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SLP Rx > Voice Rx > Flashcards

Voice Rx Flashcards

1
Q

Possible professionals to work with in voice?

A

ENT, GP, Dietician, Psychologist, gastroeneterologist

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2
Q

What are some PROMS for for Voice goals?

A 
VHI-10
PVHI
SVHI
RSI
CSI
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3
Q

VHI-10: norms

A

> 11 = disordered voice (Arffa et al 2012)

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4
Q

PVHI: norms

A

3-12 = not disordered

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5
Q

RSI: norms

A

> 15 90% chance of reflux (Belafsky et al 2002)

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6
Q

CSI: norms

A

> 3.23 is considered symptomatic for cough (Shembel et al, 2014)

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7
Q

Outcome measures for Voice goals?

A
  • PROMS
  • Perceptual analysis
  • Acoustic analysis
  • Endoscopy
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8
Q

What is Fo usually analysed from?

A

conversational speech

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9
Q

Norms for Fo?

A

Women: 199 mean,
Men 115 mean
(Leung et al 2020)

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10
Q

Norms for MPT?

A

Women 11-26secs
Men 11-28secs
(Goy et al 2013)
<10 is concerning according to Alisa

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11
Q

What is HNR analysed from?

A

MPT/prolonged vowel

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12
Q

HNR norms?

A

> 25 correlates with perceptually clear voice (Warhurst et al 2012)

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13
Q

How can we assist clients to deal with disordered voice?

A 
Provide information
Make suggestions for changing behaviour
Reorganise disordered voice
Compensate for the disordered voice
Consider client's and others perception of their voice
Consider related issues
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14
Q

Types of voice therapy?

A

Direct and Indirect

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15
Q

Direct therapy is….

A

Teaching client to use voice differently

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16
Q

Indirect therapy is…

A

making suggestions and providing advice and advocating re: voice hygiene, amplification, strategies etc

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17
Q

Considerations for voice management plans

A
  • direct vs indirect
  • further referrals required
  • information client needs
  • rx options and recovery prospects
  • child vs adult approaches
  • culture, ethnicity, gender
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18
Q

BS and F voice goals: nodules

A

Xs nodules will be reduced, demonstrated by an endoscopy conducted by the ENT by the end of the 8 week block of therapy

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19
Q

BS and F voice goals: VF closure

A

X will demonstrate improved VF closure as demonstrated by an increase MPT of … in the clinic after a 6 week block of therapy

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20
Q

Activity voice goal: auditory perceptual voice rating

A

X will demonstrate improvement in auditory-perceptual voice rating as measured by CAPE-V scores <10 for overall severity ( and other specifics) at the end of an 8 week block of therapy

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21
Q

Activity voice goals: improved vocal clarity

A

X will demonstrate improved vocal clarity as evidenced by an HNR score of >25dB or above on MPT in the clinic at the end of 8 week block of therapy

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22
Q

Participation Voice Goal: PVU

A

X will be able to undertake fulltime telephonist duties , with no deterioration in voice quality or stamina, measured by VHI-10 score of <11 at the end of 8 week therapy block.

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23
Q

Poor vocal hygiene examples

A 
shouting/screaming, 
talking loudly over noise, 
coughing/throat clearing, 
poor hydration
reduce caffeine, smoking, alcohol, drugs
manage reflux
check meds
sleep and good diet
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24
Q

Better alternative for throat clearing

A

yawn, sip water, forceful swallow, silect cough

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25
Q

Better alternative for yelling/cheering

A

gestures, whistle, amplification, ensuring in same room as person

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26
Q

Which organic voice disorders require surgery?

A

cysts
papillomas
carcinomas

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27
Q

Which organic voice disorders should be first treated with voice therapy?

