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Voice Disorders Dr. Cho > VD Test One Voice Assessments > Flashcards

VD Test One Voice Assessments Flashcards

1
Q

What does the American-Speech-Language Hearing Association (ASHA) Preferred Practice Patterns for the Profession of Speech-Language Pathology state:

A

All patients/clients with voice disorders must be examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician’s examination may occur before or after the voice evaluation by the clinician (p.99).

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2
Q

List the components of the Voice Evaluation (4).

A
  1. Background and history.
  2. Patient interview.
  3. Non-instrumental assessment.
  4. Instrumental assessment.
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3
Q

Name 2 components of a background and case history.

A
  1. Reasons for referral.

2. Medical record review.

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4
Q

Name 4 components to look at when looking at background and case history.

A
  1. Medical status
  2. Education
  3. Occupation and vocations
  4. Cultural and linguistic background
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5
Q

When can dysphonia occur?

A

Intermittently
OR
in a specific-situation

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6
Q

When can a voice problem begin? And what might be the associated conditions or circumstances in which a voice problem might begin.

A
  • Dysphonia can be “sudden onset dysphonia”

- “Sudden-onset dysphonia” might suggest a different etiology than slowly developing dysphonia.

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7
Q

What should you elicit from the patient when considering the what, how, and why of voice problems?

A

The patient’s thoughts about possible causes.

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8
Q

What are 2 questions you should ask yourself when considering the variability and consistency of a voice problem?

A

Has the voiced changed since the onset of problem, and how?

How does the voice change throughout the day, or under different conditions?

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9
Q

Where do you gather information about voice usage (2)?

A
  1. From interview with patient or family members.

2. From questionnaire filled out by patient prior to evaluation.

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10
Q

When considering description of voice usage what is important to focus on?

A

Potential vocal abuse/misuse/overuse.

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11
Q

When conducting a psychological screening, you will find that voice difficulties are often symptomatic of the inability to have?

A

Satisfactory interpersonal relationships.

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12
Q

During a psychological screening what should you look for signs of?

A

stress and anxiety

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13
Q

What are 2 components you should evaluate during psychological screening.

A
  1. coping mechanisms

2. social network

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14
Q

When conducting a non-instrumental assessment, what is being evaluated (2 things) with behavioral observation and screening?

A
  1. hearing

2. vision

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15
Q

List 2 examples of assessing without instruments.

A
  1. Auditory perceptual judgments.

2. Voice-related quality of life.

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16
Q

What does an auditory-perceptual assessment assess (6)?

A
  1. Pitch
  2. Loudness
  3. Voice quality
  4. Respiratory-phonatary control
  5. Resonance (oral and nasal)
  6. Overall severity
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17
Q

What is shimmer?

A

Short term variability in the amplitude.

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18
Q

What is jitter?

A

Short term variability in fundamental frequency.

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19
Q

What does abnormal voice quality define?

A

The presence or absence of a voice disorder clinically.

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20
Q

How are persons with an abnormal voice quality perceived?

A

More negatively than normal peers.

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21
Q

List the 4 distinct vocal qualities.

A
  1. Breathy
  2. Harsh-rough
  3. Hoarse
  4. Strained
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22
Q

Define “breathy”

A
  • Perceived as “whispery” or “airy”

- Associated with hypo-adduction (VFs don’t close enough)

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23
Q

Define “harsh-rough”

A
  • Perceived as “raspy”

- Associated with hyper-adduction

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24
Q

Define “hoarse”

A
  • Simultaneously “breathy” and “harsh-rough”

- Associated with compensatory hyper-adduction

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25
Q

Strained

A
  • Perceived as “choked” and or/effortful

- Associated with hyper-adduction

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26
Q

Define:

G = Grade

A

Overall severity or abnormality of the dysphonia

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27
Q

Define:

R = roughness

A

Psychoacoustic impression of irregular vocal fold vibration, represented by fluctuations in pitch and loudness

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28
Q

Define:

B = breathiness

A

Psychoacoustic impression of air leakage through the glottis, represented by presence of white noise

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29
Q

Define:

A = asthenia

A

Psychoacoustic impression of weak voice, lacking higher harmonics and showing instability in pitch and loudenss

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30
Q

Define:

S = strain

A

Psychoacoustic impression of effort and hyperfunction, excessive noise and elevated pitch

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31
Q

What does CAPE-V stand for?

