SPHP 123 Exam #3 Flashcards
(241 cards)
1
Q
Define Anatomical Position
A
Body facing the observer, eyes front, arms at side, palms of hands and tips of feet forward.
2
Q
Posterior/Dorsal
A
Towards the back
3
Q
Anterior/Ventral
A
Towards the front
4
Q
Caudal
A
Toward the tale
5
Q
Rostral/Cranial
A
Toward the head
6
Q
Contralateral
A
Opposite side
7
Q
Ipsilateral
A
Same side
8
Q
Superficial
A
Near the outer surface
9
Q
Deep
A
Toward the center
10
Q
Superior
A
Upper
11
Q
Inferior
A
Lower
12
Q
External
A
Toward the outer surface
13
Q
Internal
A
Toward the inner surface
14
Q
Medial
A
Toward midline
15
Q
Lateral
A
Away from midline
16
Q
Proximal
A
Toward root of a free extremity
17
Q
Distal
A
Away from root of a free extremity
18
Q
Central
A
At the center
19
Q
Peripheral
A
At outer edge
20
Q
Abduction
A
Limb moving away from central axis
EX: Vocal folds opening
21
Q
Adduction
A
Limb moving toward central axis
EX: Vocal folds closing
22
Q
Extension
A
Straightening of a limb or lengthening of a muscle
23
Q
Flexion
A
Bending of a limb or shortening of a muscle
24
Q
Frontal-Coronal
A
Separates the anterior from the posterior
25
Sagittal
Separates the left from the right
26
Transverse
Separates the superior from the inferior
27
Motor-Source
1. Lungs
2. Muscles of breathing
3. Breathe support
28
Vibratory-Source
1. Larynx
| 2. Intrinsic & Extrinsic muscles
29
Resonator-Source
1. Laryngopharynx
2. Oropharynx
3. Nasopharynx
4. Mouth
5. Lips
6. Tongue
* *All shape sound
30
Nasopharynx
Higher portion of the pharynx
31
Oropharynx
Lies behind oral cavity
| **Closes airway when swallowing
32
Laryngopharynx
Part of the throat that connects to the esophagus
33
Respiration sequence?
1. Enters through nose/mouth
2. Then goes to nasopharynx/oropharnx
3. Then down to larynx
4. Then down to trachea
5. Then splits into right and left main bronchii
6. Then into secondary bronchii: 3 on right, 2 on left
7. Secondary bronchii divides into tertiary bronchii
8. Then divides into terminal bronchioles
9. Then to the alveoli
34
Upper respiratory tract
Larynx and above
35
Lower respiratory tract
Below the level of the larynx
36
Trachea
1. 16-20 hyaline cartilage rings
| 2. Posterior is open & surface is in direct contact with esophagus
37
Laryngectomy
Hole punctured between posterior wall of trachea and anterior wall of esophagus
38
Tracheostomy
1. Hole punctured on anterior wall of trachea
| 2. Between rings 3 & 4
39
How many divisions of the bronchial tree?
24
40
What happens when there is fewer cartilaginous rings and more muscle?
Smooth muscle can contract, then have bronchial spasms and possibly asthma.
41
How are the lungs attached to the walls of the chest cavity?
At the root and mediastinum
42
Pleura
Serous membrane that encases the lungs
* *Lines the chest cavity
* * Lines the thoracic cavity
43
What holds the lung against the thoracic cavity?
A vacuum like seal
44
What will happen if one of the pleura cavities gets punctured?
The lung in the cavity will deflate
45
Without the pleura vacuum holding the lung to the chest wall, what will happen?
The alveoli in the lung deflates
46
What happens if one lung is punctured?
The other needs to remain inflated for air exchange to take place
47
Total Capacity
Amount of air that can be held in the lungs after max inspiration
48
When a person is out of shape what happens?