A

nodules

polyps

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28
Q

SLP role pre voice surgery

A

provide info and support for procedure
teach voice technique for post op
support ENT recs and client’s best interests

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29
Q

SLP role after voice surgery

A
  • assist client to implement pliability exercises to assist - healing and follow post op recs
  • track recovery
  • make sure voice functioning optimally (minimise any compensatory behaviours)
  • watch/listen for scarring and refer to ENT if needed
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30
Q

Voice use time line after surgery

A
  • follow ENT guidelines
  • no speaking for 3-10 days for epithelium healing
  • 3 weeks for swelling to reduce
  • increase in voice use of 25-33% per week (depending on voice use e.g. teacher needs to be less)
  • restructuring of VFs can take up to a month
  • complete healing of VF depending on degree of invasion up to 6mo or 12mo for cordotomy3-6 weeks for healing of deeper layers
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31
Q

example Rx for respiration subsystem

A

marking paragraphs with phrase markers for when to breathe

32
Q

Example Rx for loudness

A

refer for hearing, raise awareness and use soundometer. LSVT.

33
Q

4 steps for psychogenic voice management

A
  1. medical evaluation to exclude pathology
  2. Diagnostic voice evaluation ( case hx etc)
  3. manipulation of voice
  4. probing cause of disorder (usually psychological - refer)
34
Q

Another term for psychogenic aphonia

A

functional aphonia/dysphonia

35
Q

What is psychogenic dysphonia?

A

psychological trauma causes dissociation and loss of conscious access to vocal function

36
Q

Rx for psychogenic dysphonia

A
  • reassurance
  • blame vocal mechanism e.g. for some reason your VFs are not closing all the way
  • produce voice using emotional vocalisation/airway protection (cough, laugh, mmhhhmm)
  • extend into speech similar to RVT with no time given for client to think (mm, me, more, more money)
37
Q

How soon can you expect improvement in psychogenic dyphonia with Rx?

A

Often dramatic changes within the first session

38
Q

What is puberphonia?

A

when voice doesn’t adapt to change in size at puberty (usually strained and tight and hoarse). may have gender role, maturity issues.

39
Q

Rx for puberphonia?

A
  • Lx examination to deternime normal mechanism
  • explain problem
  • direct vocal manipulation: produce hard glottal attack to break voice into lower register. Get client to repeat and shape into words and convo and extinguish hard glottal attack
  • manual lx reposturing: resisting elevation to lower pitch, fade cues
  • consider identity and voice exploration
40
Q

List some voice rx for Muscle tension dysphonia

A 
Yawn sigh
trill with sirening
SOVTes
VFE
RVT
OPT
41
Q

Explain process of yawn-sigh

A

yawn then shape into a sigh (without breathy onset h) Appreciate sensation. then pair with vowels and shape into words)

42
Q

What does yawn-sigh do?

A

reduces medial compression
lowers lx
increase perceptual awareness

43
Q

what does trill with sirening do?
instructions?
and what is it good for?

A

reduce medial compression
lengthen and shorted VF (increases range)
increases perceptual awareness

glide up and down then siren

post surgery

44
Q

What does straw phonation do?

A

reduce medial compression
increase closure of VP port
increase perceptual awareness

45
Q

which voice rx increases closure of VP port (improves hypernasality?

A

straw phonation

46
Q

what does RVT do?

A

reduces medial compression
raises larynx
increases perceptual awareness

47
Q

What does OPT do

A 
reduces medial compression
lowers lx?
assists VF approximation
lengthens VFs
increases muscular control
reduces vocal mass
increase perceptual awareness
48
Q

What do Stemples Vocal Function Exercises (VFE) do?

A

increase loudness
assists VF approximation
lengthen and shorten vf (increase range)
increase perceptual awareness

49
Q

Examples of SOVTes?

A 
nasals
lip and tongue trills
straw phonation
spooky ghost
fricatives /v/, /z/, /zhhh/, voiced th
50
Q

What is RVT?

