symptomatic voice therapy Flashcards
(70 cards)
1
Q
Van Riper (1939) components of voice therapy? (4)
A
- pt recognizes problem
- produce new, more appropriate sound
- stabilization of new voice in many contexts
- habituation of new voice in all situations
2
Q
T or F: in terms of tx dosage and delivery, all delivery models were found to be effective.
A
true, but psychosocial progress may be more limited in intensive therapy models.
3
Q
how many sessions of voice tx are needed on avg? what % of pts return after initial discharge?
A
- range = 4.3 (presbyphonia) to 6.7 (benign lesions)
- 14.5%
4
Q
positive reasons for tx termination? (4)
A
- vocal symptoms eliminated or reduced
- +voice quality
- physical symptoms eliminated
- habituation of new vocal behaviours
5
Q
negative reasons for tx termination? (1)
A
lack of improvement after an appropriate therapy trial
6
Q
what is confidential voice? when is it most useful?
A
- easy, quiet, breathy voice as if talking confidentially to somebody nearby
- most useful when voice conservation is required (after recent injury or surgery)
7
Q
which vocal register is confidential voice?
A
right at base of falsetto (should still be comfy)
8
Q
symptomatic techniques for voice tx? (4)
A
- relaxing techniques (for hyperfunctional system)
- activating techniques (for hypofunctional system)
- techniques targeting secondary aspects of voice production
- techniques related to counseling/awareness
9
Q
technique #1 auditory feedback – what are the 2 types?
A
- real-time feedback (hands cupped around ears or speaking tube)
- looped feedback (playback of recording)
10
Q
technique #2a reducing excessive loudness – discuss the steps (5)
A
- check pt hearing
- develop voice hierarchy (children)
- discuss diff loudness levels (teens/adults)
- discuss neg psychosocial attributes
- practice quiet voice w feedback
11
Q
technique #2a reducing excessive loudness – what is the voice hierarchy? (5)
A
- whisper
- soft voice
- normal convo
- raised voice
- yelling voice
12
Q
technique #2b increasing loudness – discuss the steps (4)
A
- check pt hearing / general health
- discuss psychosocial implications
- ID comfortable F0
- if indicated, work on breathing pattern and support
13
Q
technique #2b increasing loudness – what are the 2 supportive techniques?
A
- gentle pushing: push hands during phonation
- auditory masking
14
Q
technique #3 what is chant talk? is this beneficial for hyper or hypofunctional voices?
A
- easy, continuous phonation in the style of religious chant
- hyperfunctional voices
15
Q
technique #3 – chant talk procedure? (5)
A
- explain procedure to pt
- practice chanting
- alternate bw chant and reg voice (20sec)
- record both and discuss with pt
- carry over into convo
16
Q
technique #3 – why is chant talk a beneficial technique?
A
avoids VF contact
17
Q
technique #4 what is froeschel’s chewing (2)? is this beneficial for hyper or hypofunctional voices?
A
- pretend you’re chewing tasty food, exaggerate motions; big bites + full mouth
- add soft phonation
- hyperfunctional voices
18
Q
technique #4 – in froeschel’s chewing, which articulators must move? (2)
A
- jaw
- tongue
19
Q
technique #4 – froeschel’s chewing procedure? (5)
A
- explain how chewing can reduce tension
- alternate chewing and word production
- expand to phrases and counting
- provide auditory feedback
- expand to convo and reduce chewing
20
Q
technique #5 T or F: counselling is not a necessary part of every voice therapy program
A
false
21
Q
what are 2 important things to remember regarding counselling
A
- pt should never be blamed for voice disorder
- remain inside professional boundaries by knowing when to refer out
22
Q
technique #6a digital manipulation of the larynx: anterior-posterior pressure for lowering the pitch – how does this facilitative technique work (2)? is it used often?
A
- apply gentle pressure to thyroid prominence to automatically lower pitch (shortens VFs)
- pt then tries to maintain this pitch without the pressure
- not used often
23
Q
technique #6b digital manipulation of the larynx: monitoring of the vertical laryngeal excursion – how does this technique work (2)? which patients is it most beneficial for?