The size, elasticity, and capacity of alveoli changes
49
Tidal Volume
Amount of air inhaled or exhaled during a single breath cycle
**340 cc- Women; 750 cc= Men
EX: Quiet breathing, watching TV
50
Inspiratory Reserve Volume
Max amount of air that we can inspire beyond tidal volume
| **1500-2000 cc
51
Expiratory Reserve Volume
Volume of air in the lungs at then of a normal tidal expiration
**1500-2000 cc
52
Vital Capacity
Amount of air that can be exhaled after the deepest inhalation you can take.
**TV+IRV+ERV= Vital Capacity
53
Residual Volume
- Always in lungs
- Not released in life
- Purpose is to keep lungs partially inflated otherwise alveoli would collapse
54
Whats the primary muscle of breathing?
Diaphragm
55
What does the diaphragm do?
1. Works on inhalation/exhalation of tidal volume
2. Contracts and pulls down, lungs lengthen, because of vacuum adhesion between the pleurae
3. The viscera slide down & compress
* *Does not move much at all
56
What system controls the diaphragm?
Autonomic Nervous System
| **Works while we are asleep
57
Whats the origin of the diaphragm?
Lower border on medial surface of the xiphoid process.
58
Whats the 2nd most important muscle of forced inhalation?
External Intercostals
59
How many intercostals are there?
11
60
External Intercostals
Contraction raises the ribs and slightly twists them medially
61
Internal Intercostals
1. Important for forced exhalation
2. Antagonists to external intercostals
3. 11 of them; course downward & laterally from sternum
4. Contraction lowers ribs and forcefully exhales the extra Expiratory Reserve Volume
5. Ribs want to untwist and go back to resting position
62
Transverse Abdominus Muscle or Transversalis
1. Fibers transverse across abdomen
| 2. Deepest abdominal muscles
63
External/Descending Oblique Muscle
Largest and most superficial of the abdominal muscles
64
Rectus Abdominus Muscles
1. Six pack muscle
2. Long/flat muscle that extends the whole length of the front of the abdomen
3. Has 3 tendinous intersections called lineae transverse
65
What is the role of the abdominal muscles?
Breathing
66
What happens when the pelvis and spine are fixed?
External & internal oblique muscles compress lower part of thorax, which pulls the ribs down and assisting in expiration.
67
What happens when the pelvis and thorax are fixed?
Abdominal muscles compress the abdominal viscera by constricting the cavity of abdomen; can help raise air pressure to the lungs.
68
What happens if you were to hold the abdominal muscles rigid?
You allow the diaphragm to move upward on it's path to relaxation, releasing air without raising air pressure substantially.
69
What are the muscles of breath support?
1. Rectus Abdominus
2. Transverse Abdominus
3. Internal Oblique
70
What are the three types of cartilage?
1. Hyaline
2. Fibrous
3. Elastic
71
Where is hyaline cartilage found?
- On the end of bones
- The costal cartilages
- Composes the nasal septum, bronchial and tracheal rings
72
Where is fibrous cartilage found?
- In spinal column
| - In some joints and ligaments
73
Where is elastic cartilage found?
- External ear
- Ear canal
- Epiglottis
- Small cartilages of larynx
74
What is a joint?
- Connections between bones & cartilages of larynx
- Muscles attach at and across joints
- No joint, no movement
75
What are the three types of joints?
1. Synarthrodial
2. Amphiarthrodial
3. Synovial
76
What is a synarthrodial joint?
-Immovable joint of fibrous connective tissue
-Joins structures firmly
EX: Skull & Palate
77
What is a amphiarthrodial joint?
- Yielding joint
- Slightly movable
- Found between vertebraes
- Found in mandibular symphsis
78
What is a synovial joint?
-Freely movable joint
79
What is synovial fluid?
A fluid that is continuously secreted as a protective mechanism
80
What are the 6 types of synovial joints?
1. Plane or gliding joint (ribs & vertebrae)
2. Ginglymus joint (Elbow & Knee)
3. Pivot joint (1st CV & 2nd CV pivot W/ skull & neck)
4. Condyloid joint (Where mandible attaches to skull)
5. Saddle joint (Thumb & Arytenoids)
6. Ball and socket joint (Shoulder & hip)
81
What are the three functions of the larynx?
