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)
6 types of non-neurologic organic voice disorders
- infalmmatory reactions (acute or chronic laryngitis, LPR, irritable larynx syndrome)
- benign lesions (nodules, polyps)
- endocrine disorders (hypo/hyperthyroidism)
- trauma (mechanical or burns)
- congenital disorders (laryngeal web)
- maligent tumors
ALS is
spastic and flaccid dysarthria
WD is
ataxic and hypokinetic dysarthria
MS is
ataxic and spastic dysarthria
flaccid dysarthria voice symptoms
- hypernasality
- nasal emission
- breathiness
- short phrases
- inhalatory stridor
spastic dysarthria voice symptoms
- harshness
- low pitch
- slow rate
- strained/strangles voice quality
- pitch breaks
- slow and regular AMRs
hypokinetic dysarthria voice
- monopitch
- monoloud
- variable rate
- rapid/blurred AMRs
- short rushes of speech
- reduced stress
hyperkinetic dysarthria voice (huntingtons - quick)
- slow/irregular AMRs
- distorted vowels
- prolonged intervals
- voice tremor
- voice stoppages
- transiet breathiness
ataxic dysarthria voice
- irregular articulatory breakdowns
- prodosdic excess
- prolongation of phonemes
- irregular AMRs
- Excessive loundness variation
spasmodic dysphonia
- inappropriate adduction and abduction of the VFs
- abnormal involuntary contraction of the thyroarytenoid (adductor) and PCA (abductor)
tx = botox
how to treat abdominal breathing
stabilize shoulders (lie on floor, stand against wall) force exhalation, feel recoil candle blowing panting slow rate of inhalation
how to treat glottal incompetence
pushing/hard glottal attacks
couging/throat cler
pitch manipulation
LSVT
how to decrase rate of speech
taping
metronome
DAF
listen tapes
how to use resoance to shape phonation
forward placement/focus (hum)
use forward vowels (/i/ /u/)
Lessac Madesen resonant voice
