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Voice Intervention Flashcards

1
Q

Diagnoses and treats medical conditions, such as polys, and nodules

A

ENT (Otolaryngologist)

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2
Q

Videofluoroscopic imaging of the larynx, assessing laryngeal function

A

Radiologist

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3
Q

For psychologically rooted voice issues

A

Psychologist/psychiatrist

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4
Q

Addressing concerns with CV (cardiovascular) endurance and respiration

A

Physical therapist

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5
Q

Administer formal hearing tests to rule out hearing loss

A

Audiologist

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6
Q

Trains persons to use the vocal mechanism healthily, and to maximize voice potential

A

Voice coach

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7
Q

Treatment of pulmonary and respiratory conditions

A

Pulmonologist

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8
Q

What is the role of an SLP in the management of patients with voice disorders?

A

Provide voice intervention to enhance activity and participation.
Educate the patient about the nature of the disorder
Teach voice intervention procedures

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9
Q

What are the main approaches to voice treatment?

A
  • Medical (this is where ENTs’ come in–phonosurgery, pharmaceutical, radiation)
  • Environmental (modifying surroundings, adjusting to the vocal demands of environment/occupation)
  • Behavioral (symptomatic voice therapy–VFT’s, LSVT, etc.,)
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10
Q

What is the role of mucolytics

A

Thins mucus and relieves congestion, if the problem is respiratory based

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11
Q

What do the antacids do?

A

Specific for GERD and LPR concerns
On-demand medication (Gaviscon, TUMS, Kremil-S)
Proton Pump inhibitors → Omeprazole (prolonged reduction of acid production)

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12
Q

What are systemic steroids?

A

Methylprednisolone → inflammatory relief

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13
Q

True or False. Surgical treatment for benign laryngeal lesions only recommended after medical (pharmaceutical) and voice therapy failed

A

True

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14
Q

True or False. Surgery for the pediatric population should be avoided. Voice therapy is usually initiated at around 10-13 years old, when they exhibit adequate self control for behavior modification.

A

True

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15
Q

This is the surgical removal of the larynx, to prevent further metastasis of tumorous tissue, usually due to cancer. Patients are incapable of traditional voicing due to the absence of the voice box.

A

Laryngectomy

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16
Q

This is after the laryngectomy. It is a vibrating device placed on the neck to transmit vibration into the pharyngeal column. Serves as a substitute for the vocal folds in voice production.

A

Electrolarynx

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17
Q

What is a voice prosthesis valve?

A

This can be done after the laryngectomy
One way, silicone valve
Occludes the stoma to allow airflow through the pharynx

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18
Q

What is esophageal speech?

A

This is done after the laryngectomy
Learned technique by swallowing air
Air is injected to the esophagus
(+) Appropriate tension of pharyngeal walls
(+) Expiratory airflow from esophagus
= Sound

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19
Q

What usually happens when there is an acute onset conditions, caused by virus, bacteria, or single episode vocal abuse

A
  • Usually resolves spontaneously
  • Conserve voice use during recovery period → (1) vocal rest (2) reduced volume
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20
Q

What usually happens when there is a recurrent event of inflammatory changes

A

Consideration of tonsillectomy
Aggressive therapy of reflux
Pharmacologic

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21
Q

Medical management for reflux?

A

Avoid lying down immediately post meal
Elevate head while sleeping
Avoid throat clearing or coughing → clearing of throat and coughing will encourage the upward excursion of the acid from the stomach
Avoid the following foods: citrus juices, chili food (spicy), chocolate, carbonated beverages

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22
Q

What are voice facilitating approaches?

A

These are therapeutic techniques used by speech-language pathologists (SLPs) to help clients modify their vocal behaviors and improve voice disorders. These approaches are client-centered and aim to facilitate the production of a healthy voice by modifying various aspects of voice production, such as pitch, loudness, resonance, and phonation.

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23
Q

What is auditory feedback?

A

Patients who displayed a window of voice improvement during the evaluation session (such as when masking was used as a diagnostic probe resulting in an immediate improvement in voice) often benefit from the use of auditory feedback during therapy sessions.Regardless of the causal factor of the disorder (organic, neurogenic, or functional), the patient’s voice may improve with such feedback.