1. Protection for airway (Biological)
2. Acts as a valve to prevent air from leaving the lungs, builds abdominal pressure & gives the torso more rigidity for lifting, coughing, voiding, vomiting
(Biological)
3. Voice (Non biological)
82
What are the 9 cartilages of the larynx?
1. Epiglottis
2. Thyroid
3. Cricoid
4. 2 Arytenoid
5. 2 Corniculate
6. 2 Cuneiform
83
What is the 1 bone of the larynx?
Hyoid Bone
84
What is the primary function of the epiglottis?
1. Protection of airway
2. Covers airway while swallowing
3. Made up of elastic cartilage
85
What is unique about the hyoid bone?
1. It is not attached to any other bone in the body
| 2. Supports the rough of the tongue
86
Thyroid Cartilage
1. Largest of laryngeal cartilage
| 2. Landmark= thyroid notch
87
Cricoid Cartilage
1. Foundation of larynx
2. Made up of hyaline cartilage
3. Sits on top of trachea
4. Great range of motion
88
2 Arytenoid Cartilages
1. Has 4 surfaces( posterior, medial, anterolateral, concave base)
2. A lot of influence on vocal folds
89
2 Corniculate Cartilages
Horn/cone shaped elastic cartilages
90
2 Cuneiform Cartilages
1. Covered with mucous membrane, fat & connective tissue
| 2. Either prominent/missing in people
91
What are the joints of the laryngeal cartilages?
1. Cricoarytenoid joints
| 2. Cricothyroid joints
92
What are the laryngeal membranes & ligaments
1. Extrinsic membranes
| 2. Intrinsic laryngeal ligaments
93
Spaces in the larynx?
1. Glottis: Space between vocal folds
2. Subglottal: Below trachea
3. , Vestibule: Extends from false folds to aditus laryngis (triangular space)
4. Anterior Commissure: True folds attach at the anterior of the thyroid cartilage
5. Posterior Commissure: True folds attach to anterolateral surfaces of arytenoids
94
What are the 2 major categories of the muscles of the larynx?
1. Extrinsic
| 2. Intrinsic
95
What does the extrinsic muscle do?
Raises and lowers the larynx
96
What does the intrinsic muscle do?
Controls pitch & loudness & quality of voice
97
What are the 2 groups of extrinsic muscles?
1. Suprahyoids (Elevators)
| 2. Infrahyoids (Depressors)
98
What are the 4 suprahyoid muscles?
1. Digastric
2. Mylohyoid
3. Stylohyoid
4. Geniohyoid
99
What are the 4 infrahyoid muscles?
1. Sternohyoid
2. Omohyoid
3. Thyrohyoid
4. Sternothyroid
100
What does the anterior digastric do? (SH)
Pulls hyoid bone forward & raises it
101
What does the posterior digastric do? (SH)
Pulls hyoid bone backward & raises it
102
What does the mylohyoid do? (SH)
Raises hyoid bone & pulls it forward
103
What does the stylohyoid do? (SH)
1. Raises hyoid bone & pulls it backward
| 2. Elevates & retracts hyoid & larynx
104
What does the geniohyoid do? (SH)
Raises hyoid bone & pulls it backward
105
What does the sternohyoid do? (IH)
On contraction lowers hyoid cartilage
106
What does the omohyoid do? (IH)
On contraction pulls hyoid lower
107
What does the thyrohyoid do? (IH)
On contraction raises larynx & decreases distance between thyroid & hyoid
108
What does the Sternothyroid do? (IH)
On contraction depresses thyroid cartilage
109
What are 2 things that the intrinsic muscles do to the vocal folds?
1. Abducts: Opens vocal folds
| 2. Adducts: Closes vocal folds
110
What are the 5 intrinsic muscles of the larynx?
