Voice Exam Additional Readings

Question 1

Why is Vocal Rest Controversial?

Answer 1

1. Some feel that it places too many unrealistic demands and hardships on the individual
2. others advocate such a program in certain situations because of its therapeutic effects and because of the diagnostic and prognostic information it can provide.

Question 2

When to Implement Vocal Rest

Answer 2

1. Following the various forms of laryngeal surgery to promote healing of the traumatized tissue
   a. particularly true if surgery involved the margins of the vocal folds
2. As the initial treatment of some lesions of the larynx, particularly vocal fold hemorrhage or mucosal tear
3. A program of modified vocal rest (speaking only when necessary) can be used when the patient is experiencing acute inflammations of the voice or following the development of nodules or edema

Question 3

Advantages of Vocal Rest

Answer 3

1. Usually see a rapid reduction in the size and severity of the laryngeal lesion, which decreases the severity of the associated dysphonia
2. It allows the individual the opportunity to identify those situations that promote misuse
3. Allows the therapist to determine the individual’s commitment to the process of voice improvement

Question 4

Disadvantages of Vocal Rest

Answer 4

1. For those who use their voices professionally, it may be financially impossible for them to implement
2. it’s an extremely difficult task for the average person to adhere to and is even more difficult for those who misuse their voice
3. Some patients become depressed with continued vocal rest

Question 5

Duration of Vocal Rest Program

Answer 5

typically 4-7 days, rarely more than 7

Question 6

Complete Vocal Rest

Answer 6

elimination of all activities that either adduct the vocal folds into forced approximation with each other or cause the vocal folds to vibrate and result in the production of sound

Question 7

Behaviors to Avoid in Any Vocal Rest

Answer 7

1. speaking
2. Singing
3. Humminh
4. whispering
5. coughing
6. throat clearing
7. laughing
8. lifting/pushing heavy objects
9. forceful efforts during bowel movements

Question 8

Modified Vocal Rest

Answer 8

the use of voice is significantly reduced but not completely eliminated
Allows some talking under controlled substances

Question 9

When Talking is Allowed in Modified Vocal Rest

Answer 9

1. Conversation is limited to a time of no more than 15 minutes per day
2. each period of talking must be limited to no more than 5 minutes in duration
3. conversations must be one-on-one and in an environment that has a minimum level of background noise

Question 10

Vocal Rest Program for Children

Answer 10

1. They’re more like modified vocal rest, goal is to reduce talking by 1/2 or more
2. can only be used with children who understand what has caused the laryngeal lesion, otherwise it should be avoided
3. child must be made to understand that he is directly responsible for changing his vocal behavior and not anyone else
4. parental support and encouragement are vital to the success of this program to facilitate success (modeling good vocal habits)
5. Explain to the child that they only have to reduce amount of talking for 7 days

Question 11

Guideline for Child’s Vocal Rest Programs

Answer 11

1. Child can talk quietly to parents in morning before school
2. Child can answer in classroom but should be excused from talking in large groups (no singing either)
3. Must not talk during recess, lunch, or gym (loud areas)
4. they’re permitted to talk to parents quietly after school for a brief period and then no talk until mealtime
5. allowed to talk quietly at mealtime but parents should limit verbal competition
6. talking time during evening hours should be as limited as possible

Question 12

Steps in Vocal Abuse/Misuse Reduction Program

Answer 12

1. identify patterns/behaviors related to vocal misuse/abuse
2. a baseline of occurance should be identified either through direct observation of client or having them track and monitor outside of therapy
3. Make patient aware of impact these abuses have on their voice and how they might contribute to an addative lesion
4. Discuss the identified abuses with the patient, emphasizing the need to reduce their daily frequency
5. Plot the daily occurance of vocal abuse/misuse on a graph (makes patient aware of what they have been doing and allows them to track progress)
6. have patient bring graphs to therapy and discuss (reinforce when you see behaviors decreasing)

Question 13

Purpose of Voice Evaluation

Answer 13

1. Allows therapist to make determinations regarding the patient’s voice, including
   A. a detailed description of the patient’s voice characteristics and how they vary over time
   B. how severe the voice disorder is
   C. whether the patient would benefit from voice therapy

Question 14

Description of the Patient’s Voice

Answer 14

1. better to use descriptive terms regarding patients’ voices, like what they do well, what they do poorly, and what they are unable to do
2. should include a hypothesis of possible etiologies of vocal pathology or dysfunction

Question 15

Determining Severity of Voice Disorder

Answer 15

1. done through numerical rating scales which allows therapists to make several severity evaluations concerning aspects of the voice
2. done through Subjective descriptions of severity (mild, mod, severe) but tend to be general and less meaningful

Question 16

Determining Candidacy for Voice Therapy

Answer 16

1. Should formulate a statement after the evaluation regarding potential benefit of therapy
2. Should look at prognostic considerations

Question 17

Prognostic Considerations for Candidacy of Voice Therapy

Answer 17

1. prognosis is better for those who report acute onset and those that seek help sooner (generally more motivated/anxious)
2. it’s poorer for patients who report a long-term, chronic dysphonia (not as worried and usually referred by someone else)
3. If uncertain, can do a trial run of therapy

Question 18

Therapeutic Protocol for Voice Evaluation

Answer 18

1. No standards regarding the exact procedures which should be followed during a voice evaluation
2. instrumental tests depend on setting/facility, clinician training/experience, and type of presenting problem

Question 19

What Should a Good Voice Evaluation Include?

