Voice Facilitation Techniques; dysarthria, nasality, etc.

question

Which FTs coordinate airflow?
answer

vocal function, power adduction, accent method,
question

vocal function exercises
answer

sustained /i/ as long as you can at top of head; lips in position for “null,” starting at low note and sweeping up to high note then opposite-do in quiet voice
question

power adduction
answer

do this if did well on vocal function exercises; /ol/ for singers; /i/ for nonsingers; do these at five different notes as long as can (start at note where you talk)– focus should be high front so as to take away tension
question

goal of vocal function exercises is to do it right….
answer

now to sound right
question

where are nodules found
answer

1/2 way point of membranous glottis; or 1/3 back from anterior of whole glottis
question

why are nodules bilateral
answer

the hard mass (nodule) on one vocal fold hits the other; one that shows up first is bigger
question

why are polyps not bilateral
answer

they are a squishy bag, not hard
question

causes of polyps
answer

burns, bad cough, screaming, over singing…
question

what all sounds the same
answer

polyps, nodules, and cancer
question

where do polyps happening from one time trauma happen on vf?
answer

same place as nodules (1/2 m.g.) bc that’s where vocal folds come together the hardest
question

why do polyps and nodules not go away very quickly
answer

there is no lymph at the level of the vocal folds; very important to catch cancer soon for this reason!!!
question

granuloma
answer

inlammation that usually occurs in the cartilaginous glottis from intubation; happens after contact ulcer
question

who are granuloma most common in
answer

women and children
question

what are precipitating factors of granuloma
answer

reflux and infection
question

is granuloma bi or uni lateral
answer

bilateral
question

what can cause granuloma
answer

lifting heavy weights, having babies, etc. also intubation
question

why can contact ulcers cause pain in ear
answer

the vagus nerve is close to the vestibulocochlear nerve
question

ex. of long term goal
answer

Client will demonstrate appropriate vocal hygiene and vocal quality in all speaking situations.
question

Whydon’t you want to try to fix pitch
answer

if you increase pitch, you increase the bernoulli effect, causing vocal folds to slam together
question

What is a way to check for mouth opening
answer

compare a i m
question

why do you work on vocal focus
answer

to change resonance and get clear voice
question

what sounds can you use to get focus away from vocal folds
answer

/p/ /s/; any high front focused sound (nasals are good)
question

what sounds are glottal focus
answer

/h/ and vowels
question

what are ways to get the focus in the middle of mouth
answer

make sure mouth is open; do chewing technique; gargle blowing air
question

chewing technique
answer

helps with focus; chew multiple syllable words to get mandible moving and not tense up vocal folds (good for kids and singers)
question

gargle technique
answer

helps get tongue relaxed; helps to see if they can blow air
question

what three things must be in objective
answer

behavior, stimulus, crtiterion
question

who most often has contact ulcers
answer

drill sergeants, professors (basically low loud voices)
question

who most often has vocal nodules
answer

children, cheerleaders, females, young boys (basically high pitched voices)
question

what perpetuates polyps
answer

hyperfunction is enough, not need for abusive behaviors
question

perpetuating factors for nodules
answer

phonotrauma, throat clearing, tension etc..
question

what “P” is smoking?
answer

predispose more often
question

Which P(s) do we have to focus on the most as slps
answer

precipitating and perpetuating
question

How can you reduce vocal fatigue
answer

reduce abuse (ex. throat clearing, hydration) aka vocal hygiene; compensate in healthy ways; get appropriate focus; appropriate breath support
question

vocal unloading: how it works and what for
answer

coord of breathing and muscles; releases tension in muscles Straw between lips: blow and hum–> blow and do siren sounds–> sing national anthem (don’t have to do all on one breath)
question

easy onset exercises
answer

talk on sigh, yawn-sigh, /h/ initial words (isolated, words, sentences, whisper then gradually add voice, make air (not voice) hit back of room, /m/ initial words
question

If doing /m/ for easy onset, what should the progression of sentences be
answer

single sound–> my momma,–> my boy is good–> Mary said please make cake–> reading–>asking questions to e/o–> 2 min monologue
question

which is intermittent, polyps or nodules
answer

polyps
question

primary cause of paralyzed vocal fold
answer

surgery
question

why is it good to have damage in the recurrent laryngeal nerve
answer

it can grow back; you usually wait 6 months before doing any kind of intervention
question

