1
Q
Direct Therapies for MTD (4)
A
- Resonant Voice
- Yell Well / Twang
- Giggle release
- SOVT (straw phonation, LAXVOX, trills)
2
Q
Direct Therapies for Presbyphonia (2)
A
- Phorte
- Stemples
3
Q
Direct therapies for Paresis / Paralysis (2)
A
- (SOVT) Lip trills / tongue trills with sirening
- Stemples
4
Q
Why would you choose Resonant Voice for MTD? (6)
A
- Reduces stress on VF
- improves vocal fold closure
- Soft Onsets
- reduces tension of the muscles around the larynx
- lowers larynx
- creates forward resonance
5
Q
Why would you choose Yell Well / Twang Voice for MTD? (2)
A
- increase volume
- reduce laryngeal tension
- increase resonance
- improve vocal efficiency
6
Q
Why would you choose Giggle release for MTD? (3)
A
- activation of extrinsic laryngeal musculature
- release of constriction
- retracts vocal folds
7
Q
Why would you choose phorte for presbyphonia?
A
- rehabilitates atrophy
- improves vocal efficiency, loudness and projection
8
Q
Why would you choose stemples? (3)
A
- strengthens, balances and coordinates respiration, phonation, resonance
- improves laryngeal muscle strength and control
- improves phonatory efficiently
9
Q
Why would you choose SOVT exercises for MTD? (5)
A
- takes pressure off vocal folds
- lowers larynx
- reduces hard onsets
- good for biofeedback of constriction
- siren trills → stretch and VF control
10
Q
Name some indirect therapies (4)
A
- Vocal hygiene
- Lifestyle / Environmental changes
- Education
- Counselling
11
Q
Examples of goals for vocal hygiene (8)
A
- reduce/stop smoking and drinking alcohol/carbonated drinks
- stay hydrated (water)
- replace coughing/throat clearing with an effortful swallow
- getting a good night’s sleep
- not putting strain on the voice - minimise shouting and whispering etc
- manage reflux (GP)
- manage sinus issues/allergies (ENT/Allergist)
- modify medications where appropriate (GP) - spacer for inhaler, contraceptive pill, nasal sprays,
12
Q
Examples of goals for lifestyle / environmental changes (6)
A
- reduce nights out drinking in loud places
- reduce/stop karaoke singing
- limit hours on phone (speakerphone)
- modify work hours
- consider amplification and non-verbal means of getting attention
- reduce exposure to pollutants
13
Q
Counselling skills (4)
A
- Active Listening
- Mindfulness
- Cognitive Behaviour Therapy
- OARS (Principles of Conversation - Open Questions, Affirm, Reflect & Summarise)
14
Q
Examples of education as an indirect therapy for treating voice (4)
A
- Describing how the voice works in simple language
- Describing what is happening in the voice disorder the client is experiencing in simple language
- Telling the client what they can expect (eg after surgery, during recovery)
- Describing different vocal qualities and what they can indicate
15
Q
Why would you choose lifestyle and/or environmental changes for indirect therapy? (2)
A
- To identify the primary and secondary behavioural causes of the voice disorder and then to modify or eliminate these causes.
- To protect the vocal folds and other structural anatomy relating to voice production
16
Q
Why would you choose vocal hygiene for indirect therapy? (2)
A
- To identify the primary and secondary behavioural causes of the voice disorder and then to modify or eliminate these causes.
- To protect the vocal folds and other structural anatomy relating to voice production
17
Q
Why would you choose counselling for indirect therapy? (2)
A
- If the client is stressed and anxious generally, this needs to be addressed as it can be linked with voice disorders.
- The VD may be causing them stress or anxiety
18
Q
Why would you choose education for indirect therapy? (3)
A
- To provide understanding (autonomy)
- Client can make informed decisions
- So they know what to expect
19
Q
What causes muscle tension dysphonia? (5)
A
- inefficient vocal use
- common in high voice users
- Causes tension/over activation of adductor (and sometimes abductor) muscles.
- This leads to too much force at onset of voice
- can be compensatory / secondary to an organic / neurological voice disorder.
20
Q
Characteristics of muscle tension dysphonia (7)
A
- Palpable tension
- Worsens with use
- Improves with rest
- strain
- roughness
- possibly
- At vocal cord level would see a squash of the vocal folds,
- Improvement in vocal quality observable with therapy trials
21
Q
What is the onset of MTD?
A
Gradual
22
Q
What causes vocal fold paresis / paralysis? (5)
A
- A viral infection
- A result of surgery (e.g. thyroidectomy)
- Injury to one or both superior laryngeal or recurrent laryngeal branches.
- Paralysis/paresis of cricothyroid muscle
- Not generally caused by tumours pressing on the nerve
23
Q
Characteristics of vocal fold paresis / paralysis (9)
A
- Aspiration
- Shortness of breath / breathiness
- An unusual amount of effort/exertion
- Strider in voice
- Unable to change pitch
- Symptoms may only occur in some challenging acoustic contexts e.g. when speaking over background noise, when giving a presentation
- May have surrounding muscular pain - compensation to try to bring the vocal folds together
- Observable & often palpable laryngeal tension
- s:z ratio (<1:1.40 i.e. unable to hold the voiced ‘z’ sound indicates a vocal fold pathology/lesion as it requires VF vibration)
24
Q
What is the onset of vocal fold paresis / paralysis?
A
Sudden
25
What causes presbyphonia? (7)
* Not strictly a VD - part of aging
* Gradual onset but can be accelerated by decrease in vocal load. Eg Due to:
* Retirement
* Loss of a partner resulting in decreased talking at home
* Increased stress e.g. a sick partner
* Injury resulting in hospital stay and decreased participation in usual activities
* Relates to idea of ‘Use it or Lose it!’
26
Characteristics of presbyphonia (4)
* Primary symptom = a change in voice quality. Voice may sound quieter, breathier, hoarse or less clear.
* Can lead to reduced communication, lower QoL and reduced participation in social activities.
* Looser/thinner vocal folds can contribute to a loss of tissue bulk, resulting in the characteristic bowed appearance of glottic closure patterns seen clinically in patients with presbyphonia.
* Consider whether the client has developed secondary MTD in an attempt to adduct atrophied/bowed vocal folds.
27
What is the onset of presbyphonia?
Gradual onset but can be accelerated by decrease in vocal load
28
How do you teach resonant voice?
● Hum
● What do you feel? - ‘Not sure’
● Hum again and think about the front of your face
● What do you feel at the front of your face? - ‘I can feel it vibrating’
● Great that vibration is what we are looking for. Let’s pop our fingers on the front of our face like this so you can feel the vibrations
● Hum with your fingers on your mouth. What can you feel? - ‘vibrations’
● Great! Now I want you to play with the shape of your mouth and the pitch (demonstrate up and down). I want you to keep doing that until you get to the point where you feel the most buzz (or vibration)
● Now let’s add to it. Try these - mi mi mi…. my my my… mo mo mo
29
What are the next steps when teaching resonant voice?
● Add vowels
● Words – voiced and voiceless
● Phrases
● Paragraph reading
● Controlled conversation
● Emotional manipulations
30
Principles of motor learning (8)
x5 about practise, x3 about feedback
* Large number of trials
* Distributed practise – over a longer period
* Variable practise (eg in different context)
* Random practise (eg different targets practised randomly in practise sessions)
* Complex practise (practise the whole movement, rather than part of the movement)
* Feedback is about knowledge of performance (eg ‘that sounded clear’ rather than ‘put your lips closer together)
* Reduced feedback
* Delayed feedback
1 Voice Disorders
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