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Voice and Upper Airways Disorders > Vocal Therapy > Flashcards

Vocal Therapy Flashcards

1
Q

the comprehensive voice care team

A
  • patient
  • family physician
  • otolaryngologist
  • speech-language pathology
  • vocologist
  • voice teacher/voice coach
  • other members can include radiologists, allergist, neurologist, nutritionist, speech scientist, psychologist/psychiatrist who might be called in to assist in the management and diagnosis of the voice disorder
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2
Q

comprehensive voice care team: patient

A

should work directly with all other team members in deciding the goal of voice therapy, as they are the final arbiter of what constitutes an acceptable voice and whether they are willing or able to follow through with a particular program regimen or surgical alternative

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3
Q

comprehensive voice care team: family physician

A

often the first contact for the patient with a voice disorder

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4
Q

comprehensive voice care team: otolaryngologist

A
  • the appropriate medical professional for the diagnosis and medical and/or surgical management of voice disorders
  • remember, the SLP does not diagnose organic lesions or structural changes to the vocal folds (ENT does this), rather the role of the SLP is to diagnose and treat the dysphonia that results from the vocal pathology
  • patient should be viewed by an ENT prior to the initiation of therapy
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5
Q

comprehensive voice care team: speech-language pathologist

A

the professional who is called upon to diagnose and manage the dysphonia or voice disorder that results from a particular vocal problem

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6
Q

comprehensive voice care team: vocologist

A

an appropriate professional, be they an otolaryngologist, voice teacher, or SLP who specializes in the care of the voice

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7
Q

comprehensive voice care team: voice teacher/voice coach

A

may be a professional singer, actor, or speaker who might be called upon to assist the patient in restoring and maintaining a healthy voice

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8
Q

the SLP’s role in the management of voice disorders

A
  • selection and implementation of a voice therapy program
  • development of an appropriate therapeutic relationship with the patient, his/her family, and/or significant others
  • provision of technological assistance as warranted
  • identification of appropriate reading materials, video tapes, catalogs, support groups, self-help materials, etc. to enhance the patient’s understanding of the disorder and provide information relevant to total rehabilitation
  • coordinate the involvement of various family members and other support professionals/associates in the treatment program to enhance the patient’s recovery
  • development of improved patient self-perception skills through training, self-monitoring exercises, technological feedback, counseling, etc.
  • sensitive referrals for additional specialized counseling with psychiatrists to psychologists should this be indicated
  • analysis of life-style factors and environmental factors pertinent to vocal behavior
  • presentation of hierarchies and strategies to reduce and eliminate abusive or hyperfunction behaviors
  • explanations and modeling of facilitative techniques
  • attention to the patient’s needs for improved self-esteem, realistic vocal image, and satisfying social interactions
  • use of materials and strategies that mesh with the patient’s developmental level, interests and aspirations
  • consistent data collection and documentation of progress in therapy involving the use of both perceptual and objective observations
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9
Q

selection and implementation of a voice therapy program

A
  • depending on the age of the patient, type, and severity of the disorder, the SLP may provide direct and/or indirect services for varying amounts of time
  • in the US, most voice therapy involves 1-2 sessions per week for approximately 6-8 weeks (average = 15 sessions)
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10
Q

development of an appropriate therapeutic relationship with the patient, his/her family, and/or any significant others

A

this involves the regular, clear, and appropriate communication of realistic goals, individual responsibilities, documentation, and dismissal criteria

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11
Q

provision of technological assistance as warranted

A

the SLP is usually the professional best suited to make assessments concerning the need for communication aids and assistive devices

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12
Q

analysis of life-style factors and environmental factors pertinent to vocal behavior

A

the SLP serves as a facilitator in this process, guiding the patient toward problem solving and acceptance of responsibility for making changes in their lifestyle and communication patterns

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13
Q

facilitative technique

A

a therapy technique that seems to produce optimum voice by shaping target behaviors during symptom modification

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14
Q

attention to the patient’s needs for improved self-esteem, realistic vocal image, and satisfying social interactions

A

this may be accomplished throught the design of activities to enhance the development of both insight and skills through the effective use of reinforcement

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15
Q

consistent data collection and documentation of progress in therapy involving the use of both perceptual and objective observations

A
  • data colleciton and documentation is important because the patient will need concrete evidence of progress across treatment in order to sustain motivation
  • in addition, careful documentation is required for insurance reimbursement, quality assurance, and as evidence in cases involving potential litigation
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16
Q

therapy approaches/types

A

a number of factors, related to both the patient and clinician, will affect the design of the voice treatment program and selection of the approach we might choose to implement

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17
Q

patient related factors

A

age, type/severity of the disorder, personality, their understanding of the problem and precipitating factors, commitment to change, etc.