Which is not a dysarthria: spasmodic dysphonia, vocal spasmodic tremor, or muscle tension dysphonia
answer

muscle tension dysphonia
question

What is the best test for tremor
answer

sustained vowels
question

how will the sustained vowel sound in Spasmodic Dysphonia
answer

either strained (abductor??) or breathy and losing intensity (adductor??)
question

Who does singing sound better for?
answer

muscle tension dysphonia
question

Who do sentences sound bad for?
answer

tremor bc it is hard to keep voice on
question

What will SD have trouble with
answer

voice-voicless sentences bc they have trouble turning voice on
question

what voice disorder sounds bad on all tasks
answer

muscle tension dysphonia
question

which voice disorder sounds better when singing
answer

muscle tension dysphonia???
question

what is a big difference betweed SD and MTD
answer

SD is intermittent (they both have strain/strangled quality to voice); also MTD has fewer instances of tremor
question

dysathria
answer

neurologically based disorder of voice
question

flaccid
answer

soft, hanging loose or limp
question

voice symptoms of flaccid dysarthria
answer

breathy, weak
question

disorders of flaccid dysarthria
answer

vocal fold pareses, vocal fold paralysis, myasthyenia gravis
question

spastic
answer

tightness, stiffness
question

ataxic
answer

discoordinated
question

hypokinetic
answer

decreased muscle movement but not because weakness of muscle
question

hyperkinetic
answer

increased muscle movement, resulting in abnormal movements
question

disorders of spastic dysarthria
answer

multiple strokes, tbi, multiple scerlosis, amyotrphoic lateral scerlosis
question

site of brain damage for flaccid dysarthria
answer

LMN
question

site of brain damage for spastic dysarthria
answer

bilateral dammage to corticobulbar tracts of the upper motor neuron
question

bilateral
answer

both sides
question

contralateral
answer

opposite sides
question

ipsilateral
answer

same side
question

vocal symptoms for spastic dysathria
answer

low pitch, strain-strangled; have trouble initiating movement, hypernasality if bilateral
question

vocal symptoms for ataxic dysarthria
answer

prosidic abornamility, scanning speech
question

vocal symptoms for hypokinetic dysarthria
answer

weak, monotone
question

vocal symptoms for hyperkinetic dysarthria
answer

chorea- prosodic abnormality dystonia-effortful, strain-strangled
question

dystonia
answer

slow, sustained muscle contractions
question

site of brain damage for ataxic dysarthria
answer

damage to the cerebellum and/or its sensory or motor nerve pathways
question

disorders of ataxic dysarthria
answer

stroke, tumors, CP, infection, multiple scerlosis, , and some genetic disoders (ex. Fragile X) note: Ataxic dysponia can also have hypotonia bc cerebellum is involved in muscle tone
question

site of brain damage for hypokinetic dysarthria
answer

basal ganglia
question

site of brain damage for hyperkinetic dysarthria
answer

basal ganglia
question

disorders resulting in hypokinetic dysarthria
answer

Parkinsons is biggy
question

disorders resulting in hyperkinetic dysarthria
answer

choreic (Huntingtons) or dystonic (Spasmodic Dysphonia) results from degenerative diseases, stroke, trauma,inflammation, and metabolic diseases
question

choreic
answer

quick, jerky muscle contractions
question

indication of damage to cerebellum
answer

equal stressed syllables may not be able to coordinate breathing with phonation may not be able to raise velum when needed (hypernasal)
question

what is true of all dysarthrias
answer

they lose accuracy in articulation first
question

what do you want to treat first in dysarthrias
answer

breathing
question

what disorders can cause a strained sound in voice
answer

muscle tension dysphonia, spastic dysarthria, spasmodic dysphonia, essential tremor
question

what disorders might have tremor
answer

essential tremor, parkinson’s, and cerebellar disease
question

adductor spasmodic dysphonia voice quality
answer

the adductor muscles (IA and LCA) are contracting, causing the voice to sound strain-strangled, effortful and jerky, sudden voice arrests causing speech to sound stuttered
question

abductor spasmodic dysphonia voice quality
answer

the abductor muslce (PCA) is contracting causing the glottis to be open inappropriately at times. This causes the voice to sound aphonic at times; it also sounds jerky and breathy and often like a whisper
question

what happens to voice if there is damage to the superior laryngeal nerve
answer

the vocal fold sags; you lose pitch; aspiration and drooling due to sensory problems
question

aspiration
answer

audible breath
question

what is often confused with damage to the SLN by ENT
answer

vf paralysis bc they both sag
question

why would you not do same strategies for damage to SLN as for hypokinesia (vf paralysis)
answer