A

voice production involving oral vibratory sensations, usually on anterior alveolar ridge or higher

51
Q

EBP for RVT

A

consistent results in improving voice quality and production (Yiu et a 2017)

52
Q

RVT process:

BTG and Stage 1:

A

Basic Training gesture: good posture, model breath and sigh with voice ‘molm’ drawing attention to vibrations in body, focus them to front of face and feel connection between abs and lips

  1. MOLM: with sustained pitch, varied rate, varied intensity and rate, using speech intonation with varied pitch, loudness and rate, chant /m/ heavy phrases on musical note then with over inflection
53
Q

RVT process: Stage 2 & 3

A
  1. VOICED/VOICELESS:
    - non-linguisitic phrases e.g. mamapapamamapapa with varied rate, varied intensity and rate, speech intonation. - chant voiced voiceless phrases e.g. my movie made Tim and Tom sad, and repeat with exaggerated intonation
  2. ANY PHRASE: repeat any 5-7 syllable phrase with
    - chanting
    - overinflection
54
Q

RVT process: stage 4 & 5

A
  1. PARAGRAPH with
    - phrasemarkers
    - exaggerated forward focus then normal
    - no phrase markers
  2. CLINIC CONVERSATION with no distractions
    (avoid glottal attack)
55
Q

RVT process: stage 6 & 7

A
  1. NATURALISTIC CONVERSATION

7. EMOTINALLY ENGAGING TOPICS IN CONVERSATION

56
Q

OPT process

A
  1. talk about clarity and effortlessness
  2. model and repeat aiming for clear and effortless, asking how it sounds and feels
    - breathe in and breathe out silently through mouth
    - repeat with added mmm (quiet with easy onset)
    - extend into words and phrases
    - smile if noisy
57
Q

Rx for Parkinson’s related voice issues

A

LSVT

58
Q

What is LSVT?

A

intensive rx that emphasises loud voice to improve respiratory support, articulation, facial expression and animation

59
Q

How often should LSVT sessions be

A

4 days per week for 4 weeks plus home practice

60
Q

Recommended voice treatment for reflux?

A

RVT

61
Q

Rx for VF paresis/paralysis

A

Surgery and VFE

Treat for hyperfunction with RVT if required after

62
Q

Rx for Hypoadduction

A

EMST

use of reflexive acts and increased energy to gain closure

63
Q

Rx for hyperadduction/MTD

A

RVT/OPT
posture adjustment
address underlying causes e.g. stress, reflux

64
Q

Rx for ataxic dysarthria

A

Reduce rate to provide more time to control and organise muscles

65
Q

RX for spasmodic dysphonia

A

RVT and Botox

66
Q

Which type of spasmodic dysphonia responds best to Botox?

A

adductor

67
Q

Rx for essential tremor

A

RVT/OPT/Yawnsigh

Botox (mixed success)

68
Q

rx for paradoxical VF movement

A
  • neuromodulators
  • anti reflux strategies and info
  • relaxation exercises
  • inhaling through nose with lips closed
  • RVT for MTD
  • quick sniff through nose during attack
69
Q

rx for chronic refractory cough

A

cough suppression techniques and education

70
Q

Discharge criteria for voice

A
  • symptoms gone- voice is meeting needs
  • cause is addressed
  • increased awareness of causal factors
  • Clinician judgement
  • Client choice
71
Q

Considerations for voice therapy for children

A
  • age appropriate reading passages
  • use different terminology e.g. monster vs hero voice, buzzy bee sound etc
  • rewards - extrinsic rewards use operant conditioning like Lidcombe program
72
Q

Considerations for PVU

A 
- time of work
workplace pressure
- higher level of anxiety
- reputation
- identity
- work cover requirements
73
Q

Rx for transgender M->F

A
  • elevate fundamental frequency (include coughing etc)
  • increase inflectional patterns, articulatory precision, rate
  • lengthen pauses
74
Q

Some side effects of radiotherapy

A 
Can get worse over time
xerostomia
oedema
muscle atrophy
(so many)
75
Q

Some side effects of chemo

A 
hair loss
taste issues
reduced appetite
nausea
reduced energy
mucosa damage
76
Q

a regression at 2-3 months post surgery could indicate what?

A

scarring

77
Q

Rx for loud children with roughness, loss of voice

A
  • discussion about voices in general to improve awareness
  • if I can’t see you I can’t hear you rule
  • Yell Well program
  • use of gestures for getting attention
  • instrument for cheering at sport

SLP Rx (6 decks)

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