If patient is able to improve voice nung naririnig na nila sarili nila then it could be use as vocal technique

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24
Q

What is a confidential voice?

A

Using a soft, confidential voice as an alternative to hyperfunctional effortful voice. Similar to level II of “Loudness levels”

Hindi pabulong pero mahina

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25
Confidential voice is useful for
Reducing overall hyperfunction Affects breath control Slows down speaking rate Opens the airway
26
What is glottal fry?
Using glottal fry when speaking to **shorten thyroarytenoid muscles** and vocal ligaments → **reduces the rate of vocal fold vibration**
27
Glottal fry is useful for the following
- Nodules, polyps - Cord thickening - Spasmodic dysphonia - Ventricular phonation - Hyperfunctional behaviors
28
What is laryngeal massage?
Circumlaryngeal, manual therapy of the **thyroid cartilage** Aims to relieve stress, psychological conflict, and overall systemic tension Useful for: hyperfunction/excessive laryngeal tension, **usually following yawn-sigh**, as YS is shown to be more effective for relaxation
29
What is the gold standard therapy technique for relaxation?
Yawn sigh
30
What is nasal-glide stimulation?
**Usage of sonorants (m, n, l, r vowels) as these are easy to produce** (little to no obstruction of voiced energy in oral cavities) Facilitates better voicing patterns and **makes phonation easier** Useful for: functional dysphonia, spasmodic dysphonia, nodules, polyps, and other masses Continuous voicing = less turbulence
31
What is an open mouth approach? Useful for?
Encouraging more oral openness during speaking Promotes a **more optimum approximation of the vocal folds** Corrects problems of loudness, pitch, and quality Useful for **reducing strain** (vocal hyperfunction), often combined with other VFAs
32
What is relaxation?
Applying **systematic relaxation methods to influence the vocal tract** Despite not reducing actual stress, methods may relax components of the vocal tract instead Relaxation: a realistic responsiveness to the environment, with minimal energy expended (more energy = more tension so we want to promote minimal energy) Useful for **hyperfunctional behaviors/MTD** *Relax ka lang para mabawasan yung tension*
33
What is tongue protrusion? Used to?
**Produce /i/ with the tongue extended outside of the mouth**, with a higher pitch, or low falsetto Offsets the squeezing of the pharynx → directly **relaxes muscle strains under the chin** Useful for: ventricular phonation, strained voice, hyperfunctional behaviors, **Often used with glottal fry/yawn sigh**
34
This is the first line of intervention for relaxation before doing other relaxation techniques that may also help for hyperfunction
Yawn-sigh
35
What is yawn-sigh?
One of the **most effective therapy techniques for minimizing vocal hyperfunction** ,and lessening tension Larynx drops to a low position, tongue is more forward, and there is a **slight opening between the vocal folds** Useful for: any hyperfunction behaviors, polyps and nodules, spasmodic dysphonia, functional aphonia larynx low, tongue forward, slight open VF
36
What is the most effective therapy technique to reduce hyperfunction?
Yawn-sigh
37
Usually the first initiated treatment for hyperfunction behaviors, then combined with other “relaxers” to maximize effect.
Yawn-sigh
38
What is auditory/visual feedback?
**Immediate** auditory or visual feedback from **digitized instrumentation** (microphone and headphones, visual feedback through monitors)
39
The auditory/visual feedback is useful for:
Individuals who need and increased awareness of their vocal behaviors
40
What is masking?
Masking of auditory feedback that the patient receives during speech Shown to reveal “windows” of improved phonation for patients with functional dysphonia (poor real time of auditory monitoring) Nilalabuan ang aud feedback from patient para makita kung nagiimprove siya w/o monitoring own voice
41
Masking is useful for patients with
**Functional aphonia** → patients perform a lighter voice (masking helps patients to perform a lighter voice)
42
Focused on the direct explanation of the voice problem and its cause. Sometimes, this is enough to change the phonation style, or eliminate the misuse-abuse
Counseling
43
What are the elimination of abuses?
**Recognizing and eliminating abusive behaviors** to voice such as: yelling, screaming, speaking with a loud background noise, excessive coughing/throat clear, smoking, hard glottal attacks, cheerleading, etc.,
44
What is hierarchy analysis?
