Voice & Resonance Disorders Practice Quiz 4

Voice therapy is highly individualized, depending on [mark all that apply]:

The cause of the problem

Its maintaining factors

The motivation of the patient

The availability of appropriate management and treatment

Indicate whether these behaviors are evidence-based vocal health challenges

 Use of menthol →  Potential voice health challenge

 Dehydration →  Potential voice health challenge

 Caffeine intake →  Not an evidence based vocal

 Use of steroid inhaler  → Potential voice health challenge

 Smoke exposure  →  Potential voice health challenge

 Character voices → Potential voice health challenge

 Menstrual cycle changes →  Potential voice health challenge

 Dehydration  →  Potential voice health challenge

Match the category of voice treatment to the approach

Medical →  radiation

Environmental →  amplification

Behavioral →  resonant voice training

 Match the voice therapy orientation to an approach that best fits that category.

Symptomatic Voice Therapy →  Auditory Feedback

Hygienic Voice Therapy →  Use of hydration log and humidifer

Physiologic Voice Therapy → LSVT LOUD

Eclectic Voice Therapy →  Resonant voice therapy comb

T/F: Clients with the same voice disorder may require different therapy approaches.

True

Clients benefit from easy to follow/remember guidelines for staying hydrated. Identify a hydration guideline used with clients:
 

2/3 body weight in ounces

 1/2 body weight in ounces

 8x8 rule

 all of the above

all of the above

For clients with voice issues due to poor vocal hygiene, Hygienic Voice Therapy may be insufficient because

 voice disorders are not caused by client behaviors

 clients cannot modify vocal hygiene

 modifying or eliminating the cause of the voice problem cannot improve voice

 the original cause of the voice disorder may no longer be the maintaining factor of the voice disorder

the original cause of the voice disorder may no longer be the maintaining factor of the voice disorder

Voice Facilitation Approaches are used with clients presenting with _____________voice disorders.

functional

organic

neurologic

all of the above

 all of the above

Boone et al consider these approaches to be universally applicable [mark all that apply]

Auditory feedback

Counseling

Elimination of abuses

Focus

Nasal/glide stimulation

Open mouth approach

Relaxation

Visual feedback

T/F: An individual with a high tongue carriage can interrupt the flow of resonance through the oral cavity

True

Nasal-glides are especially facilitative for good voice production because they are

affricates

non-voiced

stops

sonorants

 Sonorants

Good focus of the voice is described as voice coming from the

middle of the mouth, just above the surface of the tongue

throat, just superior to the glottis

back of the mouth, low in the oral cavity

front of the mouth, with the tongue tip forward

middle of the mouth, just above the surface of the tongue

To demonstrate the Voice Facilitating Approach Focus, a clinician could use

 

fingers on the nose/face to feel vibration

 use of nasal sounds to increase vibration

 modeling of increased vibration

 all of the above

all of the above

Your client doesn't understand the reason why you want him to chant. Of the following, which is the best explanation?

This approach will help you to use better velopharngeal valving. It is only a temporary way of talking. It will not become a permanent way of talking.

This approach will help take the effort out of talking and achieve a more resonant voice. It is only a temporary way of talking. It will not become a permanent way of talking.

This approach will help you get into your falsetto voice. It is only a temporary way of talking. It will not become a permanent way of talking.

This approach will help you to hear the effort you are using so that you may decrease it. It is only a temporary way of talking. It will not become a permanent way of talking.

This approach will help take the effort out of talking and achieve a more resonant voice. It is only a temporary way of talking. It will not become a permanent way of talking

Chant Talk draws upon the principles of

vibrato

glottal fry

falsetto

legato

 Legato

Optimum habitual pitch

Is variable

Is difficult to identify and sustain with digital technology

Is absolute

Is least fatiguing at the bottom of the speaker’s pitch range

 Is variable

The Voice Facilitating Approach of Chewing

Is specifically directed toward relaxing the pterygoid muscles

Does not require client voicing

Was introduced by Hoit and Hixon

Relaxes the overall vocal tract

 Relaxes the overall vocal tract

T/F: Negative practice should be avoided in voice therapy due to risk of practicing in non-target voice.

False

T/F: The pharynx is dilated during the yawn-sigh.

True

Glottal fry

is a poor index of vocal fold relaxation

is achieved on inhalation only

lengthens the thyroarytenoid muscles

requires little subglottic pressure

 requires little subglottic pressure

T/F: Sometimes it is desirable to teach glottal fry phonation, because this mode requires very relaxed vocal folds and reduces hyperfunction.

