Disorders Final

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jadnebalasca
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251459
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Disorders Final
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2013-12-07 21:04:14
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Disorders of Speech Final
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  1. Suprasegmental phonation
    Prosodic vocal patterns more common in toddlers
  2. Primary function of the larynx
    Biological function that allows air into and out of the lungs for life-sustaining breathing
  3. Prevalence of disorders
    • Seen more in children
    • Normal adult - 3% - 9%
    • School-age children - 6% - 23%
  4. Four types of voice disorders
    • 1. Organic
    • 2. Neurogenic
    • 3. Psychogenic
    • 4. Muscle Tension Dysphonia
  5. Organic voice disorders
    • Structural deviations of the vocal tract
    • Examples:
    • Cleft Palate
    • Vocal tract disease
    • Viral papilloma
  6. Neurogenic voice disorders
    • Neurological conditions causing faulty vocal cord closure due to paralysis or weakness
    • Examples:
    • Child with cerebral palsy
    • Adult after stroke
  7. Psychogenic voice disorders
    • Caused by psychological factors as a reaction to trauma or conflict
    • Examples:
    • Aphonia
    • Dysphonia
  8. Muscle Tension Dysphonia
    • Represents vocal hypertension
    • Too much effort to speak without organic pathologies
    • Examples:
    • Thickening and swelling of vocal folds
    • Nodules
    • Polyps
  9. Five characteristics of a normal voice
    • Loudness - must be loud enough to be heard
    • Hygiene - must be produced in a manner that is hygienic
    • Pleasantness - should have a pleasant quality
    • Flexibility - should be flexible to express emotion
    • Representation - represent the speaker in terms of age and gender
  10. Three aspects of voice
    • Respiration
    • Phonation
    • Resonance
  11. Abduction of the vocal folds
    Opening of vocal folds
  12. Adduction of the vocal folds
    Closing of the vocal folds
  13. What nervous systems coordinate laryngeal operations?
    PNS and CNS
  14. PNS is comprised of
    • Vagus Nerve (X)
    • Superior laryngeal nerve (SLN)
    • Recurrent laryngeal nerve (RLN)
  15. Seven common types of neurogenic voice disorders
    • 1. Flaccid Dysarthria
    • 2. Unilateral Upper Motor Neuron (UUMN)
    • 3. Spastic Dysarthria
    • 4. Hypokinetic Dysarthria
    • 5. Hyperkinetic Dysarthria
    • 6. Ataxia Dysarthria
    • 7. Mixed Dysarthria
  16. Function voice disorders
    2 different causes: psychogenic or excessive muscle tension disorder
  17. Four types of psychogenic voice disorders
    • 1. Falsetto
    • 2. Functional aphonia
    • 3. Functional dysphonia
    • 4. Somatization
  18. Four types of excessive muscle tension disorders
    • 1. Muscle Tension Dysphonia
    • 2. Reinike's Edema
    • 3. Vocal Fold Nodules
    • 4. Vocal Fold Polyps
  19. Vocal nodules and common causes
    • Benign lesions on vocal folds in both adults and children
    • Caused by continuous abuse of larynx
    • Generally bilateral can range from 1-4 nodules
    • Responsive to therapy
    • Associated with excessive throat clearing
    • Seen in overachievers, gymnasts, cheerleaders, prepubescent boys, fourth child
  20. Polyps and common causes
    • Grows on the vocal fold
    • Has own blood supply
    • Folds cannot come together = hoarse voice
    • More common in high school children because of yelling - common in smokers
    • Responsive to surgery after voice therapy
    • Big red bump caused by one phonotrauma
  21. Assessment
    collection of data to make a clinical decision
  22. Evaluation
    drawing of implications and significance of the assessment
  23. Diagnosis
    Making a decision as to whether a problem exists and differentiating it from other similar problems
  24. Most common voice problems in school-aged children
    Hyperfunction of the vocal folds
  25. Techniques and approaches that work well with school-aged children
    • 1.      Team approach
    • 2.      Stories and imagery
    • 3.      Structured carryover activities
    • 4.      Counseling
    • 5.      Extrinsic reinforcements
  26. School-aged children
    • May require observations outside of therapy setting or request parents to observe when abusive behaviors occur
    • When a child monitors his/her own vocal abuse, there is a notable decrease in the number of incidence
    • Short-term therapy of usually 6 weeks - best case is 4days/6 weeks
  27. Adolescence/adult
    • Easier to educate regarding vocal hygiene
    • Not as easily motivated
    • The cause for vocal behaviors are not easily identified
    • Have complicated or ambivalent feelings for authority figures
    • Respond better to intrinsic reinforcement
    • Parent involvement in treatment is minimal and homework should be relevant to a variety of activities
    • Scheduling is an issue
    • There is a balance between counseling and skill development with more time spent on counseling
  28. Five facilitating techniques and its uses
    • Change in loudness - vocal abuse in children
    • Chant-talk - hyperfunctional issues
    • Chewing - hyperfunctional issues
    • Confidential voice (quiet voice) - hyperfunctional issues
    • Counseling - hyperfunctional issues
  29. When is a voice considered disorder
    • Inappropriate for age, gender, culture
    • Causes pain
  30. 3 categories of special voice problems
