Lecture 2 Ax Flashcards
(85 cards)
1
Q
The assessment process (5 steps)
A
- Diagnostic interview
- auditory-perceptual assessment (evaluate how voice sounds)
- laryngeal imaging (cancer screen)
- acoustic/instrumental assessment (recording)
- diagnostic and therapeutic decisions
2
Q
“The science of the diagnostic interview…
A
is the knowledge base that guides the selection of questions and informs the interpretations of responses.”
3
Q
Elements of the pediatric voice history
A
- voice history
- medical history
- voice usage
- family history
- developmental information
- child’s personal profile
4
Q
Assessing voice history
A
- past and present symptoms (when does it happen)
- onset and duration
- clinical course and variability (of symptoms)
- previous evaluations and treatments
5
Q
Assessing child’s medical history
A
- major illnesses
- surgeries
- accidents and injuries
- allergies
- drugs/medications
- other relevant medical conditions (smoke exposure, asthma)
6
Q
What effect does an inhaler have on the vocal folds?
A
the inhaler is sometimes drying and may irritate vocal folds
7
Q
Assessing child voice usage
A
- excessive loudness
- voice strain/tension
- abusive habits (frequent talking)
- affective voice usage
8
Q
Assessing Family History (child)
A
- familial diseases and conditions
- family dynamics
- environment
9
Q
what impact do thyroid diseases have on voice?
A
may cause a dry larynx
10
Q
Assessing developmental information (child)
A
- hearing history
- gross and fine motor development
- speech-language delays and disorders
- cognitive development
11
Q
Assessing a child’s personal profile
A
- personality
- social interaction patterns
- personal habits and behaviours
- personal stressors
12
Q
5 Elements of the Adult Voice Assessment
A
- Voice history
- Medical history
- Current health practices
- Family/work history
- Psychological
13
Q
Assessing an adults voice history
A
- symptoms
- onset
- duration
- variability
- progression of symptoms
- previous evaluationns, treatments, results
14
Q
Levels of voice usage
A
Level 1: elite vocal performer (singers)
Level 2: professional voice user (public speaker)
Level 3: Non-vocal professional (teachers)
Level 4: Non-vocal nonprofessional (labourers, clerks)
15
Q
Assessing an adult’s medical history
A
- major illnesses
- sugeries
- accident or injuries
- allergies
- systemic diseases
16
Q
Assessing an adult’s current health practices
A
- medications
- recreational drugs
- tobacco
- alcohol
- dietary patterns
- voice usage
- stress management
17
Q
Assessing an adult’s family and work history
A
- hereditary conditions
- family dynamics and learning
- major life changes
- emotional reactions to illness
18
Q
psychological assessment on an adult
A
- psychological history
- current stress levels
- voice disability - impact of the voice disorder on daily life
19
Q
What to ask/do at the end of an assessment?
A
Ask if there is anything else you might have missed
20
Q
the voice handicap index
A
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)
21
Q
List some voice questionnaires (5)
A
- The Voice-Related Quality of Life Measure (VRQoL)
- Voice Activity and Participation Profile (VAPP)
- VocalTractDiscomfortScale(VTDS)
- VoiceSymptomScale(VoiSS)
- Transsexual Voice Questionnaire for Male-to-Female Transsexuals (TVQ-MtF)
22
Q
What parts of a patients general appearance should we note?
A
- Age and personal maturity
- Height and weight - abnormal thinness or obesity?
- Facial expression
- Posture and walk
- Skin, hair and nails
- Personal hygiene and dress
23
Q
Recall the 5 breathing types
A
- Abdominal (can be seen and felt at the abdomen)
- Costal (lower lateral ribcage)
- Thoracic (chest)
- Clavicular (sternum/ shoulders)
- Abdominal/costo-abdominal (most desirable - breathing type)
24
Q
Auditory signs of dyspnea
A
- Laboured breathing
- Stertor - noise in the airway above the vocal folds
- Laryngeal stridor
- Wheezing – rattling noise in the lower airway
25
Signs of musculoskeletal tension
1. "jaw jut" - anterior jaw slide
2. head retraction
3. raised larynx
4. suprhyoidal tension
5. posterior "tension gap" between the vocal folds in endoscopy
26
True or false: patients cannot acquire dysphonia
False
27
True or false: A patient can experience lingering voice symptoms due to a cold
True
28
Temporomanibular joint (TMJ) dysfunction
* 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
– Larger masseter;
– Pain in temporal or masseter area
29
Tactile evaluation (what to palpate on client)
1. Abdominal palpation of breath support
2. Palpation of TMJ
3. Palpation of muscular tension in the suprahyoid region
4. 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
30
True or false: laryngeal massage is used to reduce tension in the oral cavity
false
reduce tension in the larynx
31
Two types of secretions & result of each
1. hypersalivation (sialorrhea) - causes hydrophonia
2. hyposalivation - causes xerostomia
32
True or false: oral secretions indicate the laryngeal secretions
true
33
Olfactory evaluation
* Tobacco
* Alcohol
* Marijuana
* Excessive mouthwash or perfume to mask any of the above
* Personal hygiene
* Halitosis (bad breath): noted in gastroesophageal reflux, poor dental hygiene, fungal, and bacterial infections
34
Five types of registers
1. whistle
2. falsetto
3. modal
4. fry
5. whisper (unofficial)
35
What is a modal register?
