Voice

Question 1

Interview Information

Answer 1

• describe voice when problem first started, has it changed over time?
• what do you think is the cause?
• do you speak a lot at work/home/on phone/large groups?
• what types of activities are you involved in?
• do you run out of breath when you talk?
• what speaking situations is your voice best/worst?
• is your voice better/worse at different times of the day?
• have you been to an ENT specialist? results?
• any illness/accidents?

Question 2

Screening

Answer 2

• assess resonance, tone, pitch, loudness
• use 3 point scoring system (too little, normal, too much)
• tasks:
  
  • imitate words/phrases
  • count to ten
  • recite alphabet
  • read short passage
  • prolong vowels for 5 sec
  • participate in conversation
• screen measure: Buffalo Voice Profile

Question 3

Voice Qualities

Answer 3

• pitch, intensity, quality
• resonance
• prosody
• vocal habits
• respiratory support

Question 4

Instrumentation

Answer 4

• electromyography
• aerodynamic measures
• videoendoscopy/stroboscopy
• acoustic measures
  
  • fundamental frequency indicator
  • intensity measure
  • spectral measure
  • visi-pitch III
  • CSL

Question 5

S/Z Ratio

Answer 5

-task to assess respiratory/phonatory effiency
-client sustains /s/ at least 2 times
-normal = 10 sec child, 20-25 sec
adult
-client sustains /z/ at least 2 times
-compare duration of longest /s/ with longest /z/ production
-interpretation:
-1.0 ratio with normal duration = normal respiratory function
-1.0 ratio with decreased duration = possible respiratory inefficiency
-1.2 > ratio = possible vocal fold pathology

Question 6

Resonance

Answer 6

identify presence of:

• hypernasality: occludes nares & have client recite non-nasal words/phrases (ex: Janice from friends)
• hyponasality: client recites sentences with nasal sounds then repeats with nares occluded (ex: congested, cold)
• assimilation nasality: client recites phrases with single/multiple nasal sounds

Question 7

Velopharyngeal Function

Answer 7

• use “pressure consonants” which require great amount of intraoral air pressure, listen for nasal emissions, hypernasality
• Modified Tongue Anchor Procedure:
  
  • stick out tongue/puff cheeks/occlude nares
  • client continues holding air while nares released
  • listen for nasal emission
  • complete minimum of 3 trials

Question 8

Respiratory Support

Answer 8

• identify type of breathing (clavicular, diaphragmatic, thoracic
• assess breath support for speech during:
  
  • list recitation
  • gradual, slow inspiration/expiration
  • sustained vowel production (ah)
  • production of phrases of increasing length

Question 9

Stimulability

Answer 9

• attempts to stimulate normal voice function
• can manually lift velum to promote velopharyngeal closure
• can model pitch/intensity changes
• model appropriate vocal habits