1. Thyroarytenoid muscle
2. Posterior cricoarytenoid muscle
3. Lateral cricoarytenoid muscle
4. Interarytenoid muscle
5. Circothyroid muscle
111
What does the thyroarytenoid muscle do?
- Adductor
- Tensor
- Relaxer
- Lowers, shortens, thickens, stiffens vocal fold
112
What does the posterior cricoarytenoid muscle do?
-Only abductor
-Protects airway
-Elevates, elongates, thins, stiffens vocal folds
(Involved in breathing)
113
What does the lateral cricoarytenoid muscle do?
-Antagonist to posterior cricoarytenoid muscle (PMC)
-Lowers, elongates, thins, stiffens vocal folds
-Adductor
-Relaxer
(Affects whisper)
114
What does the interarytenoid muscle do?
- Adductor
- Mediating compression of vocal folds
- Depress epiglottis during swallowing
115
What are the 2 parts of the interarytenoid muscle?
1. oblique
| 2. Transverse
116
What does the cricothyroid muscle do?
-Tenses
-Elongates, lowers, stretches, stiffens vocal folds
(Helps increase pitch)
117
What muscles are the 2 adductors of the VF of the larynx?
1. Interarytenoid muscle
| 2. Lateral cricoarytenoid muscle
118
What muscle abducts the VF of the larynx?
Posterior cricoarytenoids muscle
119
What muscles are the glottal tensors of the larynx?
1. Cricothyroid muscle
| 2. Thyroarytenoids muscle (Thyromuscularis & Thyrovocalis)
120
What muscles are the glottal relaxers of the larynx?
1. Thyroarytenoids muscle
| 2. Lateral Cricoarytenoids muscle
121
What is mucosa?
- Part of the structure of the VF
| - Divided into epithelium & lamina propria
122
What 3 layers is lamina propria divided into?
1. Superficial layer (Loose & pliant)
2. Intermediate layer (Elastic fibers)
3. Deep layer (Dense; collagenous fibers)
123
What is epithelium?
- Epithelium & superficial layer (Reinke's space) of lamina propria is the "cover"
- Most lesions occur here
124
What is vocal ligament?
Made up of intermediate & deep layers of lamina propria
125
What is glottis?
- Space between the VF's
- Midpoint is where glottal space is widest during abduction & max. impact when folds close during adduction (lesions called nodules occur).
126
What muscle forms the body of the vocal folds?
Thyroidarytenoid muscle
127
What does the laryngeal wave consists of?
The fundamental frequency
128
What is fundamental frequency?
Rate of fold vibration perceived as pitch & harmonics
129
Rate of vibration depends on what?
- Length of the folds
- Mass of the folds
- Tension of the folds
130
Myoelastic-aerodynamic theory of phonation (Theory of Phonation)
- Muscular forces adduct folds, creating midline compression
- Exhaled air create subglottal pressure to overcome medial compression & displace VF's, creating airflow through folds(aerodynamic)
- VF recoil back to resting, closing at midline before air pressure forces them open again
131
Sequence of vocal folds?
1. VF's close at onset of phonation through action of lateral cricoarytenoid & interarytenoid muscles
(medially compression @ midline happens)
2. Subglottal pressure builds & overwhelms closed VF's, and air is released in vocal tract then vibrates
3. VF then closes again, constrict airway and pulled together because of bernoulli effect
132
Bernoulli Effect (Theory of Phonation)
Air passing through glottis increases flow, and pulls VF's together because of negative pressure caused by airflow
**Occurs during every vibratory cycle
133
Three Mass Model of VF oscillation (Theory of Phonation)
1. Large stabilizing mass= body
2. Superior & Inferior masses= cover
3. Area of glottal opening at bottom is larger than at top= convergent glottis formed
4. Resulting in greater intraglottal pressure which forces VF's apart.
5. Area of top of glottis is larger= divergent glottis formed
6. Resulting in lower intraglottal pressure which forces VF's together.
* *Occurs during every vibratory cycle
134
What is a mucosal wave?
