Voice and Resonance Flashcards
includes disorders, voice diagnostics, and voice characteristics
dysphonia
a voice disorder characterized by auditory perceptual symptoms
organic voice disorders
- structural
- neurogenic
organic voice disorders: structural
- physical changes of vocal mechanism
- cysts, growths, trauma to larynx, contact ulcers, nodules, edema, lesions, laryngitis, hemorrhage, glottal stenosis, sarcopenia
organic voice disorders: neurogenic
- innervation to structures is impaired/damaged
- spasmodic dysphonia, Parkinson’s disease, Myasthenia gravis, ALS, essential/vocal tremor, paralysis/paresis of vocal folds
functional voice disorders
- misuse
- psychogenic
functional voice disorders: misuse
- normal structure, improper use/misuse
- muscle tension dysphonia, vocal fatigue, diplophonia, hypofunctional (incomplete vf closure), hyperfunctional (overuse)
functional voice disorders: psychogenic
- normal structure, psychological cause
- conversion dysphonia, conversion aphonia, puberphonia (i.e., mutational falsetto), depression, anxiety, stress disorders
assessment
- case history
- auditory evaluation
- perceptual evaluation
- oral motor exam
- respiration
- articulation
- resonance
- instrumental imaging
types of voice and resonance treatment
- physiological
- symptomatic
physiological treatment of voice and resonance
aim to modify the physiology of the voice
symptomatic treatment of voice and resonance
aim to modify disordered vocal symptoms
Lee Silverman Voice Treatment (LSVT)
- developed for Parkinson’s disease, may be used with others
- intensive high-frequency treatment program designed to improve vocal fold adduction and overall speech production
- focused on “think loud, speak loud”
- SLP certification program required to implement LSVT
Phonation Resistance (PhoRTE)
- adapted from LSVT
- /a/ loud maximum sustained phonation, /a/ loud ascending and descending pitch glides, functional phrases with loud volume and high pitch voice, functional phrases with loud volume and low pitch voice
treatment: vocal function
vocal function exercises:
- strengthening muscles to improve voice production
treatment: relaxation
- hyper functional voice, relaxation techniques to reduce laryngeal tension
- yawn-sigh: minimize vocal hyperfunction tension, relax voice + improved pitch
treatment: resonance
surgery, prosthesis, medical management, speech therapy
voice diagnostics: case history
- date of onset
- chief complaint
- medical history
- vocal use/misuse
- referral source
- signs and symptoms
- prior voice therapy
- impact on everyday
informal assessment categories
- vocal characteristics
- resonance
- respiration
- intelligibility
informal assessment of vocal characteristics: acoustic/perceptual
- loudness
- quality
- pitch
informal assessment: resonance
- hypernasal
- hyponasal
- cul-de-sac
- mixed
- vp dysfunction
- vp insufficiency
- vp incompetence
- vp mislearning
hypernasal
- excess air through nasal cavity, during production of all sounds besides nasals /m, n, ŋ/
- structural abnormalities (e.g., clefts)
- genetic syndromes (e.g., 22q11.2 deletion)
hyponasal
- not enough air through nasal cavity during production of nasal consonants
- blocked air
- nasal cavity obstruction (e.g., sinusitis)
- inflammation (e.g., cold)
- severe hearing loss
cul-de-sac
- sound is trapped in oral, nasal, or pharyngeal cavity
- muffled/low voice
- nasal blockage (e.g. polyps, deviated septum)
- pharyngeal blockage (e.g., large tonsils and/or enlarged adenoids)
mixed resonance
- cooccurrence of hypernasality, hyponasality, and/or cul-de-sac resonance
- apraxia: inconsistent abnormal vp opening
- causes of hyper/hypo nasality and cul-de-sac
vp dysfunction
vp valve does not close completely during production of oral sounds
vp insufficiency
velopharyngeal dysfunction due to anatomical/structural defect (e.g., cleft palate)
vp incompentence
poor movement of structures (e.g., CN damage, dysarthria)
vp mislearning
poor closure due to mislearning (e.g., misarticulation)
respiration: types of breathing
- abdominal
- clavicular
- thoracic
informal assessment: respiration
- evaluate respiration during speech tasks
- assess coordination, length of words per breath, and maximum phonation time
intelligibility
impact on overall communication
- articulation
- prosody
- oral motor
intelligibility: articulation
vowel and consonant precision, duration, and fluency
intelligibility: prosody
rate, rhythm, and stress of speech
intelligibility: oral motor
movement, function, and symmetry of structures
acoustic evaluation: pitch
- pitch determination
- fundamental frequency
perceptual evaluation: pitch
- perceived high/low tone
- pitch level, pitch variations, pitch breaks, tremor
acoustic evaluation: loudness
measure intensity level
- sound level meter
- computer programs (PRAAT)
perceptual evaluation: loudness
- perceived loudness of sound
- loudness level: too soft (paralyzed vocal folds, Parkinson’s disease), too loud (variable innervation of vocal folds, spastic dysarthria)
- variations in loudness: mono loudness (dysarthria, affective disorder)
acoustic evaluation: quality
- jitter: frequency perturbation
- shimmer: amplitude perturbation
- s/z ratio: minimal pairs
perceptual evaluation: quality
- perceived pleasantness
- breathy: air escaping between vocal folds
- harsh: hard, glottal attacks, low pitch, hypo/hyper loudness
- hoarse: combination of breathy and harsh qualities
- rough, strained and strangled, gurgly and wet, phonation breaks, glottal fry, etc.
instrumental assessment: imaging
- laryngeal imaging may assess structure, function, and vocal fold vibration during phonation
- videolaryngoendoscopy and videolaryngostroboscopy