it could cause hypertension
question

hypernasality
answer

sound in nasal cavity due to open velopharyngeal port
question

what causes hypernasality
answer

syndromes, some dysarthrias (bilateral spastic dys), cleft palate
question

nasal emission
answer

air comes through nose
question

significance phoneme specific emission
answer

kids should be able to do these sounds structurally and developmentally but don’t; esp in high pressure sounds like plosives, fricatives, and affricates
question

manner, place or voicing first?
answer

manner!! it has the greatest effect on intelligibilty
question

submucous cleft
answer

bone did fuse, so air goes through, might have bifid uvula
question

what is an indication of subumcous cleft possibly
answer

history of heart problems
question

velopharyngeal incompetence
answer

the velum and superior laryngeal constrictor are both structurally fine, but it does not lift for some reason
question

velopharyngeal insufficiency
answer

there is not enough tissue in pharynx, velum is not long enough
question

how would velum get paralyzed (where in brain)
answer

pharyngeal branch of vagus nerve
question

what would you do for hypernasality
answer

reduce oral resistance by 1. getting mouth open 2. light articulatory context (using voiceless fricatives first) if you can’t do anything else, have them whisper bc you can’t whisper through your nose
question

what voice therapy would you do for SLN
answer

vocal function, pitch range stuff (easy to treat!)
question

paradoxical vocal cord motion
answer

the same as vocal cord dysfunction and many other names
question

PVCM def
answer

vocal folds don’t work appropriately for respiration, not necessarily phonation; could be vf hyper or hyposensitivity
question

which dysarthria has normal reflexive function but abnormal phonation
answer

spasmodic dysphonia
question

how does pvcm often start out
answer

chronic throat clearing or irritable larynx syndrome
question

How to get rid of throat clearing step by step
answer

drink water, swallow hard, sniff-swallow, yawn-sigh, start over (do for one hour!!)
question

techniques you can use when symptoms of PVCM occur
answer

abdominal breathing relaxed throat breathing: inhale through nose slowly, exhale through mouth doing /s/ while focusing making air hit alveolar ridge so tongue won’t move to pharyngeal wall; if they can’t inhale through nose, put small coffee straw between lips and focus on inhaling through it and exhaling /s/ (do 5 5x/day) if they know trigger, have them practice in that situation if trigger is smell, have them inhale through mouth and exhale through pursed lips if their vf shut down before they can use them, have them sniff then go into breathing technique
question

what stimulates PVCM
answer

airway irritants
question

what do you do for atheletes who have PVCM
answer

have them drop their body to push air out, then have them go into breathing exercise
question

desensitation
answer

start small then go rightin the middle of the stimulus
question

what techniques can be taught for exercise induced PVCM
answer

work on rhythmic breathing: can uses pursed lips or /s/, inhale 3 steps, exhale 4 with all air out by last step. next, have them pick up the pace
question

Reflux and PVCM
answer

reflux might trigger it, often accompanies it
question

Besides refulx, what else is often associated with PVCM
answer

muscle tension dysphonia and nodules bc of the increase in muscle tension
question

when do you do a laryngeal massage
answer

for muscle tension dysphonia primarily
question

how long does program last for PVCM
answer

4 weeks but they have to be motivated and do work or it won’t work and they will turn into chronic coughers, which we can’t help
question

what are you most concerned with in earlier stages of cleft palate
answer

feeding and swallowing
question

What speech tasks do you work on first with kids with cleft palates
answer

vowels, getting mouth open then do consonants, following developmental sequence (so start with bilabials and alveolars) do voicless before voiced!
question

What can you use to see what sounds kids are stimulable to?
answer

normal articulation test
question

Resonant voice therapy
answer

uses resonance to fix voice quality by changing vocal focus
question

What do we do with hyponasality
answer

refer to ENT
question

what three things should be done for hypernasality
answer

open mouth, direct airflow, light contacts
question

when hole is cut below the larynx
answer

tracheostomy
question

when hole is cut where the larynx was
answer

laryngectomy
question

what is effected when one gets a tracheostomy
answer

swallowing, speech, taste, smell; can usually eat orally
question

cuff up
answer

the cuff is inflated, so stuff can’t get in lungs; makes i hard to talk
question

cuff down
answer

the cuff is deflated, you can talk
question

passy muir
answer

redirects air breathed in from the stoma up to through the vocal folds to talk; this is for trach patients; uncuffed; can help ween off ventilator, can help with swallowing and sense of taste
question