Pattern of oscillation created by continual opening & closing of two masses of the VF cover during voicing
**Every opening & closing is 1 vibratory cycle
135
What does the VF phase refer to? (mucosal wave)
1. Open at bottom, open at top
| 2. Close at bottom, close at top
136
What is vertical phase difference?
Time differential between opening and closing the inferior and superior edges of folds
137
What is longitudinal phase difference?
Timing between opening and closing of the folds
138
How do the folds open and close?
1. Open from back to front
| 2. Close from front to back
139
What is voice onset?
Initiation of sound produced as the folds begin to vibrate
140
What are the three kinds of onset?
1. Breathy onset
2. Hard glottal attack
3. Simultaneous onset
141
What is breathy onset?
Air flows through glottis BEFORE the VF's are adducted & vibrating
142
What is hard glottal attack?
Air flows through glottis AFTER the VF's are adducted & vibrating
143
What is simultaneous onset?
Air flowing through glottis at SAME time as adduction & vibration
144
What is control of fundamental frequency?
Controlled between antagonistic relationships between cricothyroid & thyroarytenoid muscles
145
What happens when the cricothyroid contracts?
Stretches & thins VF's & results in an INCREASE of fundamental freq.
146
What happens when the thyroarytenoid contracts?
Shortens VF's & results in a DECREASE in fundamental freq.
147
Control of loudness (interaction between 3 aspects)
1. Subglottal pressure
2. VF adduction
3. Formant harmonic tuning
148
What is frequency perturbation or jitter?
Variation in amplitude during vibratory cycle
149
What is amplitude perturbation or shimmer?
Variation in amplitude during vibratory cycle
150
What is jitter and shimmer affected by?
- Asymmetry of VF's
- Differences in mass & stiffness
- Variations in lung pressure
- Secretions
- Aerodynamic fluctuations in glottis
151
What is registers?
Subdivisions within total range of pitches produced by voice
152
What is pulse?
- Lowest register
- Closed for 90% of cycle
- AKA glottal fry (popcorn popping)
153
What is modal?
- VF's closed for 50% of time
- VF's open for 50% of time
- Speech range with pulse register occurring at end of phases/sentences
154
What is falsetto?
- VF's long & stiff & thin at the margins
| - Thinner sound (Child like)
155
What are the ventricular folds?
- False VF's
- Above & parallel with true folds
- Close during swallowing & physical effort
- Abducted during phonation
156
What are the aryepiglottic folds?
- Folds of connective tissue
| - Form sphincter to pull epiglottis backward to close larynx entrance during swallowing
157
What aspects of pathology may interfere with normal vibratory function?
1. Location & size
2. Symmetry of both folds
3. Layer structure
4. Mass & stiffness of each layer
158
What are nodules/polyps?
Mass of superficial layer of lamina propria increases; stiffness changes
159
What is edema?
Stiffness decreases
160
What does fibrosis, intra-tissue bleeding, hyaline degeneration do?
May increase stiffness
161
What does epithelial hyperplasia do?
Increases mass & thickness of cover
162
What does papilloma do?
- Enters superficial layer & sometimes intermediate & deep layer of lamina propria
- Invades the vocalis muscle
163
Mouth (Articulation/Resonance)
Resonator that shapes & contains other structures
| lips, cheeks, teeth, hard palate, alveolar ridge, velum
164
What happens when the velum is lowered?
It allows air into nasal cavities (nasal sounds, m,n)
165
What are the disorders that inhibit normal velopharyngeal functioning & may cause nasal emission during production of nasal sounds?
1. Hypernasality and Hyponasality
| 2. Velopharyngeal valve
166
What sounds does the Velum (soft palate) affect?
Production of g & k
167
What does the SUPER longitudinal do?
- Intrinsic muscle
| - Elevates tip
168
What does the INFERIOR longitudinal do?
- Intrinsic muscle
- Pulls down tip
- Retracts tongue
169
What does the transverse do?
- Intrinsic muscle
| - Narrows tongue
170
What does the vertical do?