Answer 19

1. Analysis of ENT Report and Other Medical Problems
2. Case History
3. Observation of Patient’s Behavior
4. hearing assessment
5. oral motor assessment/laryngeal palpation
6. articulation/intelligibility
7. eval of pitch/frequency (perceptual and instrumental)
8. Eval of loudness/intensity (perceptual and instrumental)
9. analysis of quality/wave complexity (perceptual and instrumental)
10. judgement of air wastage/measurement of airflow rate/respiration (perceptual, instrumental or noninstrumental)
11. use of other relevent/pertinent physiologic measures (EGG, EMG,)
12. videoendoscopy
13. presentation of appropriate clinical facilitation techniques/trial therapy
14. obtain an audio/video sample of patient’s voice during the evaluation

Question 20

Parts of the Comprehensive Care Team

Answer 20

1. patient
2. family physician
3. otolaryngologist
4. SLP
5. voice teacher/voice coach
6. other members (radiologist, psychologist, neurologist, etc)

Question 21

SLP’s Role in Management of Voice Disorders

Answer 21

1. selection and implementation of a voice therapy program (depends on age of client and severity/type of disorder)
2. development of appropriate therapeutic relationship with patient and family.
3. Provision of technological assistance as warranted
4. Identification of appropriate reading materials, videos, support groups, self-help matherials, to enhance the patient’s understanding of the disorder and provice information.
5. coordinate involvement of family members and other.support professionals in the treatment program to enahnce the patient’s recovery
6. improve self-perception skills through training, self-monitoring exercises, counseling, etc.
7. Refer for additional specialized counseling with psychiatrists if needed
8. facilitator of analyzing life-style facotrs and evironmental factors to vocal behavior
9. Give strategies to reduce or eliminate abusive or hyperfunctional behaviors
10. explanation and modeling of facilitative techniques.
11. give attention to client’s needs for improved self-esteem and satisfying social interactions
12. use of materials and strategies that mesh with clients’ interests
13. careful documentation for insureance reimbursement

Question 22

facilitative techniques

Answer 22

a therapy technique that seems to produce optimum voice by shaping target behaviors during symptoms modification

Question 23

Patient related Factors for Therapy Approaches

Answer 23

age, type/severity of disorder, personality, their understanding of the problem and contributing factors, commitment to change, etc.

Question 24

Clinician related factors to therapy approaches

Answer 24

training, previous experiences, interest in voice disorders, confidence level, personality

Question 25

Symptomatic Voice Therapy

Answer 25

Direct therapy by Boone
involves direct modification of overt behavioral characteristics of the voice disorder

Question 26

Lifestyle and Environmental Modifcation

Answer 26

direct appraoch
involves analysis of precipitating and perpetuating factors associated with their lifestyle/environment, working with them and their family to make necessary modifications, implementing these modifications, and monitoring their progress

Question 27

Physiologic Voice Therapy

Answer 27

direct approach by Colton and Casper, Stemple
the utilization of objective data regarding the patient’s laryngeal function to modify function of the laryngeal musculature and the respiratory support of voice production

Question 28

Psychodynamic Voice Therapy

Answer 28

direct approach by Aronson
addresses the psychosocial aspects of voice use through the use of psychosocial goals and the use of emotional or cognitive retraining as a way of changing voice use

Question 29

Holistic Voice Therapy

Answer 29

direct approach
draws on all the other direct approaches and implements them sequentially or concurrently based on the patient’s most compelling needs to set the order of priority

Question 30

Consultation Model

Answer 30

providing the patient with information and allowing them to work on their own for the treatment of the voice disorder

Question 31

Clinical Surrogates

Answer 31

providing information and activity sheets to someone rather than the patient who is willing and able to implement them

Question 32

inservice programs

Answer 32

dissemination of information concerning the prevention of voice disorders to interested groups in a brief manner

Question 33

group workshops and mini-seminarys

Answer 33

typically provided through the university and hospital community and are similar inservices but only longer and more involved

Question 34

demonstrations

Answer 34

given in classrooms and lectures in universities by voice clinicians

Question 35

Prognostic Factors

Answer 35

1. Patient must recognize there is a problem
2. must be willing to follow a therapy plan involving regular practice periods as required
3. must be willing to give up abusive habits and to alter or eliminate some vocal use
4. Psychiatric problems may interfere with the ability to modify behavior
5. the voice disorder must be amenable to change through a voice therapy approach
6. Patients expectations must be considered
7. give full consideration to the patient’s laryngeal condition and general health status
8. SLP must have an adequate understanding of the problem, feel competent in it, and be able to establish a good relationship with the patient

Question 36

Guidelines for Voice Therapy

Answer 36

1. a simplified explanation of normal vocal physiology and of the patient’s specific deviance should be provided
2. Throughout therapy have the client verbalize perceptions of how the voice sounds and feels
3. the use of feedback is valuable to the patient in seeing change and providing the patient with models
4. Therapy should move gradually from one step or activity to the next
5. The clincian should always model a therapy task for the client
6. Record each session in while or in part
7. carefully instruct the patient in what to practice, for how long, and how often
8. a prognositc state should be made at the initiation of voice therapy
9. recognize that not all patients are candidates for voice therapy for reasons other than the nature of the pathology present
10. if the voice change persists for 2-3 wks, the individual should go seek a otolaryngologist is they haven’t yet

Question 37

Counseling in Voice Therapy

Answer 37

1. recieving information - should actively and nonjudmentally listen
2. giving information - involves the provision of information based on patient’s needs
3. clarifying - assist patient in perceiving mroe clearly and to deal more constructively
4. helping to change behavior - must do all of the above