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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

CD 508

VOICE & VOICE DISORDERS

chapter 1

Chapter 1

The Voice and Voice Therapy:

Introduction

laryngeal function
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
voice disorders in normal population
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%
types of voice disorders
Types of Voice Disorders
  • ORGANIC
    • result of structural problems in vocal tract
  • NEUROGENIC
    • result of compromise brainstem/spinal column
  • FUNCTIONAL
    • nonbiological
slide6
“… it is important that any voice problem that lasts more than a week be investigated medically for possible physical causation and treatment.”
  • Boone, p.7
organic disorders
Organic Disorders
  • RESPIRATION
    • reduced lung volume/elasticity
  • PHONATION
    • interference between folds
  • RESONANCE
    • structural problem, e.g. cleft
    • muscular weakness/incoordination
neurogenic disorders
Neurogenic Disorders
  • 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
functional disorders
Functional Disorders
  • RESPIRATION
    • inadequate/inefficient respiratory patterns
  • PHONATION
    • altered vibratory characteristics of folds
  • RESONANCE
    • altered size and configuration of oropharynx
slide10
VOCAL HYPERFUNCTIONinvolvement 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
respiration
Respiration
  • Speaking on inadequate expiration; improper use of expiration
  • Coordination of inspiration/expiration movement
  • Poor timing/control of expiration
phonation
Phonation
  • Inappropriate pitch level --> unnecessary energy to maintain
  • Hard glottal attack
  • Vocal abuse, e.g.
    • clearing throat
    • smoking
    • excessive volume
slide13
“Voice therapy techniques are primarily vehicles of facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.” Boone, p.15
resonance
Resonance
  • Hypernasality
  • Assimilative hypernasality
  • Cul-de-sac resonance
  • Baby voice
management
Management
  • Identify cause
    • breathing/resonance longstanding
    • phonation usually recent origin
  • Medical evaluation of organic and neurogenic problems
management 2
Management-2
  • “… 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
slp role
SLP Role
  • 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
useful websites
Useful Websites
  • 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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