- Intrinsic muscle
| - Depresses tongue
171
What does the genioglossus do?
- Extrinsic muscle
| - Retracts & draws tongue forward
172
What does the hyoglossus do?
- Extrinsic muscle
| - Pulls tongue's sides down
173
What does the palatoglossus do?
- Extrinsic muscle
| - Elevates the back of tongue
174
What does the styloglossus do?
- Extrinsic muscle
| - Elevates & retracts tongue
175
What is the pharynx?
Tube made up of muscle & connective tissue lined with mucous membranes (nasopharynx, oropharynx, laryngopharynx)
176
What does the cricopharyngeus do?
- Muscle of pharynx
| - Sphincter at the entrance of esophagus
177
What does the pharyngeal constrictors do?
- Muscle of pharynx
| - Tenses & tightens walls
178
What does the stylopharyngeus do?
- Muscle of pharynx
| - Elevates & opens
179
What does the salpingopharyngeus do?
- Muscle of pharynx
| - Elevates & opens
180
What is vocal tract resonance?
Happens due to tract acting as filter that selects & transmits frequencies through tube that open at one end and close at the other.
181
What is resonance disorder?
Hyper/Hyponasality (cleft palate)
182
What is resonance problems?
- Voice problems (muffled, back)
| - Voice is back in pharynx not forward
183
What is vocal tract shaping?
Changing shape of vocal tract
184
What are formants?
Resonating frequencies of vocal tract
185
What is coarticulation?
Contiguous nature of how speech sounds influence each other can affect resonance
186
What is suprasegmentals?
Varied to emphasize or stress syllable, word, phrase (Freq, intensity, duration, rate)
187
What are the affects of aging on the articulation?
- Stress & intonation issues
- Slower speech rate
- Resonance issues
188
Cerebral cortex?
- Neurological aspect of voice
- Lateral convexity of cortex is involved in vocalization
- Stimulation of precentral gyrus & supplementary motor cortex elicits vocalization
- Laryngeal muscles coordinated with other articulators for timing of voice onset
189
What are the subcortical mechanisms?
1. Limbic & diencephalic structures
| 2. Basal ganglia & extrapyramidal system
190
What serves the respiratory mechanism?
1. Cervical plexus
| 2. Brachial plexus
191
What supplies nerves to the upper limb?
Brachial plexus
192
What cranial nerves does the cervical plexus communicate with?
1. Vagus
2. Hypoglossal
3. Spinal accessory
193
What is the diaphragm influenced by?
1. Thoracic intercostal nerves
| 2. Phrenic nerve
194
Cranial nerves?
-May be motor, sensory, or mixed
195
The vagus cranial nerve?
- Sensory & motor in function
- Involved in respiratory, cardiovascular, digestive sensations
- Motor control (innervation of palatal muscles, pharyngeal muscles, all intrinsic laryngeal muscles)
196
What are two large divisions of the vagus?
1. Superior laryngeal nerve
| 2. Recurrent/interior laryngeal nerve
197
Where are sensory receptors located?
- Pharynx
- Larynx
- External ear
- Thorax
- Abdominal cavity
- Heart
- Lungs
198
Nodose ganglion?
Thickening of vagus near brainstem which fibers innervating vocal tract are present
199
Potential affects of aging on the voice?
- Changes to CNS
- Changes to Brain atrophy
- Slowing of motor planning
- Slower speech
200
What is phonation?
Results of a vibrating column of air
201
Oscillation of the VF's depend on what?
Biophysical conditions
202
What 4 things affect phonation?
1. Glottal configuration (VF's size, shape, approximation)
2. Aerodynamic changes in airflow & surface pressure
3. Changes in tension of VF's
4. Changes in elasticity, density, viscosity of structures
203
Major aspect of VF's?
Degree of adduction
204
What muscle affect tension & pitch?
Intrinsic muscles
205
What is vocal fold paralysis?
Disruption of neuromuscular innervation of muscles controlling VF movement
206
Unilateral or Bilateral? (Caused by what?)