options for speaking with trach
answer

cuffed up (talking trach-uses extenral source of air, electrolarynx, and fenestrated) cuffed down and uncuffed (passy muir, exhaled air alone is used, block tube so air goes up and not down into trach)
question

what perceptual characteristics indicate hyperfunction
answer

hard glottal attacks, strain, increased breath units, pain, hoarseness, wrong ptich, increased intensity, tension
question

what perceptual characteristics indicate hypofunction
answer

breathiness, decreased intensity, decreased pitch range, short breath units, usually a lower pitch, phonation breaks, delayed onset, hypersnasality (bc lack of muscle movement)
question

how do you know what to target
answer

target what they sound better on
question

What are hyperfunction techniques
answer

resonant voice therapy, vocal function exercise, vocal unloading, yawn-sigh, chant therapy, stretch and flow, easy onset, chewing
question

what do hyperfucntion techniques focus on
answer

focus or airflow
question

resonant voice therapy
answer

goal is to change focus to provide clearest voice with the least effort by moving through good resonance
question

ways to talk with laryngectomy
answer

espohgeal speech, tracheoesophageal puncture, electrolarynx, tonaire
question

electrolarynx
answer

source of sound is buzzer placed against neck; shapes and resonates sound in mouth; uses air already in mout, stoma blast; can have transcervical or intraoral
question

Tracheal esophageal puncture prosthetic
answer

uses pulmonary air to talk; source of sound is pharyngeal-esophageal segement; most like natural speech, no stoma blast
question

esophageal speech
answer

uses air to talk; pharyngeal esophageal segemtn is source; stoma blasts
question

why get a talking trach
answer

if you have respiratory problems and need an external source of air
question

vocal function exercises
answer

first, null and /i/ at high front focus, then coordinating airflow and muscle functin is goal
question

vocal unloading
answer

airflow technique to get air moving; helps people realize they are tense
question

yawn-sigh
answer

airflow technique
question

strech-flow
answer

get air out in steady stream and see how long you can talk on it
question

chewing
answer

focus methods, helps you bring focus to center of mouth
question

hypofunctional techniques
answer

many people who ae hypofunctioning are those with weak or parlyzed vocal folds, so exercises might be hard, may have to modify; lee silverman and lumbard effect are both good exercises
question

lee silverman
answer

good for parkinons, intensive program used to get louder
question

lumbard effect
answer

putting noise in someones ear so they make natural adjustments to try to talk over it
question

chant therapy
answer

helps with continuoys flow of air and moves up focus, helps with easy onset since you never shut air up
question

rheumatoid arthrtitus
answer

in actue stage it causes inflammation, redness, and swelling with a feeling of a lump in throat; this can lead to breathiness, stridor, hoarseness in chronic stage it causes there to be joint fixation; the symptoms depend on where the joint is fixated and if it’s unilateral or bilateral; sometimes gets mistaken for paralysis causes loss in pitch range bc of CT joint fixation
question

treatment for rheumatoid athritis
answer

depends on stage, but vocal rest is advised as well as heat to inflammation
question

what often gets confused with a paralyzed vocal fold by ENTs
answer

superior laryngeal damage… don’t do the same technique as you would for a paralyzed vocal cord bc it can cause hyperfunction
question

chronic laryngitus
answer

the vocal folds are swollen and red from front to back…. can eventually lead to scarring… low pitched, breathy, weak in volume, and hoarse.. often leads to tension, so there is strain too
question

difference between nodules, granulomas, and polyps
answer

nodules: bilateral, midpoint of membranous glottis, for from gradual misuse polyps: unilateral, can be from one time trauma or from gradual misuse, granuloma: uni or bilateral, usually in cartilagenous glottis, some shooting pain in ear bc of swelling, can lead to airway obstruction and vf fixation; happens after ulcer; can be from intubation
question

vascular lesion causes and symptoms
answer

usually in singers…basically vocal hemoraging that leads to scarring and stiffness, which leads to vocal fatigue, loss of pitch range, strain,
question

what causes vocal fatigue
answer

excessive voice use, poor vocal technique, emotional and/ or physical stress
question

symptoms of vocal fatigue
answer

weakness, decrease in dynamic and pitch range, tightness in throat, strain, reduced respiratory support
question

flaccid dysarthria often leads to…
answer

hyperfunciton

Get instant access to
all materials

Become a Member