A
- monitors position of thyroid prominence to reduce larynx vertical movement
- practiced by singing low and high notes
- beneficial for pt with laryngeal tension
24
Q
technique #6b digital manipulation of the larynx: monitoring of the vertical laryngeal excursion – how can max elevation and lowering be demonstrated?
A
swallowing and yawning
25
technique #6c digital manipulation of the larynx: maneuvering the larynx to a lower position – how does this technique work? (3)
- encircle hyoid bone w middle finger and thumb
- apply gentle pressure to thyrohyoid space
- work larynx down w light lateral movements
26
technique #6d digital manipulation of the larynx: unilateral digital pressure in unilateral vocal fold paralysis – how does this technique work? (5)
- apply gentle pressure on paralyzed side while pt phonates
- if no success with voice quality/loudness: apply pressure to contralateral side
- if no success: add head rotation (ipsi contra)
- if no success: bilateral gentle pressure onto thyroid lamina while head turning
- if no success: move on
27
technique #7a describe the procedure for elimination of misuses? (3)
- create awareness + discuss necessity for reducing the misuse
- have pt or relative tally the misuses
- log daily frequency
28
T or F: there is no optimum pitch
true
29
technique #8 describe the procedure of establishing a new pitch (6)
- explain problem + direction of desired pitch
- determine optimum pitch by analyzing bio vocalizations (yawning, sighing)
- provide instrumental feedback
- establish monopitch and monoloudness on vowels, words, phrases
- work on pitch inflections
- transfer to convo
30
boone’s (1997) definition of a good voice: “from the ___ of the mouth, just above the ____”
- middle
- surface of the tongue
31
technique #9 focus problems: excessive forward carriage vs excessive backward carriage?
- excessive forward = juvenile voice
- excessive backward = country bumpkin (deep) voice
32
technique #9 T or F: with the focus technique, pitch changes
false; resonance changes
33
technique #9 describe the procedure of focus (4)
- explain concept w anatomical drawing
- excessive forward pt: use posterior sounds to bring focus back
- excessive backward pt: use anterior sounds to bring focus front
- imagery: speaking into theatre mask
34
technique #10a describe the procedure of reducing glottal attack (5)
- explain problem (irritates VFs)
- aspirated phonation
- yawn-sigh
- chant talk
- spectrographic/oscillographic feedback
35
technique #10b describe the procedure of increasing glottal attack (5)
- explain problem (soft voice)
- demonstrate hard glottal attack
- practice sudden vowel onsets after initial /p/ (pop, peep, pick)
- spectrographic/oscillographic feedback
- use mild pushing to increase VF closure
36
technique #11 what kind of pt is glottal fry helpful for? rationale?
- pt with mass-lesions (nodules, polyps)
- rationale: glottal fry = little subglottic pressure and short VFs
37
the strohbass can be used to ____.
temporarily clear dysphonia
38
T or F: glottal fry can also be produced with high muscle tension
true
39
technique #12 rationale for head positioning technique? which pt is this useful for?
- may reduce space bw VFs
- pt with VF paralyses
40
technique #12 head positions? (5)
- normal straight ahead
- forward extension (chin up)
- chin down
- lateral head tilt
- lateral head rotation
41
technique #12 head positioning procedure? (3)
- explain and demonstrate positions
- try positions and note improvements
- id minimum head turn necessary
42
technique #12 head positioning: in unilateral paralysis, start with rotation to the ____ side, then try the ____ side
- ipsi
- contra
43
T or F: hyperfunctional voice disorders and the associated hypertension of the strap muscles can sometimes be relaxed with anteflexion of the head
true
44
technique #13 what is hierarchy analysis? which pt is this useful for?
- rank stressful situations and work on management techniques starting with least stressful situation
- hyperfunctional voice pt who report situation-dependent changes
45
technique #13 hierarchy analysis procedure? (4)
- explain concept
- help pt rank
- id factors for good voice in non-stressful situations
- id factors for bad voice in stressful situations and search for ways to manage
46
technique #14 rationale for inhalation phonation? which pt is this useful for? facilitating for?