- Concomitant disease
- Trauma
- Lesions
- Idiopathic issues
207
What is bilateral vocal fold immobility a result of ?
- Neurological disorder
- Metabolic origin
* *Post thyroidectomy
208
What are causes of VF immobility?
- Carcinoma
- Diseases
- Inflammatory conditions
- Trauma
- CNS lesions
209
What are the 6 disorders that cause hypoadduction
1. Lesions that damage vagal nuclei within brainstem
2. Lesions that damage the superior and recurrent laryngeal nerve
3. Lesions of the superior laryngeal nerve only
4. Lesions of the inferior recurrent laryngeal nerve
5. Myasthenia Gravis
6. Respiratory disorders that may co exist with flaccid dysphonia
210
Lesions that damage vagel nuclei within brainstem?
```
Symptoms? (Unilateral)
-Vocal paralysis
-Tremourous vowel productions
-Pitch difficulties
Symptoms? (Bilateral)
-Absence of vibration
-Distortion of consonants
```
211
Lesions that damage the superior and recurrent laryngeal nerve? (Same as previous symptoms)
Symptoms?
- Vocal paralysis
- Pitch difficulties
* *Pharyngeal branch: do not create velar problems
212
Lesions of superior laryngeal nerve only?
-Affect cricothyroid muscle
Symptoms?
-Loss of high pitches
-Weak voice
**Lesions of internal branch (Client complain of globus-lump in throat)
**Lesions of external branch (Ability of loudness affected)
**Bilateral signs?
thyroid cartilage will not tilt on cricoid cartilage during phonation
**Unilateral signs?
hoarse or breathiness
213
No tilt results in what?
1. Affects pitch
| 2. Affects quality of phonation
214
Lesions of the inferior recurrent laryngeal nerve?
-Cause paralysis of ALL intrinsic muscles EXCEPT criocothyroid
Causes?
-Surgery
-Trauma
-Congenital/genetic neuropathies
**Bilateral involvement major concern
**Unilateral paralysis may result in reduced airway
215
Myasthenia Gravis?
```
-Happens earlier in age in females rather than males
Symptoms?
-Swallowing problems
-Rapid deterioration in speed
-Rhythm of voice production
**Bilateral muscle weakness (bowing of VF's, incomplete adduction)
Management techniques?
-Anticholinesterase drugs
-Remove thymus gland
```
216
Respiratory issues may also coexist with flaccid dysphonia?
```
Symptoms?
-Weakness of speech muscles
-Affects respiration
Results from?
-Trauma
-Tumors
Voice related symptoms?
-Inhalation problems
-Can't open glottis wide enough
Management techniques?
-Postural change
-Physical therapy
```
217
What are the 12 dysphonias associated with hypoadduction?
1. Dysarthric dysphonia
2. ALS (amyotrophic lateral sclerosis)
3. Chorea
4. Hyperkinetic dystonic dysphonia
5. Parkinsonism
6. Syndromes related to parkinsonism
7. Essential tremor
8. Gilles de la tourette syndrome
9. Vocal apraxia
10. Deep cerebral and brainstem lesions
11. Frontal lobe lesions
12. Multiple sclerosis
218
Dysarthric dysphonia?
Increased muscle tone spasticity occurs in presence of weakness & paralysis
-Unresponsive to treatment
219
Amyotrophic lateral sclerosis?
Digenerative disease
| -Emotional support, fam counseling, alternative communication systems
220
Chorea?
Genetic disease
- Memory issues
- Deterioration of motor control
- Techniques to encourage improved phrasing
221
Hyperkinetic dystonic dysphonia?
Slow movements of speech/vocal mechanism
- Abnormal prosody
- Intellectual/behavioral impairment
- Techniques to maintain communication, help structure & simplify interactions
222
Parkinsonism?
- Tremor in voice
- Swallowing problems
- No facial expressions
- Techniques to use medication for tremors, brain stimulation, breathing/inhalation exercises
223
Syndromes & disorders related to parkinsonism?
