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SPH512 Part 2 - Voice and Fluency > What is a Voice Disorder / Anatomy > Flashcards

What is a Voice Disorder / Anatomy Flashcards

1
Q

What is the definition of a voice disorder?

ASHA

A

A voice disorder is characterised by the abnormal production and/or absences of vocal quality, pitch, loudness, resonance and/or duration, which is inapproprate for an individual’s age and/or sex.

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2
Q

What are some common symptoms of a voice disorder?

A

Hoarseness, Vocal fatigue, reduced pitch range, Breathy voice, Aphonia, Pitch Breaks, Strain/effort to produce voice, Tone instability, Pain

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3
Q

What are three (3) 3 classifications of Voice Disorder?

A

Organic, Neurologic, Functional

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4
Q

How many intrinsic muscles of the larynx are there, and what are they?

A

Adductors: Lateral Criciarytenoid , Transverse Arytenoid, Oblique Arytenoid

Abductors: Posterior Cricoarytenoid

Tensors: Cricithyroid and Thyroarytenoid (thyrovocalis)

Relaxer: Thyroarytenoid (thyromuscularis)

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5
Q

Name the only intrinsic laryngeal muscle that abducts the vocal folds.

A

Posterior Cricoarytenoid

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6
Q

Which layer of the vocal folds allows the muscosal wave pattern to occur?

A

Superficial Lamina Propria

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7
Q

When does someone have a voice disorder?

A

*When the voice deviates in pitch, loudness and/or quality from others of the same age and gender.
*When the voice doesn’t meet the person’s communication needs.
*When the voice draws attention to itself.
*When using the voice is effortful.
(Diane Bless, 2008).

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8
Q

What is an organic voice disorder (OVD)?

A

A structural change, for example a vocal fold pathology, lesions, growths (e.g. cancer)
(Aaronson / Colton, Casper and Leonard / Madill)

Baker includes Neurological (UMN/LMN) problems (e.g. Parkinsons) as SLP will only provide adjunct care, not main treatment.

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9
Q

What is Muscle Tension Voice Disorder (MTVD) (with/without organic change)?

[it is a subdivision within the functional voice disorder (FVD) classification].

A

“…a dysphonia that develops gradually as a result of disturbed psychological processses that lead to chronic patterns of misuse/dysfunction of the laryngeal musculature…over time these aberrant vocal behaviours may lead to the development of secondary organic changes, such as vocal nodules…”

(Baker, 2007, p. 102)

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10
Q

According to Baker (2007 what is Functional Voice Disorder (FVD)?

A

”..an aphonia or dysphonia where there is no organic pathology, or, if there is and it is either insufficient to account for the nature and severity of the voice disorder, or considered secondary to the functional problem.”

(Baker, 2007, p. 102)

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11
Q

According to Baker (2007) what is Psychogenic Voice Disorder (PVD)?

[it is a subdivision within the functional voice disorder (FVD) classification].

A

“…an aphonia or dysphonia that occurs as a result of disturbed psychological processes where ther is a sudden or intermittent loss of volitional control over the initiation and maintenance of phonation in the absence of structural or neurological phathology sufficient to account for the dysphonia. Symptom incongruity and reversability may be demonstrated, and psycho-social factors are often linked to onset. Whilst muscle tension patterns may be inferred or observed, such patterns are secondary to the psychological processes operating.”

(Baker, 2007, p. 102)

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12
Q

What is the classification system developed by Baker (et al.?) called, and what kind of classification system is it?

A
  1. Diagnostic Classification System for Voice Disorders (DCSVD).
  2. A ‘syndromal’ classification system. It includes terminologies, definitions, and likely symptoms that capture the essential nature of the disorder. Since aetiology of voice disorders not yet clearly established, classification is at a discriptive, syndromal level.
    (Baker, 2007, p. 102)
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13
Q

4 most common classifications of voice disorders?

Voicecraft slide

A
  • Functional: disorder
  • Neurogenic
  • Organic
  • Functional Neurological (AKA Psychogenic)
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14
Q

Voicecraft slide definition of Functional Voice disorder:

A

Disorder due to movement disorganisation or phonotrauma, e.g. Muscle tension dysphonia, Vocal nodules, Cyst, Polyp, Reinke’s oedema

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15
Q

Voicecraft slide definition of a Neurogenic voice disorder:

A

Disorder of neurological origin / dysfunction, e.g. Parkinson’s Disease, Vocal Fold Paralysis, Spasmodic Dysphonia, tremor

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16
Q

Voicecraft slide definition of an Organic voice disorder:

A

Pathophysiology of the vocal fold or surrounding areas, e.g. Leukoplakia, Cancer, Granuloma, Papilloma, Laryngitis, Varix, Web

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17
Q

Voicecraft slide definition of Functional Neurological (AKA Psychogenic) voice disorder?

A

Psychological trigger for vocal dysfunction, e.g. conversion disorder, puberphonia

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18
Q

What is Phonotrauma?

