voice therapy

Question 1

Van Riper (1939) components of voice therapy? (4)

Answer 1

1. pt recognizes problem
2. produce new, more appropriate sound
3. stabilization of new voice in many contexts
4. habituation of new voice in all situations

Question 2

T or F: in terms of tx dosage and delivery, all delivery models were found to be effective.

Answer 2

true, but psychosocial progress may be more limited in intensive therapy models.

Question 3

how many sessions of voice tx are needed on avg? what % of pts return after initial discharge?

Answer 3

• range = 4.3 (presbyphonia) to 6.7 (benign lesions)
• 14.5%

Question 4

positive reasons for tx termination? (4)

Answer 4

• vocal symptoms eliminated or reduced
• +voice quality
• physical symptoms eliminated
• habituation of new vocal behaviours

Question 5

negative reasons for tx termination? (1)

Answer 5

lack of improvement after an appropriate therapy trial

Question 6

what is confidential voice? when is it most useful?

Answer 6

• easy, quiet, breathy voice as if talking confidentially to somebody nearby
• most useful when voice conservation is required (after recent injury or surgery)

Question 7

which vocal register is confidential voice?

Answer 7

right at base of falsetto (should still be comfy)

Question 8

symptomatic techniques for voice tx? (4)

Answer 8

1. relaxing techniques (for hyperfunctional system)
2. activating techniques (for hypofunctional system)
3. techniques targeting secondary aspects of voice production
4. techniques related to counseling/awareness

Question 9

technique #1 auditory feedback – what are the 2 types?

Answer 9

1. real-time feedback (hands cupped around ears or speaking tube)
2. looped feedback (playback of recording)

Question 10

technique #2a reducing excessive loudness – discuss the steps (5)

Answer 10

1. check pt hearing
2. develop voice hierarchy (children)
3. discuss diff loudness levels (teens/adults)
4. discuss neg psychosocial attributes
5. practice quiet voice w feedback

Question 11

technique #2a reducing excessive loudness – what is the voice hierarchy? (5)

Answer 11

1. whisper
2. soft voice
3. normal convo
4. raised voice
5. yelling voice

Question 12

technique #2b increasing loudness – discuss the steps (4)

Answer 12

1. check pt hearing / general health
2. discuss psychosocial implications
3. ID comfortable F0
4. if indicated, work on breathing pattern and support

Question 13

technique #2b increasing loudness – what are the 2 supportive techniques?

Answer 13

1. gentle pushing: push hands during phonation
2. auditory masking

Question 14

technique #3 what is chant talk? is this beneficial for hyper or hypofunctional voices?

Answer 14

• easy, continuous phonation in the style of religious chant
• hyperfunctional voices

Question 15

chant talk procedure? (5)

Answer 15

• explain procedure to pt
• practice chanting
• alternate bw chant and reg voice (20sec)
• record both and discuss with pt
• carry over into convo

Question 16

why is chant talk a beneficial technique?

Answer 16

avoids VF contact

Question 17

technique #4 what is froeschel’s chewing (2)? is this beneficial for hyper or hypofunctional voices?

Answer 17

• pretend you’re chewing tasty food, exaggerate motions; big bites + full mouth
• add soft phonation
• hyperfunctional voices

Question 18

in froeschel’s chewing, which articulators must move? (2)

Answer 18

• jaw
• tongue

Question 19

froeschel’s chewing procedure? (5)

Answer 19

• 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

Question 20

technique #5 T or F: counselling is not a necessary part of every voice therapy program

Answer 20

false

Question 21

what are 2 important things to remember regarding counselling

Answer 21

• pt should never be blamed for voice disorder
• remain inside professional boundaries by knowing when to refer out

Question 22

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?

Answer 22

• 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

Question 23

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?

Answer 23

• monitors position of thyroid prominence to reduce larynx vertical movement
• practiced by singing low and high notes
• beneficial for pt with laryngeal tension

Question 24

digital manipulation of the larynx: monitoring of the vertical laryngeal excursion – how can max elevation and lowering be demonstrated?

Answer 24

swallowing and yawning

Question 25

technique #6c digital manipulation of the larynx: maneuvering the larynx to a lower position – how does this technique work? (3)

Answer 25

- encircle hyoid bone w middle finger and thumb - apply gentle pressure to thyrohyoid space - work larynx down w light lateral movements

Question 26

technique #6d digital manipulation of the larynx: unilateral digital pressure in unilateral vocal fold paralysis – how does this technique work? (5)

Answer 26

- 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

Question 27

technique #7a describe the procedure for elimination of misuses? (3)

Answer 27

- create awareness + discuss necessity for reducing the misuse - have pt or relative tally the misuses - log daily frequency

Question 28

T or F: there is no optimum pitch

Answer 28

true

Question 29

technique #8ab describe the procedure of establishing a new pitch (6)

Answer 29

- 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

Question 30

boone’s (1997) definition of a good voice: “from the ___ of the mouth, just above the ____”

Answer 30

- middle - surface of the tongue

Question 31

technique #9a focus problems: excessive forward carriage vs excessive backward carriage?

Answer 31

- excessive forward = juvenile voice - excessive backward = country bumpkin (deep) voice

Question 32

T or F: with the focus technique, pitch changes

Answer 32

false; resonance changes

Question 33

describe the procedure of focus (4)

Answer 33

- 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

Question 34

technique #10a describe the procedure of reducing glottal attack (5)

Answer 34

- explain problem (irritates VFs) - aspirated phonation - yawn-sigh - chant talk - spectrographic/oscillographic feedback

Question 35

technique #10b describe the procedure of increasing glottal attack (5)

Answer 35

- 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

Question 36

technique #11a what kind of pt is glottal fry helpful for? rationale?

Answer 36

- pt with mass-lesions (nodules, polyps) - rationale: glottal fry = little subglottic pressure and short VFs

Question 37

the strohbass can be used to ____.

Answer 37

temporarily clear dysphonia

Question 38

T or F: glottal fry can also be produced with high muscle tension

Answer 38

true

Question 39

technique #12 rationale for head positioning technique? which pt is this useful for?

Answer 39

- may reduce space bw VFs - pt with VF paralyses

Question 40

head positions? (5)

Answer 40

- normal straight ahead - forward extension (chin up) - chin down - lateral head tilt - lateral head rotation

Question 41

head positioning procedure? (3)

Answer 41

- explain and demonstrate positions - try positions and note improvements - id minimum head turn necessary

Question 42

head positioning: in unilateral paralysis, start with rotation to the ____ side, then try the ____ side

Answer 42

- ipsi - contra

Question 43

T or F: hyperfunctional voice disorders and the associated hypertension of the strap muscles can sometimes be relaxed with anteflexion of the head

Answer 43

true

Question 44

technique #13 what is hierarchy analysis? which pt is this useful for?

Answer 44

- rank stressful situations and work on management techniques starting with least stressful situation - hyperfunctional voice pt who report situation-dependent changes

Question 45

hierarchy analysis procedure? (4)

Answer 45

- 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

Question 46

technique #14 rationale for inhalation phonation? which pt is this useful for? facilitating for?

Answer 46

- results in high-pitched voice - functional or psychogenic dysphonias - ventricular fold phonation

Question 47

inhalation phonation procedure? (7)

Answer 47

- 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