Assessment Flashcards
(42 cards)
What are the steps in the assessment process?
- Diagnostic interview - talking to the partner
- Auditory-perceptual assessment - evaluate how the voice sounds (subjective)
- Laryngeal imaging
- Acoustic/instrumental assessment
After all that -> diagnostic and therapeutic decisions
DIAGNOSTIC INTERVIEW- what are the elements for the paediatric population?
- Voice history
- Medical history
- Voice usage
- Family history
- Developmental information
- Child’s personal profile
PAEDIATRIC - What is part of voice history?
- Past and present symptoms
- Onset and duration
- Clinical course and variability
- Previous evaluations and treatments
PAEDIATRIC - What is part of medical history?
- Major illnesses
- Surgeries
- Accidents and injuries
- Allergies (swelling of the VF)
- Drugs/ medications (could be the allergy medication)
- Other relevant medical conditions
PAEDIATRIC - What is part of voice usage?
- Excessive loudness
- Voice strain/tension (ex. child using habitually high voice)
- Abusive habits (ex. throat clearing)
- Affective voice usage
PAEDIATRIC - What is part of family history?
- Familial diseases and conditions
- Family dynamics
- Environment
PAEDIATRIC - What is part of developmental information?
- Hearing history
- Gross and fine motor development
- Speech-language delays and disorders
- Cognitive development
PAEDIATRIC - What is part of child’s personal profile?
- Personality
- Social interaction patterns
- Personal habits and behaviours
- Personal stressors (ex. moving to a new school)
DIAGNOSTIC INTERVIEW- what are the elements for the adult population?
- Voice history
- Medical history
- Current health practices
- Family/work history
- Psychological considerations
ADULT - What is part of voice history?
- Symptoms
- Onset
- Duration
- Variability
- Progression of symptoms
- Previous evaluations, treatments, results
What are the levels of voice usage?
Level 1: Elite vocal performers
– Singers, actors
Level 2: Professional voice user
– Clergymen, public speakers
Level 3: Non-vocal professional
– Teachers, lawyers
Level 4: Non-vocal nonprofessional
– Labourers, clerks
ADULT - What is part of medical history?
- Major illnesses
- Surgeries
- Accidents or injuries
- Allergies
- Systemic diseases
ADULT - What is part of current health practices?
- Medications (ex. dehydrating ones like allergy medicine or psychotropic drugs)
- Recreational drugs
- Tobacco
- Alcohol
- Dietary patterns (ex. increased reflux due to diet - more cola, fries, etc.)
- Voice usage
- Stress management
ADULT - What is part of family and work history?
- Hereditary conditions (ex. any family members with voice disorders)
- Family dynamics and learning
- Major life changes
- Emotional reactions to illness
ADULT - What is part of psychological considerations?
- Psychological history
- Current stress levels
- Voice disability -> impact of the voice disorder on daily life
What is a final question you can ask in the diagnostic interview?
“Is there anything else we have not discussed that you feel is important?”
What is the Voice Handicap Index?
- A standard tool for the evaluation of the impact of voice disorders across different etiologies
Three factors:
– Emotional impact (10 questions)
– Functional impact (10 questions)
– Physical handicap (10 questions
My notes:
- Do the index before and after intervention
What are some things to look for in regard to the general appearance of the patient?
- Age and personal maturity
- Height and weight - abnormal thinness or obesity
- Facial expression (ex. seeing their facial muscles pop out due to tension in the face)
- Posture and walk
- Skin, hair and nails
- Personal hygiene and dress (tells you about their ability to take care of themselves)
What are the breathing types?
- Abdominal (can be seen and felt at the abdomen)
- Costal (lower lateral ribcage)
- Thoracic (chest)
- Clavicular (sternum/shoulders)
Abdominal or costo-abdominal breathing is believed to be the most physiological – or desirable - breathing type
What are the auditory signs of dyspnea (feeling like you can’t get enough air in)?
- Laboured breathing
- Stertor -> noise in the airway above the vocal folds
- Laryngeal stridor (upper airway)
- Wheezing – noise in the lower airway
What are the signs of musculoskeletal tension disorder (MTD)?
- Jaw jut (jaw is held too anteriorly)
- Head retraction
- Raised larynx
- Suprahyoidal tension
- Posterior “tension gap” between the vocal folds in endoscopy
What is temporomandibular joint dysfunction (TMJ)?
Often associated with musculoskeletal disorders or posture misalignment
Possible signs:
- Audible soft click or loud ‘crepitus’ on mouth opening
- Palpable TMJ click at the temple
Tactile evaluation…
- Abdominal palpation of breath support
- Palpation of TMJ
- Palpation of muscular tension in the suprahyoid region
- Palpation of muscular tension in the laryngeal region
- Encircling of the thyrohyoid space with thumb and middle finger indicates if this space has been reduced by laryngeal elevation; pain or marked discomfort suggest excessive musculoskeletal tension
What are the secretions?
- Hypersalivation (sialorrhea)
- Can lead to hydrophonia (gurgly voice) - Hyposalivation <more frequent
- Xerostomia (too little lubrication of the oral cavity -leading to dry larynx)
Oral secretions are usually a good indicator of the laryngeal secretions