- a speakers f0
- adduction of VFs
- interarytenoid adduction
- tension from thyroarytenoid muscles
- cricothyroid stretch
*check
36
What is falsetto register?
- more activation of cricothyroid muscle
- stretched vocal folds
- higher f0 *check
37
What is whistle register?
- high f0
- VFs vibrate anteriorly
- adduction so tight that vibration stops at the part of VFs that closest to the tip of the arytenoid
- anterior part of VFs is still open just open enough to produce sound
38
What is vocal fry?
- bubbly/gurgly
- short VFs
- prolonged closure phases; opens every second or third cycle - allows us to hear individual pulses
39
what is whisper register?
- posterior adduction of arytenoids helps to project voice
40
What is yodelling?
Use of voice register to create yodel
41
List the non-speech diagnostic voice tasks & name some tools
– Sustained phonation of /i/, /a/, /u/
– note quality, stability, and max duration
– Vocal range:
– Establishment of habitual pitch and loudness
– Highest and lowest pitch possible
– Loudest and softest volumes possible
– Quality of transitions from high to low (vocal register changes)
– Quality of transitions from soft to loud (like gear shifting)
Can use a phonetogram, PRAAT, piano key app
42
List the speech diagnostic voice task
– Examples of text passages
– Grandfather Passage, Rainbow Passage
– Semi-standardized speech samples
– Standard interview
– Description tasks (e.g., Cookie Theft picture, cartoon)
– Spontaneous speech
43
Describe the Vocal Profile Analysis (1991)
* Assessmentofthe whole vocal tract:
– lips
– mandible
– tongue tip
– tongue dorsum
– velopharynx
– phonation type
– laryngeal position
* Muscle tension
– vocal tract
– larynx
* Prosody
– pitch
– loudness
* Tempo
* Other
– denasality
– pharyngeal constriction
44
What is the RBH System? (1996)
Roughness: irregular, growl/grunt; 0-1-2-3
Breathiness: air leakage, aphonia; 0-1-2-3
Hoarseness: overall severity of the voice disorder; 0-1-2-3
(hoarseness + breathiness)
45
What is the GRBAS Scale? (1981)
* Grade: overall severity or abnormality of the voice; 0-1-2-3
* Roughness: vocal irregularity; 0-1-2-3
* Breathiness: air leakage; 0-1-2-3
* Asthenia: weakness; 0-1-2-3
* Strain: effort and hyperfunction; 0-1-2-3
Asthenia and Strain sometimes difficult to perceive, often omitted
46
*idk how to make this card*:
Prothetic continua are additive: Continuous scales such as visual analogue scales or direct magnitude estimates should be used
– Example loudness
* Metathetic continua are substitutive: Equal appearing interval scales can be used
– Example pitch
47
What is the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)? (2002)
- Combines previously reviewed rating scales, but dropped asthenia.
- rate severity, roughness, breathiness, strain, pitch, loudness (mild-severe)
- measure how many mm out of 100 were used
- indicate if it is constant, intermittent, inconsistent
48
How to evaluate a recording?
- listen in a quiet environment
- use good headphones (avoid gaming headphones with enhancements)
- switch off all sound enhancement in the computer (bass boost, equalizer presets)
- check your ratings with colleagues often to gauge consistency
49
True or false: When dysphonic voice samples were associated with Black speakers, experienced White SLPs ranked overall severity numerically slightly lower.
true
50
True or false: the time of day could influence your biases
true
51
List 6 measurement types to assess quality of voice
1. pulmonary function
2. neurophysiological
3. laryngeal imaging
4. vocal fold contact area
5. aerodynamic
6. acoustic
52
What do pulmonary function measures assess?
1. lung volumes (TV, IRV, ERV, VC)
2. forced spirometry (forced VC, flow volume loop)
3. respiratory movements (ribcage excursion, abdominal excursions)
53
What does Respitrace assess?
