Voice notes

Question 1

What are SOFTEs

Answer 1

Semi occluded vocal tract excercises.
If these exercises are done in the right way, they should make your voice and throat feel
better, and your voice should sound better: smoother, clearer and more resonant, with ease.
Over time, these exercises should help your voice improve, and vocal effort should be reduced.
they are used as recovery excercises to help improve voice quality

Question 2

what is MPT

Answer 2

maximum phonation time

can be trainable. is a combined measure of of vocal and respiratory control (holding long a or e sound)

Question 3

questions to ask for case study

Answer 3

How does she communicate when working. Scream, speak loud at work?
How has her voice changed?
Do you work with groups of one on one?

Find out about ‘vocal load”
Voice use at home with kids and family.
Hobbies? How often do you go?
Singing warm-ups.
What exactly worries you. How does it impact you
Do yu have a mic for work when giving instructions? Music in the background not to shout.
Find out how she uses her voice every day. Des it add up to excessive vocal load.
Determine vocal load(handout) self-assessment.
Loud doesnt equal voice problems. Its when you start ramping up the effort thats when voice gets affected.
How to reduce vocal effort?

Question 4

what excercise could indicate a tight throat(muscles)

Answer 4

piggy snort. do a tiny piggy snort. if client cant it could be an indication of tight muscles in throat

Question 5

client case: husky/ breathy voice . no health concerns. no vocal load at work. had viral illness. what voice assessment tasks would shed light on vocal function

Answer 5

glottal stroke u-o - would give an indication of vocal fold function (paralysis). voice onset task. does the glottal initiation. if the client has an aspirated onset haho .
aaaooo, it sounds not like the sounds have a clear start. it sounds like that. a breathy onset. anything that doesn’t sound clear or sudden, it could indicate a vocal fold paralysis/ weakness or physiological fatigue.

voluntary cough - if vocal folds don’t close the cough sounds ineffective, air escaping. if they dont close it sounds like a huff. we want to hear a glottal plosive that indicates a closing of the folds.

a post viral flu/virus could indicate idiopathic (related to a disease)vocal fold paralysis. thats when it started.

Question 6

normal/average maximum phonation time.

when to use?

Answer 6

max phonation time - we would expect for a health adult to have 25-30 seconds(male) 15-25(female) and up normal (anything below could indicate vocal fold paralysis). gives an indication about vocal fold function.
often the first voice capabiity task. its quick and easy. (not useful for person with scratchy voice).
posibly indication of vocal fold paralysis.

Question 7

client case: muscle tension dysphonia (MTP+harsh voice thats effortful)) by ENT. lack of ability to project his voice. vocal fatigue. what needs assessing?

Answer 7

this often creates an overcompensating to work voice harder and harder to get their voice to the project.
this would show in a husky voice.
test voice loudness. ask client to call name and ask him to get louder every time. ask them how it feels and if it’s different then before. “calling out’ /oi/ stand on other side fo room and ask to call out. read rainbow passage out loud. and another passage louder again.

Question 8

if voice cant be projected it means:

Answer 8

they can’t speak loud. need to do tasks that make client increase voice volume.

Question 9

client case: crackly voice, ENT found nothing wrong. maximum phonation time is normal. what to do?

Answer 9

sounds like glottal fry. stimulability task to seeif it helps relieve the vocal fry. change their vocal fry behaviour. by giving instructions. ask them to imagine reading a story to kids and lift their voice with intonation to reduce the fry. test if any tasks can get them have a better voice.
ask them to pruce their happiest voice. NEEDS modelling so they can copy you. say” iagine going WOOOW. lift your voice and make it sound exited. see if they are able to find a way to reduce the glottal fry.

Question 10

loss of vocal range (maybe no high notes)

Answer 10

possible vocal fold swelling.

cant get low notes=vocal cords cant relax

Question 11

MPR vs MPT

Answer 11

maximum phonation time: a combined measure of respiratory and vocal control.

maximum phonation range: maximum pitch range, from highest down to the lowest note. the perceptual judgement of physical voice abilities. loss of high notes indication of vocal note swelling. looks at the ability of vocal folds to stretch and relax enough to get high and low pitches.

Question 12

what gives us an indication of what we assess first/ which vocal task?

Answer 12

the client case history comes first and gives an indication on the assessment that needs undertaking.

Question 13

Trial vocal excercises to test stimulability. what are possible tests?

Answer 13

SOVTEs, piggy nort (test for tension, how responsive are throat muscles), yawn (test for ossible sdwollenness if lower notes cant be reached.

Question 14

LPR- laryngopharyngeal reflux

Answer 14

is a condition in which acid that is made in the stomach travels up the esophagus (swallowing tube) and gets to the throat. Do some of the 3 throat checks (yawn, fry, snort), provide feedback and teaching.

Question 15

2. Voice problem

Answer 15

Voice assessment. Note the referral info, if client has seen ENT. Vocal hyperfunction? If you suspect LPR, complete RSI. Other symptom questionnaires as appropriate.
Assess severity of voice problem, and consider ease of vocal control, through stimulability testing/therapeutic probes
Depends on findings. Consider 3 throat checks.
LPR education.
Stimulability for SOVTEs or other facilitative techniques, exercises. Reduce vocal hyperfunction, but need to address cause of the problem if possible (ie, clinical reasoning again).

Question 16

3. Cough / throat clearing

Answer 16

Chronic cough assessment, or description of patterns, triggers. Observe in session. Consider RSI.
See Assessment of Chronic Cough revised 2018 page.
Use throat clearing flow chart if needed, to aid clinical decision making.
Education: awareness of cough triggers, key strategies to address chronic cough, including cough control breathing.
LPR education if appropriate. Consider mucus strategies handout.

Question 17

1. Swallowing difficulties
   a. Choking
   b. Throat tightness

Answer 17

Careful symptom description and/or questionnaires, clinical swallowing assessment if needed.
a. Really check what client means by “choking.” Eg is food or drink going down the wrong way, and do you cough and splutter automatically as a result?
b. Or is it a feeling of throat tightness or even an ‘obstruction,’ (+ see globus in [7] below), and is it hard to get the food/drink down because of this?
a) If you suspect aspiration, consider dysphagia and referral for VFSS. Conduct clinical swallowing eval.
Immediate education on safe swallowing strategies (eg handout), and possible dietary modification in the meantime, if indicated. Client must be SAFE.
b) If tightness in throat, consider Ax for LPR and possible PVFM. Consider checking throat muscle responsiveness (3 checks).
If you suspect PVFM, conduct appropriate assessment and teach the ‘emergency solution’ to sniff in quickly through the nose, if throat feels like it’s closing over.