Voice therapy Flashcards
What is the primary aim of voice therapy?
To improve voice production and optimise function across impairment, activity, participation and wellbeing. Goals should be mutually agreed on, client-centred, measurable, functional, evidence-based and achievable
Main principles of voice function
Power-source-filter model
- Minimal noise, maximal harmonics
- Normal voice is balance/efficient in respiration, phonation and resonance
What leads to voice problems?
- Too much/inappropriate work in respiration, phonation or resonance
- Too great a ‘load’, more likely to injure
- Fatigue can cause us to be maladaptive
Purpose of voice assessment process
- Clear picture of impact of voice problem on person
- Profiles perceptual features
- Refutes/accepts working hypothesis of nature of voice problem
- Identifies whether further testing is necessary
- Identifies entry point for therapy
What is stroboscopy?
Seeing adduction/abduction of VFs as well as vibratory cycle
By the end of voice assessment we should know:
- Underlying laryngeal physiology for voice therapy
- Primary reason for impairment
- Contributing factors to development of VP
- Prognosis
- Key factors of behaviours to adapt
- Exercises that can achieve improved physiology/function
What is plasticity of voice ‘quality’?
The degree of improvement in deviant voice quality that can be achieved immediately or quasi-immediately by changing basic voicing conditions, posture, articulation or resonance, breathing mechanics, laryngeal position or auditory feedback
What is stimulability? voice
- An individual’s ability to modify a behaviour when provided with models/cues
- Eg. Might be stimulable for clear voice but might have a habitual voice posture
Normal voice relies on:
- Adequate respiratory support and control
- Glottic competence and dynamic control (quality/pitch/volume)
- Supraglottic competence and dynamic control
= power, source, filter/resonance
Normal vibratory characteristics, how normal voice quality is achieved
- Pliable SLLP
- Functioning ligamaent and thyroarytenoids
- Functioning intrinsic and extrinsic laryngeal muscles
- Normal mucosal waves, amplitudes symmetry, periodicity, proportionate open vs closed phases
We need to help
- Need to be able to control airflow subglottically
- Need to have control over shape and fluidity of supraglottis to optimise sound
- Length of vocal tract
Targeting voice therapy (2)
- Bring all diagnoses back to level of power/source/filter model
- Identify level of breakdown to target therapy
Features of mechanical voice disorders
- Muscle tension dysphonia = imbalance in tension
- Different categories of MTDs
- Hyperfunction more common than hypo
- All relate to inefficient laryngeal posturing
Common symptoms:
Hoarse, low, rough, breathy, strain, voice breaks, fatigue, inability to sing as before, worsens with stress, inconsistent, sometimes returns to normal short-term
Primary and secondary causes of muscle tension dysphonias
Primary
- No clear predominant organic cause
- Not detectable abnormality of the larynx
Secondary
- Abnormal patterns of muscle activation and coordination as a result of another underlying disorder
- Compensatory strategy
- VF atrophy
- VF paresis/paralysis
- VF lesion
Therapy outcomes are based on: (5)
- Accuracy of diagnosis
- Suitability of intervention to diagnosis
- Stimulability/plasticity for improvement
- Motivation/compliance/understanding of disorder and therapy requirements
- Therapist-client relationship
Impairment related goals and secondary goals/responsibilities
- Improve vocal endurance
- Improve throat comfort on voicing
- Improve voice quality/reliability
- Improve pitch and/or loudness
- Improve resonance
- Improve intelligibility/naturalness
Secondary
- Educate about voice production
- Reinforce that improvement can be achieved
- Advocacy
- Sourcing/recommending equipment
- Collection of treatment outcome data
