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CD 508

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

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CD 508

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  2. Chapter 1 The Voice and Voice Therapy: Introduction

  3. 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

  4. 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%

  5. Types of Voice Disorders • ORGANIC • result of structural problems in vocal tract • NEUROGENIC • result of compromise brainstem/spinal column • FUNCTIONAL • nonbiological

  6. “… 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

  7. Organic Disorders • RESPIRATION • reduced lung volume/elasticity • PHONATION • interference between folds • RESONANCE • structural problem, e.g. cleft • muscular weakness/incoordination

  8. 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

  9. Functional Disorders • RESPIRATION • inadequate/inefficient respiratory patterns • PHONATION • altered vibratory characteristics of folds • RESONANCE • altered size and configuration of oropharynx

  10. 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

  11. Respiration • Speaking on inadequate expiration; improper use of expiration • Coordination of inspiration/expiration movement • Poor timing/control of expiration

  12. Phonation • Inappropriate pitch level --> unnecessary energy to maintain • Hard glottal attack • Vocal abuse, e.g. • clearing throat • smoking • excessive volume

  13. “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

  14. Resonance • Hypernasality • Assimilative hypernasality • Cul-de-sac resonance • Baby voice

  15. Management • Identify cause • breathing/resonance longstanding • phonation usually recent origin • Medical evaluation of organic and neurogenic problems

  16. 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

  17. 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

  18. 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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