Assess contraction and expansion of lungs, movement in the chest and abdomen.
*seen in PT clinics, some SLP clinics
54
What is the (laryngeal) electromyography (EMG) used for?
For botox injection into thyroarytenoid muscle
To confirm if one or both VFs are paralyzed
Often used if patient has unilateral paralysis of VFs
55
What images are acquired through laryngeal imaging?
- Static images
- Dynamic images
56
List tools used to get dynamic laryngeal images.
- laryngeal mirror
- videoendoscopy
- cineradiography/videofluoroscopy
- high-speed videokymography
- ultrasound
- videostroboscopy
57
List tools used to get static laryngeal images.
- computerized tomography (CT) - bones
- magnetic resonance imaging (MRI) - soft tissue
58
How is mirror laryngoscopy conducted?
The ligaments connecting the tongue and the epiglottis control the position of the larynx
Pulling tongue forward and placing mirror deep into oral cavity to get clear view of larynx
59
How to position a flexible endoscope?
through nose, at back of pharynx pointing downward
60
How to position rigid endoscope?
90 degree scope: place inside at back of mouth
70 degree scope: place inside at back of mouth at an angle downwards
61
Videostroboscopy speed settings
running: slow-motion view of vocal folds
walking: even slower zipper-like motion
stop: stroboscopy flashes are locked to the fundamental frequency
62
Why is the stop phase of the videostroboscopy important?
important for examination because it indicates if the movement of the VFs is regular
63
Describe a complete glottal closure
- closure at anterior commissure
- closure at posterior commissure
- closure in between
- complete closure
- looking for symmetrical movement of the VFs
64
Describe a posterior gap (glottal closure)
- arytenoids aren’t closing; could be an incomplete closure or could be a normal variation.
- most commonly seen in female speakers; unsure why
65
Describe an anterior gap (glottal closure)
- open at anterior portion
- more common in male speakers because of the shape of the VFs
66
Describe an hourglass glottal closure
- caused by a lesion in VFs (in centre)
- VFs come together but don't allow for a complete closure due to lesion, creating an hourglass shape
67
Describe an incomplete glottal closure
- VFs not making complete contact for a full closure
68
Describe a bowed/spindle glottal closure
- bowing closure
- VFs are adducted at arytenoids
- VFs have lost muscle tone (degenerative diseases like Parkinsons)
- air flow blows the VFs apart causing breathiness
- can bring VFs together by speaking in a higher pitch; lengthening the VFs bring them closer together
69
Describe an irregular glottal closure
- VFs are out of sync
- can make them appear irregular and rough
- can somewhat close, but will be out of phase
- no complete closure
70
True or false: true vocal fold closure can trigger the closure of the ventricular folds
True
71
What is the mucosal wave?
- back and forward movement (zipper-like)
- inward and outward movement (medial/lateral movement)
- vertical movement (up and down movement)
72
What is a vertical level difference?
When the two arytenoids might be moving differently, which could cause irregularity or breathiness
VFs are not at the same level
73
True or false: supraglottic structures are used to dampen voice
false, used to exert voice
74
true or false: supraglottic activity during phonation could indicate hypoactivity
false, it could signal hyperactivity
75
When checking the vocal fold edge, look for:
- smoothness
- roughness/irregularities
- lesions
76
True or false: f0 and the mucosal wave have a direct relationship.
false, indirect.
when f0 increases, mucosal wave decreases (faster vibration, narrow movement)
77
true or false: loudness and the mucosal wave have a direct relationship
true, a stronger collision creates a louder voice
78
What is a digital videokymography?
high-speed imaging technique includes pictures of series of opening and closing for the SLP and ENT to analyze any irregularities
79
Qualities of good speech recording
- 16 bit signal with 44.1 kHz freq
- good mic at 10-15cm distance from mouth
mic at 45 degree angle
80
what is a quiet recording
does not fill the software window (low amp)
81
what is an overdriven recording
sound signals beyond software window (high amp)
82
What is the KAy Multi-Dimensional Voice Profile (MDVP)
voice diagram (circle plot)
marks if voice is within normal range
shows you vibratory cycle, pitch
83
the dysphonia severity index
calculated weight of:
- Maximum phonation time in s (MPT)
- Highest frequency in Hz (F0-High)
- Lowest intensity in dB (I-low)
- Jitter in %
results: -5 is severe, +5 is normal
84
acoustic index of dysphonia severity
7 point severity scale
for sustained /a/
85
face masks and acoustic analysis
dampening between 3-5 kHz depending on mask type
voice range profile unaffected by mask, but spectral changes