    • Particular populations
    • Respiratory-based problems
    • Laryngeal cancer
  31. Particular Population
    • Aging voice
    • Deaf and hard of hearing
    • Pediatric
    • Professional Voice users
    • Transgender
  32. Aging Voice
    • 65 years old and older
    • Characteristics are:
    • Tremor
    • Hoarseness
    • Breathiness
    • Voice breaks
    • Decreased loudness
    • Slower speaking rate
    • Change in pitch
    • Therapeutically:
    • Improve overall phys fitness
    • Vocal function exercises
    • Counseling regarding the need for good vocal hygiene
    • Improving respiratory efficiency
    • Increasing rate of speech
    • Techniques:
    • Auditory feedback
    • Focus
    • Glottal fry
    • Masking
    • Visual feedback
  33. Deaf and Hard of Hearing population
    • Severe hearing loss affects voice
    • Around 50dB sensorineural loss affects voice
    • The later in life the onset of severe-to-profound hearing loss occurs the less impact on voice
    • Characteristics:
    • Varied pitch and loudness changes
    • Resonance variations
    • Slower rate of speech by prolonging vowels
    • Variations in prosody
    • Cochlear implants - when implants are off for 24 hours elevated fundamental frequencies increased intraoral pressure. It improves pitch, resonance and rate of speech
    • Profoundly deaf - efforts to improve voice should not occur until amplification
    • Developing a child's awareness of other's voice and their own pitch level can be achieved by using instrumental and software programs
    • Technique - SLP can use "Cue arrows" pointing to the desired direction of pitch. Once desired pitch is established the child can read while placing fingers lightly ton the thyroid cartilage - to monitor unnecessary laryngeal movement
    • A child can have problems with nasal resonance with recessive pharyngeal resonance causing a back focus and too much/too little nasal resonance
    • Technique - altering tongue position to move it forward can establish more normal oral resonance
    • Instrumental techniques and software programs are beneficial. To eliminate nasality, a nasometer may be used in addition to a computer based system
  34. Professional voice users
    • Puts unusual demands on respiration, phonation, and resonance
    • Professional voice users are: actors, singers, teachers, politicians, salespersons, ministers, telemarketers, broadcasters
    • Vocal hygiene needs to be coupled with voice instruction to maintain the functional, professional voice
    • Voice clinician is not convincing enough for the professional
    • Voice clinician and professional do not share meaning "same" language
    • Technique - loop auditory feedback
    • Use of questionnaire regarding the professional's use of voice and how voice problem may affect their quality of life
    • SLP works with voice coach and combines vocal hygiene with therapy
    • Teachers comprise the highest number of vocal problems in the category
  35. Two basic causes of airway obstruction in respiratory problems
    • Structural and lesion mass airglow interference
    • Abnormal laryngeal movement interference
  36. Four resonance disorders
    • Hypernasality - most common
    • Hyponasality
    • Assimilative nasality
    • Oral-pharyngeal resonance disorders:
    • Stridency, thin voice quality, cul de sac voice
  37. Aerodynamic data
    Measures air pressure and air flow from nasal and oral cavities during speech and provides information regarding leakage through the nose when velopharyngeal mechanism should be closed
  38. Acoustic information
    Measures amount of oral-to-nasal acoustic energy during speech, nasometer provides nasalance data
  39. Radiography data
    Provides information regarding structural and physiological limitations or the mechanism in velopharyngeal incompetence
  40. Visual probe
    Includes endoscopes, nasopharyngeal apparatus to determine degree and type of velopharyngeal closure
  41. Disorders that are affected by the listener's perception
    • Hypernasality
    • Assimilative nasality
  42. Goal of therapy for oral-pharyngeal resonance problems
    • Lower larynx
    • Decrease pharyngeal constriction
    • Promote general throat relaxation
  43. Hypernasality
    • Excessive (undersirable) amount of nasal cavity resonance during production of nasal sounds. Caused by lack of closure of velopharyngeal port
  44. Hyponasality
    • Reduced nasal resonance for the three nasalized phonemes /m/, /n/, /ng/
    • Resulted by anatomical obstruction within the nasal cavity - abnormally large adenoids, tonsils, deviated septum
  45. Assimilative nasality
    • Vowels and voiced consonants appear nasal when adjacent to 3 nasal consonants
    • May be a result of overexposure of faulty speech models or exaggerated regional dialect patterns 
    • Considered a functional voice disorder
  46. Aphonia
    Complete loss of voice
  47. Dysphonia
    hoarsness without a physical cause
  48. Diagnostic probe
    Selection of an approach for trial
  49. Papilloma
    wart-like growth that are viral in nature
  50. Laryngeal web
    grows along the glottis between vocal folds and inhibits normal fold vibration
  51. Presbyphonia
    • the gradual weaking of voice
    • associated with poorer health as one ages
  52. Paradoxical vocal fold dysfunction
    • Voice dysfunction that may not manifest itself when evaluation/voice assessment
    • Strained to breathe
    • Usually seen in athletes that may convey asthma symptoms.

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