Voice Diagnostics

Question 1

What is the objective to a voice diagnostics? 3 parts

Answer 1

To determine if:

1. There is a problem
2. Can anything be done about it (not just SLP)
3. Should we do anything about it

Question 2

What are the categorization of etilogies for VDs?

Can etilogies co-occur?

Answer 2

1. Organic
2. Non-organic (hearing loss, psych, etc)
3. Mixed

Yes, they often co-occur because one will often cause another (loud talker (functional) leading to hemorrhage (physical))

Question 3

What are the 2 considerations as whether or not there is a problem with the person’s voice?

Answer 3

1. Is the voice deviant in terms of the product or the process?
2. What is the impact on the speaker or the listener?

**presently or anticipated

**need to be considered together

Question 4

What are the combinations of deviancy and impact that are a problem and which are more questionable?

Answer 4

• Hi deviancy, high impact: clear problem
  
  • e.g. hoarse patient and they don’t like it
• Low deviancy, high impact: more questionable
  
  • e.g. professional voice user: don’t see/hear much but they say voice is impacting them greatly
• Low deviancy, low impact: not a problem
• Hi impact, low deviancy: questionable problem. Lots of deviance but no one seems to care. Should keep going on dx model (predict future harm)
  
  • e.g. scgool0age hoarseness, cheer leader, Down syndrome

Question 5

How do you figure out the degree of deviancy?

2 considerations

Answer 5

1. Observations of typical speech/voice
   
   1. Product: what can the ears, eyes, and acoustics tell us about
      
      • Presence/absense of symptoms
      • type of symptoms
      • severity of symptoms
   2. Process: physical, psychological
      
      1. endo-stroboscopy
      2. aerodynamics
      3. EGG
      4. Emg
2. Maximum performace testing

Question 6

How do you figure out the defree of impact-

on the speaker?

on the listener?

Answer 6

Speaker:

• formal quality of life measures (voice related)
• other reporting of impact by speaker re: family, social, vocational life
• observation of others (clinician, family, etc) suggesting impact on speaker (less talking, emotional state, etc)

Listener:

• Ratings of overall impact on communication
• report (or observation of) by speaker of listener reactions

Question 7

How do you figure out the potential for change?

Answer 7

Figure out the etiology, then seeing there are other limits

1. Are there any physical limits (less potential for SLP) OR is this primarily behavioral (more potential for SLPs)?
2. Are there any limits to change that are either cognitive (dementia, delays, TBI) OR psychological (depression, anxiety OR behavioral (compulsive, lifestyle, vocational) OR sensory (hearing issues, body awareness) OR latrogenic (heavy meds, chemo induced fatigue, etc)

Question 8

If the etiology is physical and there is a high amount of other limits, what is the likelihood of change dependent on?

Answer 8

1. Availability of good physical tx

AND

1. Whether “other limits” lesson effectiveness or outcomes of physical fix

OR

1. possibilty of SLP tx (qualified outcomes) having an impact

Lots of of possible tx decisions but may have the lowest expectation of changing the situation

Question 9

If the etiology is physical and there is a low amount of other limits, what is the likelihood of change dependent on?

Answer 9

1. availbilty of good physical tx
   
   • if yes, then physical tx t correct problem
   • if no, determine if SLP tx (compensatory) is worthwhile
2. Availbility of good behave tx of symptoms of physical problems
   
   • If yes, SLP tx compensatory
   • If no, ??nothing? trial SLP tx

Sometimes, like with PD behavioral fix is better than physical one

Question 10

If the etiology is functional/behavioral and there is a high amount of other limits, what are the options?

Answer 10

1. Try to reduce or eliminate the “other limits” if possible e.g. address hearing lossw hearing aid, wait for chemo/rad effect to go away
2. If can’t reduce/eliminate, could take them on behaviorally fr SLP tx, trial tx or compensatory qualified outcomes expected

Lesser likelihood for change, usually with behavioral/function intervention

Question 11

If the etiology is functional/behavioral and there is a low amount of other limits, what is the likelihood of change dependent on?

Answer 11

High likelyhood of change, usually with behavioral/functional intervention

Usually SLP-corrective tx e.g. hyperfunctional voice problem

Question 12

How do you figure out if this is an organic or a behavioral problem?

Answer 12

• Interview info: onset, course, associated events, other med hx, etc
• ENT and other medical info
• Observations of:
  
  • typical voice (pitch, loud, quality, stability, consistency, ect)
  • vegetative/emotional phonation (vs. speaking voice)
  • demeanor, emotional, psych state
  • physical appearance: indications of underlying health, etiology, lifestyle
• stimulability

Question 13

How do you figure out if there are limits on the client’s ability to change-either cognitive or psychological or other?

Answer 13

• interview info
• referral/medical info
• observations of client during all parts of the eval

Question 14

How do you determine if there is profit in doing anything?

Answer 14

1. Look at value of trying to affect change in voice: balancing out potential for change with severity of problem
2. Look at cost of trying to change voice: $, time, mental energy, convenience, etc

High cost, high value=questionable profit

High cost, low value= questionable

Low cost, high value=winner!

Low cost, low value=questionable, but cost is low so maybe why not