- results in high-pitched voice
- functional or psychogenic dysphonias
- ventricular fold phonation
47
technique #14 -- inhalation phonation procedure? (7)
- explain and demonstrate
- use shoulder elevation
- change bw inhalation and exhalation voice
- match quality and pitch bw the two
- on inspiration, drop to habitual pitch
- drop shoulder movement
- move to words, convo etc on inhalation and exhalation
48
technique #15 manual circum-laryngeal massage -- what kind of voice disorders is this useful for?
hyperfunctional
49
technique #15 manual circum-laryngeal massage -- steps? (6)
1. encircle hyoid major horns w thumb + middle finger
2. exert light pressure in circular motion (watch for facial expressions)
3. repeat with thyrohyoid space (thyroid notch to posterior borders before SCM)
4. work larynx downward and laterally
5. ask pt to produce vowels noting changes in quality/pitch (allows rests)
6. experiment with new voice
50
technique #15 -- which group is manual circum-laryngeal massage popular among?
singers
51
technique #16 masking -- what does masking lead to (1)? which voice disorders is it beneficial for (2)?
- leads to louder vocal production
- functional and psychogenic dysphonia
52
technique #16 masking -- procedure? (4)
- do NOT explain procedure
- headphone presentation of white noise at 70dB SPL; pt phonates and reads passage
- voice-reflex effect should be immediate (if not, move on)
- switch bw masking and non-masking conditions
53
technique #17 nasal and glide stimulation -- syllables used (3)? rationale (1)?
- ŋi/, /ŋo/, /ŋa/ etc
- rationale: nasals/glides require little to no oropharyngeal pressure = relaxed phonation
54
technique #17 nasal and glide stimulation -- procedure? (4)
1. mono and polysyllabic words w nasals
2. mono nasals with /a/ in between (a man a man)
3. mono and polysyllabic words w glides
4. mono glides with /a/ in between (lee a lee a)
55
technique #18 open mouth approach -- what does this facilitate (2)?
- relaxed voice production
- tensions adjustment of VFs
56
technique #18 open mouth approach -- procedure? (4)
1. visual feedback w mirror (talking rlly big)
2. ventriloquy demonstration so pt sees difference (talking rlly big)
3. use slight head tilt and jaw drop
4. let pt tally faulty productions
57
technique #19 pitch inflections -- which pt is this useful for?
monotonous
58
technique #19 pitch inflections -- procedure? (5)
1. explain problem and use audio feedback for awareness
2. use up and down pitch changes in phrases
3. use pitch changes within words
4. instrumental feedback
5. transfer to convo
59
which technique is this referring to: “When you can’t change the world, you can learn to change your response to it”
relaxation (technique #20)
60
technique #21 respiration -- procedure? (3)
1. explain and demonstrate
2. deep breathing, yawning, sighing, surprise
3. extend inhalation by counting or sound prolongation tasks
61
technique #21 respiration -- procedure for professional voice users? (5)
- start in sitting or standing to demonstrate abdominal breath
- work on upright posture
- tactile feedback w consent
- practice abdominal support
- alternate abdominal support w previous breathing
62
technique #22 tongue protrusion /i/ -- rationale?
tongue protrusion = open and stretched pharynx/larynx
63
technique #22 tongue protrusion /i/ -- procedure? (5)
1. demonstrate comfy tongue protrusion + /i/ phonation
2. watch for voice improvement
3. chant mimimi
4. adjust pitch if necessary
5. phase out tongue protrusion and move to convo
64
technique #24 warble -- rationale?
can break established phonation pattern
65
technique #24 warble -- procedure? (5)
1. explain and demonstrate
2. use feedback instruments
3. ID best production
4. reduce warble
5. transfer new voice to words, phrases, convo
66
technique #25 yawn-sigh -- rationale?
relaxed yawning reduces laryngeal tension + widens pharynx
67
technique #25 yawn-sigh -- procedure? (5)
1. explain and demonstrate
2. one word per yawn
3. practice words with low vowels and syllable-initial /h/
4. transfer to normal speech
68
half-swallow boom: rationale? which pts is this useful for (4)
- approximation of the vocal folds during swallowing is used to facilitate voice
- unilateral VF paralysis, partial laryngectomy, bowing, falsetto voice
69
half-swallow boom: procedure? (4)
1. swallow
2. say "boom" on top of swallow
3. head rotate if necessary
4. expand phrase after boom and phase boom out
70
the swedish /b/ procedure? (1)
lip trill then maintain vocal quality
