Voice 46 questions Flashcards
What are the important sections or main inclusions in a voice assessment?
Case history Auditory perceptual evaluation Vocal capability testing Stimulability Provision of education/information Make recommendations
If a client can describe their voice problem well, and we get good referral information from an ENT, why do we need to do a clinical voice assessment? That is, what additional information does a clinical voice assessment give you, apart from client report/referral info?
As a trained professional, it is important to form your own judgements on the auditory perception of the voice
SP’s will assess for pitch, quality and loudness
Some of these may not be covered in the ENT’s report or in the description by the client
Assessment will allow investigation into the vocal load, and what the clients goals and long term outcomes are
With experience and training, an SP will be able to identify conditions that perhaps the client hasn’t realized are connected
Which voice Ax tasks require a maximal performance from the client, and which ones are just typical ones?
Maximal Phonation time
Maximal Phonation range
Reading of a balanced passage
Spontaneous speech – monologue or picture description task
What kinds of parameters are evaluated, in a perceptual voice evaluation, and what kinds of (published) tools or frameworks are most commonly used?
Pitch Loudness Quality All three Perceptual voice profile CAPE-V GRBAS Scale Client feedback Voice Handicap Index
Why might it be important to assess voice-related quality of life, and which (published) tools are most commonly used? How long do they each typically take to administer?
It is important to find out the impact the voice problem has on the individual within their own personal life. Some people might be happy to live with their voice disorder, it causes them minimal discomfort, while others rely on their voices for their livelihood.
For others again, having a voice that differs so much from the norm can make them feel highly self-conscious and unwilling to participate in many situations
Tools
Three Questions about your voice
Voice Handicap Index
Reflux symptom index
Glottal Function Index
Vocal Symptom Questionnaire
Voice Symptom Scale
Throat Discomfort Scale
Each should take no more than 10-15 minutes to administer
What are all the aspects of normal vocal function that we need to consider, in a clinical voice evaluation?
Pitch
Loudness
Quality
PITCH: How do you assess vocal pitch?
IE What parameters of pitch can you assess,
High and low pitch
Normal pitch
And how would you do that?
Maximal phonation range
Standard passage reading or monologue
What are some aspects of vocal pitch related to typical vocal function?
There will be fluctuations within normal speech, where the pitch of the voice will lower or raise, for example, the raising pitch at the end of the sentence when
LOUDNESS: How do you assess vocal loudness?
IE What aspects of vocal loudness can you assess,
Perception of how loud or how soft a voice is
It is related to the lung air pressure and degree of adduction
And how would you do that?
Perceptual ratings by the clinician
CAPE-V
GRBAS Scale
What aspects of vocal loudness are related to typical vocal function? (ie, what are typical expectations of vocal loudness and its control?)
There should be some variations in loudness during normal speech to indicate emphasis or emotion, and helps to convey meaning and importance to certain aspects of the content
The acoustics of the room, distance between speakers should be taken into account
What specific questions in a case history interview do you want answers to, about the voice problem itself? (ie, as opposed to background information). Sort your questions into subheadings and nest the more detailed questions under each. Depending on the answers you get, when would you ask even more detailed follow up questions?
Onset When did the problems start? Can you remember what you had been doing at the time? Since onset, has it always been the same, or does it fluctuate in severity? Provocation or palliation What makes the disorder worse? What makes the disorder better? When is it better/worse? Quality Can you rate the quality of your voice on a scale? GRBAS CAPE-V Voice Handicap Index Region and radiation Can you tell me where you feel the problem is? Does it remain in that one spot, or does it appear to move around? Severity Using a scale, how bad is the problem? Voice Handicap Index Three questions about your voice Can you describe your usually activities and how your voice problem affects your participation in these? Time How long has this been happening? Has it happened before? Have you had treatment before? What happened with this treatment? Do you feel it was successful? How long ago was this?
How would you give explanations and feedback to a client about some of the voice assessment tasks? How much detail would you go into
Use laymans terms
Avoid technical language
Provide them with some measurements, and write these down for a record for them. People like to have a reference point, to assess progress against
Explain the tasks, and demonstrate them also.
Use analogies or try to relate the tasks to real life, so people can see why they doing what they are doing. Especially as some of the tasks may make people feel silly.
I would go into as much detail as I felt the person wanted. I would judge by body language and responses if they were taking in the information at that time.
I would write it all down and provide the client with a report, for their reference and encourage them to ask questions about the content
Why might it be useful to assess maximum phonation time in a clinical voice evaluation?
MPT provides information on respiratory control
The ability to take in as much air as possible
The ability to slowly release this air
The ability to maintain lung air pressure is vital for controlled speech
MPT provides information on phonatory control
The ability to keep the voice stable when the lung volume is decreasing
What kinds of voice assessment tasks will give you information about vocal fold function per se? And how do they do that?
Standard passage reading Monologues Assess for Breathiness Audible air escape during phonation Incomplete adduction of vocal folds Strained Excessive vocal effort May be restricted to true vocal folds, but may include ventricular folds Rough Perceived as lack of clarity during speech Thought to be a result of irregular vibration Glottal fry Creaky quality of speech Tightly adducted vocal folds, free edges may be flaccid Falsetto High-pitched Perception of excessive air escape High-freq vibration, incomplete vf closure Phonation breaks Sudden, uncontrolled break of voice Sudden cessation of vibration Heard as moment of turbulent air escape with no voice Voice arrests Uncontrolled adduction of vocal folds During adductor spasm, might sound strangled or strained Glottal stroke “uh-oh” Coughing and throat clear
Why might you ask a client to yawn deliberately, in a voice assessment? IE, what in particular are you evaluating in this task and why? (ie, what is the significance or importance of this task? – and there might be a number of reasons.)
Yawning lowers the larynx, and allows for assessment of good laryngeal movement in the neck region
During MPR, it allows the individual to attain a deeper pitch, if the yawn is voiced
Yawning provides an internal throat stretch
Can highlight if muscles are very tight
In some voice assessments, we ask a client to cough deliberately. Why might we do this, and what aspects of the client’s response are we looking for? (ie, what is the significance or importance of this task?)
A cough results from tight closure of the vocal folds, a build up of air pressure, then a sudden release
A weak sounding cough might indicate poor vocal fold closure, resulting in poor air pressure build up
The cough reflex is important to remove foreign objects (food and fluid) from the airway to prevent aspiration
In stimulability for some voice therapy tasks or exercises, what are we specifically looking for? Give some examples.
Looking for the ability or the potential for the voice to achieve some progress.
They allow the SP to assess which therapy might be beneficial for the client and their individual goals
SOVTE’s are a good example. If a client comes to see the SP with a weak, fatigue sounding voice, the SOVTE’s can allow for some voicing to take place with minimal stress of the voice. It can sometimes provide immediate feedback or improvement.
What are some pitfalls or things to watch out for, in assessing maximum phonation time? When might you get possibly spurious results?
By changing the sound the individual makes, this can drastically alter the length of time produced eg ‘ee’
By changing the ‘loudness’ of the sound, this can alter the results
By changing the pitch of the sounds, this can alter the results
It should be a natural, non-excessive or stressful sound
