Everything Flashcards
(27 cards)
Vocal Hygiene
- dehydration: increase water (64 oz/day, unless contraindicated), decrease diuretics/drying agents
- trauma by exogenous agent (smoking, fumes, drugs)
- trauma by endogenous agents (allergies, asthma, reflux)
- phonotrauma: vocal abuse, misuse, overuse
- throat clearing/coughing, hard glottal onsets, glottal fry
Sample goals for vocal hygiene
- patient will avoid vocally stressful/abusive situations for 2 weeks to promote short-term vocal fold recovery
- patient will reduce throat clear/coughs to less than 3 times in a 60 minute session
8 Principles of Voice therapy
- education
- life style/behavior modification
- relaxation work
- postural work
- breath work
- voice-production / shaping
- functional carryover
- counseling
McClosky progressive relaxation
- massage face
- stretch tongue
- passive movement of jaw
- massage anterior hyoid muscles
- massage strap muscles
- massage neck and shoulder muscles
Postural assessment
Plumb line: ear, shoulder, hip, knee, ankle
Breathing
- work on abdominal gentle breathing
rationale: voice disorders disrupt normal speech breathing behaviors (Hillman, Holmberg, Sperry)
PVFM
- it is not a disorder, it is a protective mechanism
- larynx closes off not allowing person to breathe in defensive mannerism
- need to train larynx control, desensitize patient to it
- RESCUE BREATHING
CNs and voice
- CN X: 2 branches
- palato-pharyngeal branch: palate and pharynx
- SLN: internal branch =sensation of larynx, external branch = CT motor
- RLN: motor to all intrinsic laryngeal muscles except CT
dysphonia
abnormal voice quality which can also involve pitch, loudness, and or flexibility
aphonia
absence of a definable vocal tone (whisper-like)
F0 norms male
100-150 Hz
F0 norm female
180-250 Hz
F0 norm children
250-275 Hz
Adducted and Non-adducted vocal hyperfunction
result of increased and poorly regulated laryngeal muscle tension
-can cause or contribute to formation of edema, nodules, polyps, contact granulomas, etc, or functional disorders (aphonia, vocal fatigue, puberphonia)
Non-adducted vocal hyperfunction
increased activity of laryngeal muscles that cause under-approximations of the VFs
- VFs are abnormally stiff, increased turbulent airflow so more breathy and strained
- may be aphonic
- no secondary trauma because NO collision forces
- vegetative function are NORMAL
Tx of non-adducted vocal hyperfunction
diagnosis confirmed via endoscopy with veg. fxn
- describe problem to patient (laryngeal muscle tension)
- provide cues of progression back to normal voice
- lay ground rules to be enforced: NO SIDE TALK, do exactly as i say, maintain certain criteria, teach how to get back from bad voice
- clinician tool box: cough, throat clear, laugh, gargle, cry, laryngeal massage, DAF, pulling tongue, etc
adducted hyperfunction
too much hyperfunction, vocal cords bang together from increased muscle tension
-sometimes is secondary/reactive hyperfunction in pts who compensate for anatomical/physiological deficits
treatment of adducted hyperfunction
- vocal hygiene
- vocal rest/modified voice rest
- vocal entrainment exercises (ee, ah, oo)
- voice therapy (Verdolini RVT) or VFE (stemple)
Vocal function exercises
- (Stemple)
- aim to retrain/balance laryngeal muscle activity and breath flow for hyperfunction and hypofunction
- also good for bowing
- specific exercises, daily routine
abductor SD
- often action induced
- inappropriate co-contraction of PCA muscles during speaking
- inappropriate breathy speech from vocal folds abducting
adductor SD
- abnormal involuntary contraction of TA muscle (vocalis) during speech
- straining or breaks in speech
SD treatment
- resistant to most txs including meds, surgery, VT
- best treatment currently is BOTOX injections
total laryngectomy
surgical excision of entire cartilaginous larynx
-epiglottis, hyoid bone, extrinsic strap muscles and all of larynx
electronic larynxes
trans-cervical
oral
tran-soral
