Voice Exam Additional Readings Flashcards
(37 cards)
Why is Vocal Rest Controversial?
- Some feel that it places too many unrealistic demands and hardships on the individual
- others advocate such a program in certain situations because of its therapeutic effects and because of the diagnostic and prognostic information it can provide.
When to Implement Vocal Rest
- Following the various forms of laryngeal surgery to promote healing of the traumatized tissue
a. particularly true if surgery involved the margins of the vocal folds - As the initial treatment of some lesions of the larynx, particularly vocal fold hemorrhage or mucosal tear
- A program of modified vocal rest (speaking only when necessary) can be used when the patient is experiencing acute inflammations of the voice or following the development of nodules or edema
Advantages of Vocal Rest
- Usually see a rapid reduction in the size and severity of the laryngeal lesion, which decreases the severity of the associated dysphonia
- It allows the individual the opportunity to identify those situations that promote misuse
- Allows the therapist to determine the individual’s commitment to the process of voice improvement
Disadvantages of Vocal Rest
- For those who use their voices professionally, it may be financially impossible for them to implement
- it’s an extremely difficult task for the average person to adhere to and is even more difficult for those who misuse their voice
- Some patients become depressed with continued vocal rest
Duration of Vocal Rest Program
typically 4-7 days, rarely more than 7
Complete Vocal Rest
elimination of all activities that either adduct the vocal folds into forced approximation with each other or cause the vocal folds to vibrate and result in the production of sound
Behaviors to Avoid in Any Vocal Rest
- speaking
- Singing
- Humminh
- whispering
- coughing
- throat clearing
- laughing
- lifting/pushing heavy objects
- forceful efforts during bowel movements
Modified Vocal Rest
the use of voice is significantly reduced but not completely eliminated
Allows some talking under controlled substances
When Talking is Allowed in Modified Vocal Rest
- Conversation is limited to a time of no more than 15 minutes per day
- each period of talking must be limited to no more than 5 minutes in duration
- conversations must be one-on-one and in an environment that has a minimum level of background noise
Vocal Rest Program for Children
- They’re more like modified vocal rest, goal is to reduce talking by 1/2 or more
- can only be used with children who understand what has caused the laryngeal lesion, otherwise it should be avoided
- child must be made to understand that he is directly responsible for changing his vocal behavior and not anyone else
- parental support and encouragement are vital to the success of this program to facilitate success (modeling good vocal habits)
- Explain to the child that they only have to reduce amount of talking for 7 days
Guideline for Child’s Vocal Rest Programs
- Child can talk quietly to parents in morning before school
- Child can answer in classroom but should be excused from talking in large groups (no singing either)
- Must not talk during recess, lunch, or gym (loud areas)
- they’re permitted to talk to parents quietly after school for a brief period and then no talk until mealtime
- allowed to talk quietly at mealtime but parents should limit verbal competition
- talking time during evening hours should be as limited as possible
Steps in Vocal Abuse/Misuse Reduction Program
- identify patterns/behaviors related to vocal misuse/abuse
- a baseline of occurance should be identified either through direct observation of client or having them track and monitor outside of therapy
- Make patient aware of impact these abuses have on their voice and how they might contribute to an addative lesion
- Discuss the identified abuses with the patient, emphasizing the need to reduce their daily frequency
- Plot the daily occurance of vocal abuse/misuse on a graph (makes patient aware of what they have been doing and allows them to track progress)
- have patient bring graphs to therapy and discuss (reinforce when you see behaviors decreasing)
Purpose of Voice Evaluation
- Allows therapist to make determinations regarding the patient’s voice, including
A. a detailed description of the patient’s voice characteristics and how they vary over time
B. how severe the voice disorder is
C. whether the patient would benefit from voice therapy
Description of the Patient’s Voice
- better to use descriptive terms regarding patients’ voices, like what they do well, what they do poorly, and what they are unable to do
- should include a hypothesis of possible etiologies of vocal pathology or dysfunction
Determining Severity of Voice Disorder
- done through numerical rating scales which allows therapists to make several severity evaluations concerning aspects of the voice
- done through Subjective descriptions of severity (mild, mod, severe) but tend to be general and less meaningful
Determining Candidacy for Voice Therapy
- Should formulate a statement after the evaluation regarding potential benefit of therapy
- Should look at prognostic considerations
Prognostic Considerations for Candidacy of Voice Therapy
- prognosis is better for those who report acute onset and those that seek help sooner (generally more motivated/anxious)
- it’s poorer for patients who report a long-term, chronic dysphonia (not as worried and usually referred by someone else)
- If uncertain, can do a trial run of therapy
Therapeutic Protocol for Voice Evaluation
- No standards regarding the exact procedures which should be followed during a voice evaluation
- instrumental tests depend on setting/facility, clinician training/experience, and type of presenting problem
What Should a Good Voice Evaluation Include?
- Analysis of ENT Report and Other Medical Problems
- Case History
- Observation of Patient’s Behavior
- hearing assessment
- oral motor assessment/laryngeal palpation
- articulation/intelligibility
- eval of pitch/frequency (perceptual and instrumental)
- Eval of loudness/intensity (perceptual and instrumental)
- analysis of quality/wave complexity (perceptual and instrumental)
- judgement of air wastage/measurement of airflow rate/respiration (perceptual, instrumental or noninstrumental)
- use of other relevent/pertinent physiologic measures (EGG, EMG,)
- videoendoscopy
- presentation of appropriate clinical facilitation techniques/trial therapy
- obtain an audio/video sample of patient’s voice during the evaluation
Parts of the Comprehensive Care Team
- patient
- family physician
- otolaryngologist
- SLP
- voice teacher/voice coach
- other members (radiologist, psychologist, neurologist, etc)
SLP’s Role in Management of Voice Disorders
- selection and implementation of a voice therapy program (depends on age of client and severity/type of disorder)
- development of appropriate therapeutic relationship with patient and family.
- Provision of technological assistance as warranted
- Identification of appropriate reading materials, videos, support groups, self-help matherials, to enhance the patient’s understanding of the disorder and provice information.
- coordinate involvement of family members and other.support professionals in the treatment program to enahnce the patient’s recovery
- improve self-perception skills through training, self-monitoring exercises, counseling, etc.
- Refer for additional specialized counseling with psychiatrists if needed
- facilitator of analyzing life-style facotrs and evironmental factors to vocal behavior
- Give strategies to reduce or eliminate abusive or hyperfunctional behaviors
- explanation and modeling of facilitative techniques.
- give attention to client’s needs for improved self-esteem and satisfying social interactions
- use of materials and strategies that mesh with clients’ interests
- careful documentation for insureance reimbursement
facilitative techniques
a therapy technique that seems to produce optimum voice by shaping target behaviors during symptoms modification
Patient related Factors for Therapy Approaches
age, type/severity of disorder, personality, their understanding of the problem and contributing factors, commitment to change, etc.
Clinician related factors to therapy approaches
training, previous experiences, interest in voice disorders, confidence level, personality