A

the repetitive and excessive nature of vocal chord vibration (the muscles hit each other). Can be caused by severe coughing, throat clearing etc. It can result in a FVD similar in terms of disorganisation of movement of vocal fold, with no mention of psychological impact.

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19
Q

What are 6 basics of assessing and treating voice disorders?

A
  1. Anatomy and Physiology
  2. Acoustics
  3. E3BP
  4. ICF (International Classification of functioning, disability and health)
  5. PML (Principles of Motor Learning)
  6. Quality of Evidence
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20
Q

How to manage clients with voice disorders:

A
  • Assessment
  • Diagnosis
  • Treatment plan - direct vs indirect therapy
  • Implementing treatment plan
  • Reassessment
  • Discharge
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21
Q

How much of a Speech Pathology caseload do voice disorders take up?

A

about 5%

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22
Q

Frequency of a sound wave is measured in cycles per second, or ____?

A

Hertz (Hz)

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23
Q

What property of a sound wave gives it it’s particular pitch?

A

Frequency

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24
Q

What determines the loudness of a sound?

A

Amplitude

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25
Q

What range of freqencies can a person with normal hearing hear?

A

20-20,000 Hz

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26
Q

The amplitude of a sound is determined by…?

A

Maximum displacement of air molecules, which leads to pressure fluctuations in the air,
which are expressed in units called decibel sound pressure level.

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27
Q

We can hear sounds from ___ decibel sound pressure level and tolerate sounds of up to ____ decibel sound pressure level.

A

0-120

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28
Q

Frequency of vibration of the vocal folds:

A

Fundamental frequency (Fo)

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29
Q

What are the principals of Motor learning (pre-practice)?

A
  • Motivation (goal setting, intrinsic vs extrinsic)
  • Instruction (whole vs part)
  • Modeling (expert, beginner, frequency)
  • Attempts (Freq)
  • Feedback (Freq, whole vs part)
30
Q

What are the principals of Motor learning (pre-practice)?

A
  • Motivation (goal setting, intrinsic vs extrinsic)
  • Instruction (whole vs part)
  • Modeling (expert, beginner, frequency)
  • Attempts (Freq)
  • Feedback (Freq, whole vs part)

McIlwaine et al., 2010

31
Q

What are the principals of Motor learning (Practice)?

A
  • Distributed practice
  • High rate of practice
  • Feedback on outcome, timing, random, not 100%
  • Target complexity (increase)

Maas et al. 2008

32
Q

What are the 4 levels of Evidence quality?

A 
I a) Systematic Review
  b) RCT
II Non RCT
III Experimental
IV Opinion/ Textbooks
33
Q

How do you know if someone has a voice disorder?

A

Assessment!

Look at the components: Power - source - Filter

How do they function?
Normal function or Disordered function?

34
Q

What does a multi-dimensional Assessment of voice consist of?

A
  • Subjective Measures
  • Self-report tools (screeners, PROMS)
  • Case Hx
  • Auditory-Perceptual Rating
  • Functional tasks
  • Visual imaging of larynx
  • Objective Measures
  • Acoustic analysis
  • Airflow
  • Electrophysiological
35
Q

Do the objective measures (Acoustic analysis, Airflow, Electrophysiological) measure symptoms or signs of voice disorder?

A

Signs

36
Q

Do the subjective measures of Self-report tools (screeners, PROMS) and Case history measure symptoms or signs of voice disorder?

A

Symptoms

37
Q

Do the Subjective measures of Auditory-Perceptual Rating, Functional tasks and Visual imaging of the larynx measure symptoms or signs of voice disorder?

A

Signs

38
Q

Does a Multi-dimensional assessment for voice disorders, using Subjective measures + Objective meaures address all parts of the ICF?

A

yes, it should

39
Q

What are PROMS?

A

Patient-Reported Outcome Measures.

Measure specific aspects of vocal function as reported by the client.

40
Q

What information should be collected during case history, and why is it important?

A

As much information about onset, co-occuring factors, background, medical history etc. The case history has been found to be highly predictive of diagnosis.
(need a ref).

41
Q

What does the (subjective measure) self-report tool ‘screener’ do?

A

Assess risk of voice disorders

42
Q

What does the (subjective measure) Functional assessment task do?

A

See what the voice is capable of (quality, pitch, volume) and more complex task (e.g. singing)

43
Q

What do electrophysiological tools measure?

A

Contact area of the vocal folds, lung volumes, and other things…

44
Q

What is a sign?

A

Can be observed or tested

e.g. “her voice is breathy” or “her pitch range is limited” or “He has an F0 of 71Hz (below normal limits)”.

45
Q

What is a symptom?

A 
A complaint made by the client:
"My throat feels dry", "It hurts", "I sound like an old woman", "My class can't hear me"
46
Q

Can something be both a sign and a symptom?

A

Yes - a client can report a breathy voice (symptom), but you can also hear it (sign).

47
Q

What is the difference between a sign and a symptom?

A

Signs can be observed by an external party, and can be tested.
Symptoms are a report by the client of what they feel, or what they think is going on… their interpretation.

