Voice Flashcards
LPR symptoms
- hoarseness
- globus sensation
- pain
- irritation & inflammation
- increased mucous production
LPR treatment
suppress acid through a PPI
- dont eat 3 hours after meals
- elevate head of bead
- diet changes
principles of voice therapy (7)
education behavioral modifications relaxation work postural work breath work voice production shaping counseling
Relaxation approaches
- progressive relaxation (Jacobson)
- direct massage (McClosky) —- massage face, stretch tongue, passive movements of jaw, massage neck, etc.
- stretch/flex and release exercises
Postural tx
- assess “plumb line”
- assess balance of head on atlas
- look at their work-station, etc.
- -tx:
- “here i am sitting”
- sit as you would stand
- refer to OT or chiropractor
why work on breathing & problems
“voice disorders disrupt normal speech breaking behaviors (Hillman)
- shallow inhalations
- running out of air
- exhalation prior to speech
- breath holding
- paradoxical respiratory movements
tx for breathing
target abdominal breathing
- stablalize shoulders
- force exhalation, feel for recoil
- candle blowing
- slow rate of inhalation
- breath through nose
PVFM
- when the larynx closes off not allowing the person to breath
- difficulty getting breath in
- tightness in throat
- inhalatory stridor
- 02 stats stay above 90
- stops soon after excersise
tx for PVFM
rescue breathing technique
- breathe in through nose slowly with wide throat posture
- breath out through puckered lips
- feel throat widen as you breathe in
decreased glottal competence tx techniques
- pushing
- hard glottal attacks
- coughing, troat clearning
- pitch manipulation
- laryngeal manipulation
approaches to shape phonation
- onset manipulation
- aspirate onset to reduce hard glottal attacks
- light glottal attacks to reduce breathiness
- easy/gentle onset - reinforce active/continuous breath flow
- kazoo buzzes
- lip/tongue trills
in voice don’t treat the _______, treat the _____
don’t treat the symptoms, treat the cause
non-adducted hyperfunction
- aphonia or dysphonia
- crisp, vegetative cough or throat clear
-dx confirmed via endoscopy
severe hoarseness—>aphonia–>conscious transfer into a whisper—>URI resolves —>pt remains locked in a whisper
tx for non-adducted hyperfunction
- describe the problem – “laryngeal muscle tension”
- lay the ground rules
- explain bad vs good voice
- you have control over your voice
—**Clinician’s toolbox of tricks
what CN involved most in voice??
CN x -Vagus
3 branches of the vagus
- palato-pharyngeal branch - palate and pharynx
- superior laryngeal branch - interior branch (laryngeal interior) and external branch (cricothyroid)
- recurrent laryngeal branch - intrinsic laryngeal muscles except cricotyroid
tx of adducted hyperfunction
- vocal hygiene
- vocal rest
- vocal entrainment exercises
- resonant voice therapy (verdoloni)
- voice therapy
resonant voice therapy
** Verdoloni
-the goal is to achieve the strongest “cleanest” voice possible with the least effort and impact between the VF to minimize trauma
- “forward focus voice”
- work on the “basic resonant voice training gesture”
Vocal function exercises
**Stemple
exercises are practiced 2x day
-works to improve the strength and endurance of the VF muscles & the coordination of respiratory and laryngeal muscles
-includes maximal prolongations, pitch glides, sustained vowels to words and phrases
Clinician toolbox tricks
**Bunting
- cough
- throat clear
- cry
- sing
- laryngeal manipulation
- gargling
LMN damage
flaccid dysarthria
UMN system
spastic dysarthria
Cerebrllum system
ataxic dysarthria
Extraparymadal system
- hypokinetic
- hyperkinetic (quick or slow)
- tremor (organic voice tremor)
