Voice

Question 1

LPR symptoms

Answer 1

• hoarseness
• globus sensation
• pain
• irritation & inflammation
• increased mucous production

Question 2

LPR treatment

Answer 2

suppress acid through a PPI

• dont eat 3 hours after meals
• elevate head of bead
• diet changes

Question 3

principles of voice therapy (7)

Answer 3

education
behavioral modifications
relaxation work
postural work
breath work
voice production shaping
counseling

Question 4

Relaxation approaches

Answer 4

• progressive relaxation (Jacobson)
• direct massage (McClosky) —- massage face, stretch tongue, passive movements of jaw, massage neck, etc.
• stretch/flex and release exercises

Question 5

Postural tx

Answer 5

• assess “plumb line”
• assess balance of head on atlas
• look at their work-station, etc.
• -tx:
• “here i am sitting”
• sit as you would stand
• refer to OT or chiropractor

Question 6

why work on breathing & problems

Answer 6

“voice disorders disrupt normal speech breaking behaviors (Hillman)

• shallow inhalations
• running out of air
• exhalation prior to speech
• breath holding
• paradoxical respiratory movements

Question 7

tx for breathing

Answer 7

target abdominal breathing

• stablalize shoulders
• force exhalation, feel for recoil
• candle blowing
• slow rate of inhalation
• breath through nose

Question 8

PVFM

Answer 8

• when the larynx closes off not allowing the person to breath
• difficulty getting breath in
• tightness in throat
• inhalatory stridor
• 02 stats stay above 90
• stops soon after excersise

Question 9

tx for PVFM

Answer 9

rescue breathing technique

• breathe in through nose slowly with wide throat posture
• breath out through puckered lips
• feel throat widen as you breathe in

Question 10

decreased glottal competence tx techniques

Answer 10

• pushing
• hard glottal attacks
• coughing, troat clearning
• pitch manipulation
• laryngeal manipulation

Question 11

approaches to shape phonation

Answer 11

1. onset manipulation
   - aspirate onset to reduce hard glottal attacks
   - light glottal attacks to reduce breathiness
   - easy/gentle onset
2. reinforce active/continuous breath flow
   - kazoo buzzes
   - lip/tongue trills

Question 12

in voice don’t treat the _______, treat the _____

Answer 12

don’t treat the symptoms, treat the cause

Question 13

non-adducted hyperfunction

Answer 13

• aphonia or dysphonia
• crisp, vegetative cough or throat clear

-dx confirmed via endoscopy

severe hoarseness—>aphonia–>conscious transfer into a whisper—>URI resolves —>pt remains locked in a whisper

Question 14

tx for non-adducted hyperfunction

Answer 14

• describe the problem – “laryngeal muscle tension”
• lay the ground rules
• explain bad vs good voice
• you have control over your voice

—**Clinician’s toolbox of tricks

Question 15

what CN involved most in voice??

Answer 15

CN x -Vagus

Question 16

3 branches of the vagus

Answer 16

1. palato-pharyngeal branch - palate and pharynx
2. superior laryngeal branch - interior branch (laryngeal interior) and external branch (cricothyroid)
3. recurrent laryngeal branch - intrinsic laryngeal muscles except cricotyroid

Question 17

tx of adducted hyperfunction

Answer 17

1. vocal hygiene
2. vocal rest
3. vocal entrainment exercises
4. resonant voice therapy (verdoloni)
5. voice therapy

Question 18

resonant voice therapy

Answer 18

** Verdoloni

-the goal is to achieve the strongest “cleanest” voice possible with the least effort and impact between the VF to minimize trauma

• “forward focus voice”
• work on the “basic resonant voice training gesture”

Question 19

Vocal function exercises

Answer 19

**Stemple

exercises are practiced 2x day
-works to improve the strength and endurance of the VF muscles & the coordination of respiratory and laryngeal muscles

-includes maximal prolongations, pitch glides, sustained vowels to words and phrases

Question 20

Clinician toolbox tricks

Answer 20

**Bunting

• cough
• throat clear
• cry
• sing
• laryngeal manipulation
• gargling

Question 21

LMN damage

Answer 21

flaccid dysarthria

Question 22

UMN system

Answer 22

spastic dysarthria

Question 23

Cerebrllum system

Answer 23

ataxic dysarthria

Question 24

Extraparymadal system

Answer 24

1. hypokinetic
2. hyperkinetic (quick or slow)
3. tremor (organic voice tremor)

Question 25

6 types of non-neurologic organic voice disorders

Answer 25

1. infalmmatory reactions (acute or chronic laryngitis, LPR, irritable larynx syndrome) 2. benign lesions (nodules, polyps) 3. endocrine disorders (hypo/hyperthyroidism) 4. trauma (mechanical or burns) 5. congenital disorders (laryngeal web) 6. maligent tumors

Question 26

ALS is

Answer 26

spastic and flaccid dysarthria

Question 27

WD is

Answer 27

ataxic and hypokinetic dysarthria

Question 28

MS is

Answer 28

ataxic and spastic dysarthria

Question 29

flaccid dysarthria voice symptoms

Answer 29

- hypernasality - nasal emission - breathiness - short phrases - inhalatory stridor

Question 30

spastic dysarthria voice symptoms

Answer 30

- harshness - low pitch - slow rate - strained/strangles voice quality - pitch breaks - slow and regular AMRs

Question 31

hypokinetic dysarthria voice

Answer 31

- monopitch - monoloud - variable rate - rapid/blurred AMRs - short rushes of speech - reduced stress

Question 32

hyperkinetic dysarthria voice (huntingtons - quick)

Answer 32

- slow/irregular AMRs - distorted vowels - prolonged intervals - voice tremor - voice stoppages - transiet breathiness

Question 33

ataxic dysarthria voice

Answer 33

- irregular articulatory breakdowns - prodosdic excess - prolongation of phonemes - irregular AMRs - Excessive loundness variation

Question 34

spasmodic dysphonia

Answer 34

- inappropriate adduction and abduction of the VFs - abnormal involuntary contraction of the thyroarytenoid (adductor) and PCA (abductor) tx = botox

Question 35

how to treat abdominal breathing

Answer 35

``` stabilize shoulders (lie on floor, stand against wall) force exhalation, feel recoil candle blowing panting slow rate of inhalation ```

Question 36

how to treat glottal incompetence

Answer 36

pushing/hard glottal attacks couging/throat cler pitch manipulation LSVT

Question 37

how to decrase rate of speech

Answer 37

taping metronome DAF listen tapes

Question 38

how to use resoance to shape phonation

Answer 38

forward placement/focus (hum) use forward vowels (/i/ /u/) Lessac Madesen resonant voice