48
Q

In the Cover-body theory (Hirano, 1974) what are the body, transition and cover?

A

Body: Vocalis Muscle

Transition: Lamina Propria (vocal ligament) - intermediate and deep layers

Cover: Epithelium and the superficial layer of the lamina propria (responsible for mucosal wave)

49
Q

Glandular tissue in the _______ secretes mucus onto the vocal folds for lubrication.

A

False vocal folds (Ventricular folds)

50
Q

What kind of skin cells form the outer layer of the vocal folds?

A

Stratified squamous epithelium.

51
Q

Which muscle forms the ‘body’ of the vocal folds, in cover-body theory? (Hirano, 1974).

A

Thyroarytenoid muscle

52
Q

What happens to the cover when the thyroarytenoid is lengthened?

A

It passively lengthens and becomes tighter and vibrates faster (and it becomes more flaccid and vibrates slower when the thyroarytenoid shortens). BUT abnormalities to the structure of the cover can impact this in a big way.

53
Q

How does the voice change? What 2 main adjustments of the larynx? What else?

A
  1. Medial compression
  2. Logitudinal tension
    +
    Variable air supply and resultant change in subglottic pressure
    =
    change in MASS, TENSION, LENGTH
54
Q

What are the 6 pairs of intrinsic muscles?

A

Abductors: Posterior Cricoarytenoid

Adductors: Transverse (not paired) and oblique arytenoids, Lateral Cricoarytenoid

Tensors: Cricothyroid, Thyroarytenoid (tensor/relaxer)

55
Q

What properties of the vocal folds that influence voice, change due to medial compression and longitudinal tension?

A

Mass
Tension
Length

56
Q

What do pitch and voice quality depend on?

A
  1. frequency of vocal fold vibration
  2. pattern/mode of vibration
  3. configuration of vocal tract
57
Q

What are the 3 types of voice onset?

A
  1. Breath before tone
  2. Simultaneous onset
  3. Glottal stroke / attack
58
Q

What percentage of the vibratory cycle at conversational intensity are the vocal folds open and closed?

A

Open phase - 50%

Closed phase - 13%

59
Q

Why do we need to recruit the extrinsic laryngeal muscles for extreme changes of pitch?

A

To brace the laryngeal cartilages in place, so that the very intense pull of the intrinsic laryngeal muscles enacts the movements of the cartilages relative to each other, rather than moving them as a whole.

60
Q

Which muscles mediate pitch change?

A

Cricothyroid
Thyroarytenoid
Posterior Cricoarytenoid
(extreme changes facilitated by extrinsic muscles)

61
Q

Increase in length = decrease in mass = increase in tension = increase pitch
True or false?

A

True

62
Q

How to increase vocal intensity?

A 
Increased closed phase
   \+
Increased medial compression
     =
INCREASED RESISTANCE
therefore increased subglottal pressure
(this may also increase vocal fold tension, which may increase the pitch as people get louder)
63
Q

Intensity ranges are frequency (pitch) dependant. Which pitches are percieved as quieter and which as louder?

A

Lower pitches are perceived as quieter than higher pitches.

64
Q

What are vocal registers?

A

Areas of vocal range with specific acoustic characteristics that are the result of a change in the vibration pattern of the vocal folds as they stretch and shorten.

65
Q

List 4 vocal registers:

A
  1. Glottal Fry
  2. Chest (Modal) voice
  3. Head voice
  4. Falsetto (loft register)
66
Q

Describe Glottal Fry

A

Lowest vocal register. Vocal folds are very short and flaccid and are vibrating very slowly (they almost ‘slap’ together).
Thyroarytenoid muscle is activated and cricothyroid is relaxed. Can be a symptom of a voice disorder.

67
Q

Describe Chest/Modal voice.

A

Vocal folds are slightly longer than for glottal fry, with a shorter closed phase. Most common voice quality used in speaking modalities. Can change the pitch without changing the vibration pattern for expressive intonation.
Thyroarytenoid muscle is activated, cricothyroid is relaxed.

68
Q

Describe Head voice:

A

Vocal folds lengthen and begin to stretch (more than chest voice) and vertical meeting area of the folds becomes thinner.
Thyroarytenoid relaxes to passively stretch as cricothyroid tilts the thyroid cartilage forwards. This thins and puts tension on the cover of the vocal fold. Closed phase less than in chest voice. Not as much volume or power.

69
Q

Describe falsetto (loft) register:

A

Technically, a sub-category of head voice.
Cricothyroid muscle dominates and thyroarytenoid is relaxed. Vocal folds are very stretched and may not even touch at all in the glottal cycle. The voice may be very breathy and tight, without much power.

70
Q

What are the 2 basic registers, within the vocal registers?

A
  1. Thyroarytenoid muscle is domiant and the Cricothyroid must relax.
  2. Cricothyroid is dominant and the thyroarytenoid must relax.

SPH512 Part 2 - Voice and Fluency (7 decks)

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