
63
Q

Abductor spasmodic dysphonia treatment

A
  • Botulinum toxin (Botox)
  • Inject in posterior cricoarytentoid muscle
64
Q

Examples of physiologic voice therapies (4)

A
  • Vocal function exercises
  • Lessac-Madsen Resonant Voice Therapy
  • Lee Silverman Voice Therapy
  • Inspiratory and expiratory muscle strength training
65
Q

Confidential voice- who?

A

Hyper functional voice disorders

66
Q

Voice therapy techniques should not be based on what?

A

Their popularity or promotion

66
Q

Factors contributing to a successful therapy outcome: (6)

A
  • Agreement of the therapy process
  • Willingness to change
  • Elimination of other medical problems
  • Development of realistic expectations
  • Consideration of other health problems
  • Development of a trusting rapport between clinician and patient

Voice (8 decks)

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