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18
Q

clinician related factors

A

training, previous experience, interest in voice disorders, confidence level, personality

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19
Q

direct treatment approaches

A
  • symptomatic voice therapy (Boone)
  • lifestyle and environmental modification
  • physiologic voice therapy (Aronson)
  • holistic voice therapy
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20
Q

symptomatic voice therapy (Boone)

A
  • involves the direct modification of overt behavioral characteristics of the voice disorder
  • typically this involves identification of the behaviors that need to be eliminated, modified, or improved upon, selection of a facilitating technique to directly target the behavior, and then shaping, stabilizing, and habituating the behavior
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21
Q

lifestyle and environmental modification

A

this approach involves analysis of precipitating and perpetuating factors associated with the person’s lifestyle/environment, working with them and their family to make necessary modifications, implementing these modifications, and monitoring their progress

22
Q

physiologic voice therapy (Aronson)

A
  • this approach addresses the psychosocial aspects of voice use through the use of psychosocial goals and the use of emotional or cognitive retraining as a way of changing voice use
  • this approach is based on the idea that voice disturbances frequently arise from problems with self-esteem and interpersonal relationships
  • even voice problems that are not psychogenically based usually disrupt the patient’s emotional equilibrium to some extent because communication interactions are impaired
23
Q

holistic voice therapy

A

this approach draws on all the approaches mentioned above implementing them sequentially or concurrently based on the patient’s most compelling needs to set the order of priority

24
Q

indirect treatment approaches

A
  • consultation model
  • clinical surrogates
  • in-service programs
  • group workshops and mini-seminars
  • demonstration lessons
25
Q

consultation model

A
  • providing the patient with information (reading material, videotapes, etc.) and allowing them to work on their own for the treatment of the voice disorder
  • this typically works best for the highly motivated adult who had a very mild voice disorder
26
Q

clinical surrogates

A
  • providing information and activity sheets to someone other than the patient who is willing and able to implement them (teachers, parents)
  • we see this frequently in the use of vocal hygiene and prevention of vocal abuse type programs
27
Q

inservice programs

A

dissemination of information concerning the prevention of voice disorders to interested groups (teachers, cheerleaders, telemarketers, etc.) in a brief manner

28
Q

group workshops and mini-seminars

A
  • for specialized groups who are at risk for or suffer from voice disorders
  • these are typically provided through the university and hospital community and are similar to inservices but only longer and more involved
29
Q

demonstrates lessons

A
  • in school classrooms and lectures in university courses by voice clinicians
  • this is frequently done for vocal hygiene/vocal abuse reduction and is being used more as the inclusion model for the delivery of service model becomes popular
30
Q

prognostic variables

A
  • because voice therapy requires full patient participation, it is often difficult to predict whether or not the anticipated outcome will/can be met
  • as much, our prognosis and the determination of whether the patient is an appropriate candidate for voice therapy is based on a variety of factors
31
Q

prognostic indicators/factors

A
  • the patient must recognize there is a problem
  • the patient must be willing to follow a therapy plan involving regular practice periods as required
  • the patient must be willing to give up abusive habits and to alter or eliminate some vocal use
  • psychiatric problems, if present, may interfere with the ability to modify vocal behavior
  • the patient’s voice disorder must be amenable to change through a voice therapy approach
  • appropriateness of patient expectations must be considered (normal voice wanting changed to sound like someone else)
  • it is necessary to give full consideration to the patient’s laryngeal condition and general health status
  • the SLP must have an adequate understanding of the problem, feel competent in handling it, and be able to establish a good relationship with the patient
32
Q

