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Neurogenic Disorders. RESPIRATION. trauma to neck/brainstem; central motor problems; ... clearing throat. smoking. excessive volume

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CD 508

VOICE & VOICE DISORDERS


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Chapter 1

The Voice and Voice Therapy:

Introduction


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Laryngeal Function

  • Biological

    • prevents food from entering the airway

  • Emotional

    • reflected in control of respiration, vertical position of larynx, relaxation of folds and oropharyngeal muscles

  • Linguistic

    • suprasegmental phonation


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Voice Disorders in Normal Population

  • General Population

    • School-age - 7%

    • Adults - 3%

      • Brindle & Morris (1979) - 2.68%

      • hoarseness, hypernasality most often cited

  • Special Groups

    • Teachers - 20%

    • Cheerleaders - 75%


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Types of Voice Disorders

  • ORGANIC

    • result of structural problems in vocal tract

  • NEUROGENIC

    • result of compromise brainstem/spinal column

  • FUNCTIONAL

    • nonbiological


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Organic Disorders more than a week be investigated medically for possible physical causation and treatment.”

  • RESPIRATION

    • reduced lung volume/elasticity

  • PHONATION

    • interference between folds

  • RESONANCE

    • structural problem, e.g. cleft

    • muscular weakness/incoordination


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Neurogenic Disorders more than a week be investigated medically for possible physical causation and treatment.”

  • RESPIRATION

    • trauma to neck/brainstem; central motor problems; disease of CNS

  • PHONATION

    • unilateral vocal fold paralysis; spasmodic dysphonia

  • RESONANCE

    • alter function/shape of oropharynx, e.g. CVA


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Functional Disorders more than a week be investigated medically for possible physical causation and treatment.”

  • RESPIRATION

    • inadequate/inefficient respiratory patterns

  • PHONATION

    • altered vibratory characteristics of folds

  • RESONANCE

    • altered size and configuration of oropharynx


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VOCAL HYPERFUNCTION more than a week be investigated medically for possible physical causation and treatment.”involvement of too much muscle force and physical effort in systems of respiration, phonation, and resonance

  • Excessive patterns of vocal misuse/abuse

  • Can lead to organic change

  • Voice therapy usually preferred Tx


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Respiration more than a week be investigated medically for possible physical causation and treatment.”

  • Speaking on inadequate expiration; improper use of expiration

  • Coordination of inspiration/expiration movement

  • Poor timing/control of expiration


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Phonation more than a week be investigated medically for possible physical causation and treatment.”

  • Inappropriate pitch level --> unnecessary energy to maintain

  • Hard glottal attack

  • Vocal abuse, e.g.

    • clearing throat

    • smoking

    • excessive volume


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Resonance facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.”

  • Hypernasality

  • Assimilative hypernasality

  • Cul-de-sac resonance

  • Baby voice


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Management facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.”

  • Identify cause

    • breathing/resonance longstanding

    • phonation usually recent origin

  • Medical evaluation of organic and neurogenic problems


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Management-2 facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.”

  • “… unless the patient is experience-ing hoarseness (dysphonia) as part of an allergy or severe upper respiratory infection (URI), he or she should wait no longer than seven days to have a medical evaluation of the problem.”

  • Boone, p.16


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SLP Role facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.”

  • SLP to assess respiration-phonation-resonance components

    • Clinical

    • Instrumental

  • Refer for medical Dx/Rx

  • Voice therapy to

    • Eliminate functional problems

    • Conserve function and/or Compensate for organic or neurogenic problems


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Useful Websites facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.”

  • National Center for Voice and Speech

    • http://ncvs.shc.uiowa.edu/

  • Wake Forest Center for Voice Disorders

    • http://www.bgsm.edu/voice/

  • National Institute of Deafness & Communication Disorders

    • (http://www.nidcd.nih.gov/)


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