```
1. Parkinson + syndrome: Abnormal gait, tremor at rest
A. Multiple system therapy
B. Shy-Drager syndrome
C. Progressive supranuclear palsy
2. Pseudobulbar palsy
3. Meiges syndrome
4. Tardive dyskinesia
5. Wallenburg syndrome
6. Cerebral disorder
```
224
Essential tremor?
Organic/essential tremor
- Head,neck,face tremor
- Techniques: Beta blockers
225
Gilles de la tourette syndrome?
Tics and involuntary vocalization
| grunting,barking,swearing
226
Vocal apraxia?
```
Lesion in broca's area (speech disorder)
-No articulatory movements
-VF's are normal
-Articulation with air only
Techniques?
-Shape phonation
-Clearing throat
```
227
Deep cerebral and brainstem lesions?
-Caused by tumors, cerebrovascular accidents,lack of oxygen
-Failure to maintain eye contact
-No sound of any kind
Techniques?
-Voice therapy (not too effective)
228
Frontal lobe lesions?
Mutism with apathy, emotional change, may be associated with brain tumor
229
Multiple sclerosis?
-Inflammatory disease of CNS
-Scarring of white matter (cerebral cortex, brainstem, spinal tracts)
-Diagnosed by MRI
-Impaired articulation
-Nasal emission
Techniques?
-Physical therapy
-Medication
-Speech & voice therapy
230
Spasmodic dysphonias?
```
-No lesions (not related to neurology)
Early yrs= Spastic Dysphonia
New yrs= Laryngeal Dystonia
-Not proven to be psychogenic
-Strained
-Choked
-Voice pattern similar to stuttering
**Unsuccessful treatments
```
231
What are the 4 symptoms of spasmodic dysphonia?
1. Adductor spasmodic dysphonia
2. Abductor spasmodic dysphonia
3. Mixed type (both above)
4. Essential voice tremor
232
Major issue of spasmodic dysphonia?
-Loss of control of voice
-Client becomes anxious
Onset?
-Upper respiratory infection
-Emotional stress
-Time when needed to rely on voice
Disease course?
Worsens & deterioration occurs for about 2 yrs
**No signs when singing, emotional outburst, angry outbursts
233
Adductor spasmodic dysphonia?
- Incidence in caucasians
- Prevalent in women not men
- Assumed psycogenic
234
Techniques used for spasmodic dysphonia?
1. Xylocaine injection: some relief (voice deteriorates with time)
2. Botox injections: given bilaterally & unilaterally, achieve max. reduction of spasms but minimal voice weakness. (been useful)
3. Surgery: Less effective than botox but botox less effective on patients who had prior surgical intervention
235
Abductor spasmodic dysphonia?
- Spasm appear on voiceless phonemes (initial position in words)
- Best on sentences with voiced consonants
236
Mixed type?
- Rare form
- Problems with vowels
- Reduced vol. when speaking
237
Essential tremor?
-May co exist with other tremors of head, face, hands
-Tremor occurs at rest
-Increases as patient ages
Onset?
-Usually woman
-Familial
-In the 6th decade
238
Dysphonia was primarily due to what?
Disease process rather than physiological aging alone
239
What are the 5 disease processes?
1. Central neurologic disorders
2. Benigns vocal fold lesion
3. Inflammatory disorders
4. Laryngeal neoplasia
5. Laryngeal paralysis
240
What happens when the vocal mechanism ages?
- Decrease in vocal power
- Ossification of cartilage
- Atrophy & edema
- Cause vocal abuse
- Arthritis
241
What are commonly found in elderly men?
1. Vocal fold bowing
2. Vocal fold atrophy
3. Sulci and fat degeneration
4. Bowing plus prominent vocal processes
* *Loss of teeth, no tongue mobility(related to resonance)
* *Trained voice may be protected from early onset of aging
* *Mixed model of vocal tract resonance changes with age
* *Attributes with aging (lower pitch, hoarseness)
* *More glottal gaps seen in older men than in women