A

The Consensus Auditory-Perceptual Evaluation of Voice

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32
Q

What organization developed the Cape-V?

A

ASHA SID 3: Voice and Voice Disorders (2002)

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33
Q

What technique does the CAPE-V use?

A

The Visual Analog Scaling technique

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34
Q

How does one score the CAPE-V?

A
  • Rater places a tick mark along each line.
  • Far left = normal
  • Far right = most deviant from normal
  • Then the tick mark location is measured and written in column on the right
  • There are 2 unlabeled lines, to add features not listed
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35
Q

On the CAPE V, what does “C” stand for?

A
  • consistent presence of a particular voice attribute

- the attribute was continuously present

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36
Q

On the CAPE V, what does “I” stand for?

A
  • intermittent presence of a particular voice attribute

- indicates that the attribute occurred inconsistently within or across tasks

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37
Q

On the CAPE V, what does overall mean?

A

integrated impression of voice deviance

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38
Q

On the CAPE V, what does roughness mean?

A

perceived irregularity in the voicing source

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39
Q

On the Cape V, what does breathiness mean?

A

audible air escape in the voice

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40
Q

On the Cape V, what does strain mean?

A

perception of excessive vocal effort (hyperfunction)

41
Q

On the Cape V, what does pitch mean?

A

perceptual correlate of fundamental frequency

42
Q

On the CAPE V, what does loudness mean?

A

perceptual correlate of sound intensity

43
Q

When considering voice related quality of life, what should you consider for your patient?

A

The impact dysphonia has on the quality of life. Including the individual’s perception of his or her illness.

44
Q

What is the voice handicap index?

A
  • A 30 item scale which contains one total score and three subscales: functional, physical, emotional.
  • Uses an equal-appearing interval scale.
45
Q

Name an example for a visual examination of the larynx.

A
  • stroboscopy
46
Q

List 3 instrument assessments for the the voice.

A
  1. acoustic analysis
  2. aerodynamic analysis
  3. phonatory respiratory efficiency analysis
47
Q

Name 2 examples of acoustic analysis.

A
  1. frequency related measures

2. intensity related measures

48
Q

What factors determine fundamental frequency?

A
  1. Vocal fold length
  2. vocal fold mass (thickness)
  3. tension
49
Q

What is the average fundamental frequency?

A

the average rate of vibration of the vocal folds expressed in Hz

50
Q

Name 3 examples of speaking tasks in assessment.

A
  1. isolated vowels
  2. reading
  3. connected speech
51
Q

What does an individual’s habitual pitch depend on?

A

age and gender

52
Q

What is the average Fo for children?

A

350 - 400 Hz

53
Q

What is the average Fo for an adult male?

A

120 Hz

54
Q

What is the average Fo for an adult female?

A

240 - 260 Hz

55
Q

What published “norm” information should a clinician use when making clinical judgements about voice?

A

Average Fo and Speaking Fundamental Frequency

56
Q

What is the frequency range for males 17 - 26?

A

80 - 764 Hz

57
Q

What is the frequency range for males 68 - 89?

A

85 - 394 Hz

58
Q

What is the frequency range for females 18 - 38?

A

140 - 1122 Hz

59
Q

What is the frequency range for females 35 - 70?

A

136 - 803 Hz

60
Q

What does frequency range vary by?

A

training

61
Q

What does vocal intensity correspond with?

A

acoustic power of the speaker (auditory perception of loudness)

62
Q

What is habitual loudness?

A

The average loudness level used by the speaker for the majority of his or her vocalizations.

63
Q

How is average/habitual intensity measured?

A

sound level meter

64
Q

What is intensity variability?

