Quiz 4 Flashcards
(20 cards)
What are the five voice therapy orientations?
- Hygienic voice therapy
- Symptomatic voice therapy
- Psychogenic voice therapy
- Physiologic voice therapy
- Eclectic voice therapy
What is Hygienic Voice Therapy?
- Concentrates on discovering the behavioral causes of the voice disorder and modification/elimination of the causes to improve the vocal condition and the voice quality.
– Organized and promoted by every voice text
– There is always a cause for a voice disorder; discover, modify/eliminate and the voice improves
– Weakness: The cause may no longer be the precipitating factor
What is the Hygienic Therapy Approach?
- General focus would be to identify the primary and secondary behavioral causes of the voice disorder and then to modify or eliminate these causes including:
1. Smoking
2. Laryngeal dehydration from poor hydration,
caffeine intake, and medications
3. Voice abuse such as talking loudly over noise at work, coughing, and throat clearing
4. Inhalation of large quantities of powder
What is Symptomatic Voice Therapy?
- Modification of deviant vocal symptoms such as
breathiness, inappropriate pitch, loudness, hard glottal attacks, and so on
– Organized and promoted by Daniel Boone in his text The Voice and Voice Therapy (1971)
– If the voice component is inappropriate, modify that
component
– Weakness: What is symptom/cause?
What is the Symptomatic Therapy Approach?
- General focus uses facilitating techniques to:
– Raise pitch
– Reduce loudness
– Reduce laryngeal area tension and effort
What is Psychogenic Voice Therapy?
Focus is on the emotional and psychosocial status of the patient that led to and maintained the voice disorder
– There is always a psychosocial reason for the behavior that led to the voice disorder; treat the psychosocial problem and the voice improves
– Weakness: Psychosocial contribution may be over stated
What is the Psychogenic Therapy Approach?
- General focus would explore the psychodynamics of the voice disorder including:
1. Detailed interview to determine the cause and effects of stress, tension, and depression
2. Determination of the exact relationship of emotional problems and voice problem
3. Counsel the patient regarding the effects of emotions on the voice problem
4. Direct reduction of musculoskeletal tension
5. Support of ongoing psychological counseling
What is Physiologic Voice Therapy?
- Based on expanded knowledge of vocal function as
evaluated through objective voice assessment - Strives to improve the balance among voice respiratory support, laryngeal muscle strength, control and stamina, and supraglottic modification of the laryngeal tone
- Promotes a healthy vocal fold cover
– Concentrates on the modification of the underlying
physiology of the voice producing mechanisms:
respiration, phonation, resonance
– Weakness: Does not account for behavior
What is the Physiologic Therapy Approach?
- General approach would be to evaluate the present physiologic condition of voice production and develop direct physical exercises or manipulations to improve that condition.
- The physiologic management program may include:
1. Vocal Function Exercises and Resonant Voice Therapy to improve laryngeal muscle control, strength, and stamina and to balance airflow, laryngeal muscle activity, and resonance
2. Hydration program and decrease in caffeine to improve lubrication
What is Eclectic Voice Therapy?
- Combination of any and all of the previous orientations to affect positive vocal change
- As voice pathologists, we should be aware of all
management approaches and use those which are most effective not only for the patient, but for the therapist as well.
Strategies for Hygienic Voice Therapy
- Vocal hygiene counseling involves:
– Identifying the abusive behaviors
– Describing the physiologic effects of those behaviors
on the voice production mechanisms
– Defining the specific occurrences
– Modifying or eliminating the behavior - Typical voice abuses/misuses:
– Shouting (eliminate)
– Loud talking (may be required, strategies)
– Screaming (ask me about the kid in my hood)
– Vocal noises (will change over time, modify)
– Coughing (needs medical work-up, may be a hypersensitivity issue)
– Throat clearing (eliminate with behavior modification approach)
Chronic Cough Syndrome
- Typical Presentation:
– Patient has coughed for months or years
– All medical testing has proven to be negative
– No medications are causing the cough (Lisinopril – ACE inhibitors, Less with AGII blockers, Advair) - In some cases, LPR is not an issue
- 30 million doctor visits to MD per year
- 10-20% have persistent idiopathic cough
- Laryngeal hypersensitivity caused by the cough causes coughing during:
- Forced inhalation
- Normal drainage
- Humidity changes
A cough begats a cough!! - Cough substitution
– Forceful swallow (Similar routine to chronic throat clearing)
– Hydration
– (Cold/Hot water can sometimes trigger the cough)
Summary of Vocal Hygiene Plan
- Identify the phonotrauma:
– Shouting
– Loud talking
– Vocal noises
– Throat clearing - Describe the effect:
– Utilize pictures, diagrams, drawings, and video.
* Do not hesitate to give simple explanations of anatomy and physiology to patient - Define specific occurrence:
– These will be distinctly different with every individual child.
– Psychodynamics of the behavior must also be described. - Modify the behavior:
– modify or eliminate vocal noises
– eliminate throat clearing
Symptomatic Voice Therapy: Strategies for Direct Symptom Modification
Major Components of Voice Production
– respiration
– phonation
– resonance
– pitch
– loudness
– rate
Any one of these components may be used
inefficiently necessitating direct modification.
The question remains; symptom or cause?
Symptomatic Voice Therapy: Direct Modification of Respiration
- Problem:
– Talking on end of airstream - Solution:
– Identify the problem - Ear training:
» use audio recorded samples
– Component modification:
– say as many numbers as possible on a normal
exhalation
– mark a paragraph with phrase markers
– audio record open discussion - Problem:
– shallow breathing - Solution:
– utilize a box diagram to describe breathing strategies
– book on stomach
– hands on chest and abdomen
– words, phrases, paragraph reading, conversation
Symptomatic Voice Therapy: Direct Modification of Phonation
- Problem:
– hard glottal attack - Solutions:
– initiate phonation with /h/ - vowels, vowel/consonants, words, phrases,
sentences, paragraphs, conversation - Problem:
– glottal fry phonation - Solution:
– train a slight increase in pitch and loudness - may use acoustic instrumentation for monitoring
speech output - Problem:
– breathy phonation - Solution:
– establish a more firm or engaged vocal fold approximation
– use more precise articulation
– increase vocal intensity
– exercise closure with glottal attack and pushing
Symptomatic Voice Therapy: Direct Modification of Functional Resonance Problems
- Functional resonance problems may include:
– hypernasality
– Hyponasality (denasality)
– tone focus problems
The presence of any anatomical causes must be ruled
out prior to the onset of behavioral therapy
Symptomatic Voice Therapy: Direct Modification of Functional Hypernasality
- articulation therapy
- Lower pitch and increase loudness modification
- non-speech phonation (animal, engine noises)
- articulation deep test
- do the obvious (denasality- using a “cold” voice explored for hypernasality)
- negative practice
- Instrumental biofeedback- nasometer
Symptomatic Voice Therapy: Direct Modification of Functional
Hyponasality
- utilize the normal nasal phonemes
- humming
- utilize hypernasal resonance
- non-speech phonation
- negative practice
What is the difference between hypernasality and hyponasality?
-Hypernasality—occurs when there is abnormal sound energy in the nasal cavity during production of voiced, oral sounds. Hypernasality is primarily a vowel phenomenon but can occur on other voiced sounds.
-Hyponasality—occurs when there is reduced nasal resonance or energy associated with nasal sounds, typically due to a blockage or an obstruction in the nasopharynx or nasal cavity or related to a neurological condition.