Centered around the anxious contexts that the patient engages in **Listing various situations** in a person’s life that produces **anxiety** Ordering them in sequential order Apply also to voice Makes the patient aware of **variations of voice depending on the situation** Paano ba niya iniiba ang pagbises niya base sa anxiety niya sa situation
45
Hierarchy analysis is useful for
* Gender transitioning care * Psychogenic/psychologically rooted concerns
46
What is respiration training? What bresthing pattern is encouraged?
Dedicated **training of breath support** by singing teachers or vocal coaches Patients with functional voice disorders, who are not vocal performers may also need only some instruction for **expiratory control** Emphasizing **diaphragmatic-abdominal breathing**
47
Respiration training is useful for
Patients with inadequate breath support
48
Modifying the actual function of the vocal folds during phonation
Modification of the phonatory and related behaviors
49
What is digital manipulation? What characteristic of people with MTD does it address?
This is useful for patients who have **problems with pitch** **Finger pressure on the thyroid cartilage** (Adam’s apple) Light placing of fingers on the thyroid to assess laryngeal vertical position → **Patients wil MTD had higher hyolaryngeal resting positions** compared to controls Useful to **lower the larynx ** along with the yawn-sigh method
50
Digital manipulation is useful for which issues?
Excessive laryngeal vertical movement UFVP
51
What is establishing a new pitch?
Creating and facilitating patient’s awareness and feedback of conversational pitch **Describing where the habitual pitch vs the target pitches are**
52
Establishing a new pitch is useful for
Additional **masses** that produce lower pitch levels Personality and psychological etiologies (**persistent falsetto**)
53
A good focus is “from the middle of the mouth” . Problems occur when the tongue is too far forward or too backward. This is useful for thin front voice, back voice, low in the throat voice, singers
Focus
54
What is head positioning? Useful for?
Placing the head during speaking in different positions in an attempt to find one that facilitates better voice. This is useful for **neurogenic diseases (UVFP), and functional aphonia** Identifying anong head position yung makakabigay ng better voice
55
What is inhalation phonation? It is useful for
Teaching the patient how to **phonate while inhaling** Alternating inhalation, and exhalation matched phonation Useful for: ventricular phonation, hyperfunction, functional aphonia
56
What are pitch inflections? It prevents?
Promoting pitch variations to **prevent monotony** Useful for: monotonic speaker, functional dysphonia (little to no pitch fluctuations) Often **combined with increasing loudness** (loudness + pitch for better prosody)
57
What is redirected phonation?
Searching for some kind of **vegetative phonations** (coughing, gargling, laughing, etc.,), intentional voicing (playing kazoo, humming, singing, etc.,) or saying “um-hmmm” sounds Useful for: functional aphonia → important to find any kind of vocal vibration to be the **first step in treatment** (if total functional aphonia, it is important to have redirected phonation)
58
This is total or limited inhibition of laryngeal usage. Restriction of the usage of voice for a specified period of time (4 days to 2 weeks). Avoidance of the following: speaking (except for modified voice rest→ 15 minutes), singing, humming, whispering, coughing, laughing, pushing, lifting
Vocal rest
59
What are the advantages of vocal rest?
Reduction in lesion size Avoidance of vocal abuse
60
What are the disadvantages of vocal rest?
Financially impractical Emotional and depressing
61
Specific treatment approach for PD and other neurological conditions. Focusing on calibrating the perceptions of individuals about how soft or loud they sound. This is the “think loud” “think shout”. Usage of voice in a “normal” loudness level
Lee Silverman Voice Treatment (LSVT)
62
What is the target goal for LSVT?
Target: **vocal loudness (amplitude)**. These strategies are consistent with the most effective, evidenced-based strategies for learning and neuroplasticity (the brain’s ability to change)
63
What is the mode for LSVT?
Intensive dosage and high effort
64
What is the calibration for LSVT?
Generalization
65
What are the environmental modifications to help improve voice?
- Humidification (reduce throat dryness) - Increasing water consumption → less throat irritation, modify viscosity of mucus secretions (thinner) - Amplification devices (microphones, lapels, etc.,)–establishing a normal level of pitch and loudness while still being participative in occupation

Catalyst (36 decks)

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