A

the range of intensities used in connected speech

65
Q

Normal voices have some intensity variability, how is this perceived by the listener?

A

Perceived by the listener as acceptable changes in intonation.

66
Q

In some dysphonic speakers what can happen to intensity?

A

Intensity can be either more or less variable than expected or tolerated by the listener.

67
Q

What can a dysphonic speakers’ loudness be perceived as?

A

Monoloudness because intensity can be either more or less variable than expected or tolerated by the listener.

68
Q

How is intensity variability measured?

A

in terms of the standard deviation (SD) from the average intensity

69
Q

What is the intensity level SD for a neutral, unemotional sentence

A

around 10dB

70
Q

What is vocal perturbation?

A

cycle to cycle variability in the vocal signal

71
Q

What is vocal perturbation aimed at?

A

identifying the short term, cycle to cycle non-volitional variablity

72
Q

What is typically extracted from connected speech for assessment since vocal perturbation is aimed at identifying the short term, cycle to cycle non-volitional variability?

A

sustained vowels or steady state portions of vowels

73
Q

What are the 2 vocal perturbation measures commonly obtained?

A

jitter and shimmer

74
Q

What is jitter?

A

the short term variability in fundamental frequency

75
Q

What is shimmer?

A

the short term variability in the amplitude

76
Q

What do lung volumes refer to?

A

the amount of air in the lungs at a given point in time and how much air is used for various purposes, including speech

77
Q

What do lung capacities combine?

A

various lung volumes

78
Q

Various air pressures are needed for speech. List all 3 kinds.

A
  1. pressure inside the lungs
  2. pressure below the vocal folds
  3. pressure inside the oral cavity
79
Q

What unit is used to measure air pressure?

A

Units of cmH20

80
Q

What is a possible total pressure that a person can generate?

A

over 50 cmH20

81
Q

What amount of air pressure is needed for conversational speech?

A

5 - 10 cm H20

82
Q

How is subglottal pressure estimated?

A

indirectly by measuring oral pressure during production of the closed portion of /pa/

83
Q

What is laryngeal airflow?

A

the volume of air passing through the glottis in a fixed period of time

84
Q

How is laryngeal airflow typically measured?

A

cubic centimeters (cc) or millimeters per second (mL)

85
Q

What is laryngeal/glottal resistance?

A

a measure derived from peak intraoral pressure and peak airflow during production of /pa/ repeated at a rate of approximately 1.5 syllables/second

86
Q

What is estimated from the /p/ portion of the syllable?

A

peak intraoral pressure

87
Q

What is estimated from the /a/ portion of the syllable?

A

peak airflow

88
Q

Assessment of laryngeal/glottal resistance helps compare what 2 types of voices?

A

breathy vs. strain strangled voice

89
Q

What is the durational measure: MPD?

A

Maximum Phonation Duration

90
Q

What is the durational measure: MPT?

A

Maximum Phonation Time

91
Q

Name an example of a durational measure.

A

s/z ratio

92
Q

What is maximum phonation time?

A
  • an indirect index of laryngeal airflow
  • it is the greatest length of time over which the /a/ vowel can be sustained at the patient’s most comfortable pitch and loudness following a maximal inhalation
93
Q

How many MPT trials are conducted? Which one is reported?

A

3 and the longest

94
Q

Name another indirect index of laryngeal airflow except for MPT?

A

s/z ratio

95
Q

How do you obtain an s/z ratio?

A

the clinician asks the patient to first sustain the /s/ as long as possible, and then to sustain the /z/ as long as possible, each at a normal pitch and loudness following a maximal inhalation

96
Q

What does the clinician usually do during the s/z ratio assessment? How is it measured?

A
  • clinician provides verbal encouragement

- the longest /s/ and longest /z/ from one of the three alternating /s, z/ trials is used to calculate the ratio

97
Q

What does the s/z ration of a normal subject approximate?

A

1.0 (60 secs) check this!

98
Q

A high s/z ratio is……?

A

above 1.4

Voice Disorders Dr. Cho (9 decks)

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