Voice Disorders Midterm Flashcards
Modified Jaw Release Exercise
Purpose: To release the jaw to the neutral, rest position.
- Sit comfortably with your feet flat on floor. Rub your hands together rapidly to warm them.
- Close your eyes & gently cup your jaw so that it rests in the warm palms of your hands.
- Ask your jaw to release & allow the teeth to part slightly. You can now feel the freeway space of ~2-4 mm between the teeth.
- Gently remove your hands without adjusting your jaw & note what you feel in your jaw.
Can be used in a session to set up the larynx for easy phonation. Hourly practice during the day reinforces a more released posture.
8 Mantras for a New Clinician
- It is impossible to remember and implement everything you have learned in your coursework.
- Your skills will improve as you gain more experience.
- Listen to the patient’s account of his voice problem. Be in the present, explore, and ask for more information regarding his perspective.
- Every patient is unique.
- Remember that you do not empathize with the patient in the way you do with family and friends in your personal life.
- You cannot persuade or convince anyone of anything.
- No technique or model works for every patient.
- It is okay to say, “I don’t know”
Hypothesis
- Simple declarative statement that incoporates cause & effect, and can be tested.
- Based on behavior, not judgement or assumption.
- Critical reasoning: Observe behavior, listen to the voice, take history, incorporate patient’s perspective.
Goal of All Rehabilitiation
To facilitate change.
Plan
Individualized management strategy for this specific patient and his particular symptoms.
Develop hypotheses based on knowledge of…
- Normal anatomy & physiology
- Anatomical changes
- Manner of phonation
- Symptoms
Test Hypotheses
- Engage in therapeutic behaviors
- Observe the results
- Ask about sensations in head, neck, and thorax
- If the results support hypothesis - accept it.
- If the results do not support hypothesis - modify or reject it.
Perpetual Characteristics of Voice Problems
- Pitch
- Loudness
- Quality
Classification of Probable Underlying Physiological Breakdown
- Aperiodicity in vibration
- Adduction & Stiffness of vocal folds
- Changes in resonance
- Breath Control
Aperiodicity of Vibration
- Roughness
- Vocal Fry
- Creaky Voice
- Pitch Breaks
- Voice Breaks
- Aphonia
- Tremor
- Diplophonia
Rough Voice
- VF aperiodicity
- Difference in weight between VFs
- Change in stiffness between VFs
Vocal Fry
- Arytenoid cartilages are tightly adducted & VFs are relatively slack & compact
- Loose glottal closure
- Low airflow rate
- Low subglottal air pressure
Creaky Voice
- Foreceful adduction of arytenoid cartilages & medial compression of VFs
- Stiffened & lengthened VFs
- Stiff vocal tract
Pitch Breaks
- Instantaneous, involuntary change in speed of vibration of VFs
- Abrupt change in length & stiffness of VFs
- Differential weighting of VFs
Phonation Breaks
- Instantaneous, involuntary stoppage of vibration of VFs
- Abrupt change in length and stiffness of VFs
- Differential weighting of VFs
- Abrupt abduction of VFs
Aphonia
• VFs do not vibrate
- Adducted out of breath stream
- Stiffened to stop vibration
- Voiceless consonanty (aphonic) - /f, h, k, p, s, t/
- Whisper - an aphonic production
- Loud whisper - 20 dB quieter than conversational speech
Aphonia (hypotheses of probably underlying physiology)
- Absence of vibration of VFs
- Passive stiffening of VFs - Swelling or other increase in mass of VFs
- Passive decrease in tone of VFs - Paralysis or other neurological disorder
- Mismatch between strenth of expiratory drive & stiffness of VFs
Tremor
- Involuntary, rhythmic, oscillating movement of VFs, intrinsic laryngeal muscles, or extrinsic laryngeal muscles - Neurological or phsyiological
- Involuntary, rhythmic, oscillating movements in the diaphragm produce inconsistent subglottal air pressure - Neurological or physiological
- Referred tremor from involuntary tremor in the head, hand, etc. to the larynx - Neurological or physiological
Diplophonia
- Asychronous vibration of VFs
- Different weighting of VFs
- Different length and stiffness of VFs
Adduction and Stiffness of Vocal Folds and Vocal Tract
- Breathy
- Abrupt initiation
- Pressed phonation
- Strident
- Strained - strangled
- Presistent falsetto
- Virilzation
- Inappropriate pitch variability
- Limited pitch range
Breathy
- Inadequate adduction of VFs - Paralysis
- Gab anterior and posterior to vocal fold lesion allows air to leak
- Lack of adduction of VF - neurological problem, alkalosis
- Bowing of VFs - neurological, aging, surgical damage
Abrupt Initiation of Phonation
- Hyperadduction & stiffening of VFs prior to onset of phonation
- Build up of subglottal air before initiation of phonation
Pressed Phonation
- Hyperadduction & excessive stiffness of VFs
- Excessive subglottal pressure
- Stiffness above & below glottis
- Abrupt initiation of voice
- Long closed phase of vibration
Strident
- Hyperadduction & ecessive stiffness of VFs
- Excessive subglottal pressure
- Increased stiffness of vocal tract
- Abrupt initiation of voice
Strained - Strangled
- Hyperadduction of arytenoid cartilages & vocalis muscle - learned behavior or neurologically based
- High subglottal air pressure
- Small range of excursion of VFs due to high muscle tone
Persistent Falsetto
- Excessive length & stiffness of VFs
- Excessive elevation of larynx (extrinsic laryngeal muscles)
- Decreased space between hyoid bone & thyroid cartilage
- Tighness in jaw and tongue
Virilized Voice
- VFs shortened and stiffened
- Larynx lowered in throat (extrinsic laryngeal muscles)
- Reduced air flow between VFs
Inappropriate pitch variability
- Excessive changess in length of VFs
- Monopitch: VFs excessively stiffened
- Excessive pitch changes: VF stiffness varies excessively
Limited pitch range - Loss of high & low notes
• Excessive, passive stiffness of VFs
Changes in Resonance
- Hypernasality
- Hyponasality
- Back quality