general guidelines/considerations related to/for voice therapy

A
  • a simplified explanation of normal vocal physiology and of the patient’s specific deviance should be provided
  • throughout therapy have the patient verbalize perceptions of how the voice sounds and feels
  • the use of feedback, be it auditory, visual, or instrumental, is valuable to the patient in seeing change and providing the patient with models
  • therapy should move gradually from 1 step or activity to the next
  • the clinician should always model a therapy task for the patient
  • tape record each session either in whole or in part
  • carefully instruct the patient in what to practice, for how long, and how often
  • a prognostic statement should be made at the initiation of voice therapy
  • recognize that not all patients are candidates for voice therapy for reasons other than the nature of the pathology present
  • if a voice change persists for approximately 2-3 weeks, the individual should see an otolaryngologist if they haven’t already done so
33
Q

a simplified explanation of normal vocal physiology and of the patient’s specific deviance should be provided

A

this allows them to begin understanding the nature of the problem and to draw connections between various behaviors and their own particular problem (begins the process of having them assume responsibility)

34
Q

throughout therapy have the patient verbalize perceptions of how the voice sounds and feels

A

provides the SLP with information regarding how the patient views the problem, how attuned to the problem they are, and assists us in shaping the therapy plan and increases patient self-awareness (promoting self-discovery)

35
Q

therapy should move gradually from 1 step or activity to the next

A

allow the patient sufficient time to learn and master a technique as this not only gives them a sense of accomplishment but provides a solid base upon which to introduce other steps in a progression (avoid overdoing and moving on too quickly)

36
Q

the clinician should always model a therapy task for the patient

A

this allows us to demonstrate clearly what we want the patient to do as well reduce the feeding of self-consciousness on the part of the patient after you have asked them to engage in some fairly strange behaviors

37
Q

tape record each session either in whole or in part

A

this provides a record of the patient’s voice and allows you to demonstrate progress and illustrate various aspects of the intervention, and provide a model for home practice

38
Q

carefully instruct the patient in what to practice, for how long, and how often

A

frequent practice sessions of limited duration are best, as they help the patient focus on the voice to a greater extent and promote generalization via the “overflow effect” more frequently

39
Q

overflow effect

A

follow-up/generalization of practice for a period of time immediately after it has been practiced

40
Q

a prognostic statement should be made at the initiation of voice therapy

A

remember this statement constitutes an educated guess and should be modified as therapy progresses

41
Q

recognize that not all patients are candidates for voice therapy for reasons other than the nature of the pathology present

A

refer to your prognostic considerations

42
Q

counseling

A

Boone has encouraged the voice therapist to offer more supportive, counseling role in voice therapy

43
Q

in counseling the patient, all of the following should be done in a continuous and dynamic way

A
  • receiving information
  • giving information
  • clarifying
  • helping to change behavior
44
Q

counseling: receiving information

A

the SLP should actively and nonjudgmentally listen for the real meaning of the patient’s message, without planning what to say next, and then restate in his/her own words what the patient has said

45
Q

counseling: giving information

A

this is the easiest of the counselor functions (because of the expertise we bring to the task) and involves the provision of information based on the patient’s needs (must remember, however, that the patient can only process so much information at 1 time)

46
Q

counseling: clarifying

A

assist the patient in perceiving more clearly and to deal more constructively with issues impacting their voice problem

47
Q

counseling: helping to change behavior

A

to do this you must exercise all of the above, with the first step being to clearly explain the target behavior and its potential benefit, and incorporating discussion, practice, observation, and role-playing

48
Q

dismissal from services

A

though we have an idea of how the voice should sound following therapy, it is beneficial to ask the patient how he or she would like to sound following therapy at the time of discharge

49
Q

sample dismissal criteria

A
  • people don’t ask if I have a cold
  • the voice is clear
  • my throat isn’t tight
  • reduction of hard glottal attacks by 90%
  • elimination of throat clearing
  • normal looking vocal folds
  • resolution of vocal nodules
  • otolaryngologist clearance
50
Q

some final thoughts regarding the SLP’s management of voice disorders

A
  • consider the whole person
  • understand that to examine a voice is to examine an individual
  • understand that the way the person feels physically and emotionally is reflected in the voice
  • know that voice therapy requires counseling and motivational skills
  • be aware that the person’s voice is truly a mirror of his/her soul
  • Boone “among the good and bad things happening in the life of that person, there is also voice problem”

Voice and Upper Airways Disorders (19 decks)

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