True

Masking works on the principles of

Bernoulli

Lombard

Talbolt

van den Berg

 Lombard

The Open-Mouth Approach

Minimizes vocal amplitude

 Increases oral resonance

 Increases nasal resonance

 Increases oral resistance

 Increases oral resonance

The tongue protrusion /i/ approach

 Narrows the laryngeal aditus

 Is designed to reduce the space of the pharyngeal resonating cavity

 Is not appropriate for clients with long-standing ventricular phonation

 Pulls the base of the tongue up and forward

 Pulls the base of the tongue up and forward

Visual Feedback in voice therapy uses

 mirror

 VisiPitch

 drawing

 any of the above

any of the above

T/F: Hierarchy analysis is often helpful for dealing with vocal inconsistencies experienced while talking with different people in various situations.

 True

 An effective Redirected Phonation task would feasibly be a 

 Clinician-directed interview

 Kazoo

 Procedural description

 Reading passage

Kazoo

Using non-communicative voicing (i.e., cough) to shape speaking voice

 is called inhalation phonation

 is used with functional aphonia

 should be used in later voice therapy sessions

 none of the above

 is used with functional aphonia

Confidential Voice is

 Good for increasing speaking rate

 The same as a whisper

 Associated with relaxed supralaryngeal structures

 Understood and produced by adults only

 Associated with relaxed supralaryngeal structures

 Confidential voice may be described as a voice that one could use

 in a library

 with a baby sleeping

 if one was talking to someone near but trying not to be heard by someone farther away

 all of the above

 all of the above

T/F: Confidential voice is the same as a whisper.

False

Resonant voice techniques aim to increase the power and clarity of the voice while decreasing the  vibratory forces that can contribute to mucosal trauma. The goal is to create an optimal pressure balance between the lung pressure below the vocal folds, the air pressure in the vocal tract above the glottis, and the vocal fold resistance to the airflow. Order the 7 stages of Resonant Voice Therapy (RVT).

1.  non-linguistic voiced sounds 

2.  voiced and voiceless contras

3.  chanting, then forward focus 

4.  combine phrases into paragra

5.  controlled conversation with f

6.  environmental manipulation

7.  emotional manipulation

T/F: Clinicians must be certified to administer Resonant Voice Therapy (RVT).

 False

Vocal Function Exercises (Stemple, 1994) are done twice a day using the sound

 'eee'

 'knoll'

 'ol'

 all of the above

all of the above

Semi-Occluded Vocal Tract (SOVT) exercises

 may facilitate resonant voicing

 improve vocal economy by using back-pressure air to improve vocal fold valving and vibration

facilitate optimal phonation using neutralized level of adduction (not to pressed, not too breathy)

 all of the above

all of the above

Semi-Occluded Vocal Tract Exercises (SOVTEs)

is a new evidence-based technique in voice therapy

uses increased pressure above the vocal folds to improve vibration of the vocal folds

are most useful with organic voice disorders

require straws to complete

 uses increased pressure above the vocal folds to improve vibration of the vocal folds

T/F: SOVT exercises with the greatest occlusive effect would be the most representative of speech.

 False

Digital manipulation

 Lengthens the vocal folds

 Should only be performed to assess the vertical position of the larynx in the neck

 Remediates all dysphonias through one, identical procedure

 Can help medialize the vocal folds in some cases of unilateral vocal fold paralysis

 Can help medialize the vocal folds in some cases of unilateral vocal fold paralysis

Digital manipulation may include

Gently nudging thyroid cartilage inward, to shorten VF length; used for puberphonia

Gently nudging thyroid cartilage, to decrease laryngeal tension; used for muscle tension dysphonia

Gently pushing lateral thyroid wall inward, to approximate VF; used for VF paralysis

All of the above

 All of the above

 Digital Manipulation may be an effective therapy technique for clients with 

 Puberphonia

 MTD

 Unilateral Vocal Fold Paralysis

 All of the above

 All of the above

 Laryngeal Massage

 Can only be performed by the clinician

 Elevates the larynx

 Takes several sessions to complete

 Can be attempted if the yawn-sigh is not successful in lowering the larynx

Can be attempted if the yawn-sigh is not successful in lowering the larynx

Digital Manipulation/Laryngeal Massage should only

be performed by an ENT

be performed paired with vocalizations to support muscle relaxation during phonation

be performed to assess position of the larynx within the neck

be performed in medical facilities

be performed paired with vocalizations to support muscle relaxation during phonation

Conversational Training Therapy (CTT) focuses on voice awareness and production in patient-driven conversational narrative, without the use of a traditional therapeutic hierarchy. Match the CTT fundamentals to the clinician statements during a session that best represent the CTT technique.

Clear speech → Say that using your "clear" voice

Auditory and kinesthetic awareness →  How did that feel? How did that sound?

Negative practice/labeling →  What would you call that voice you don’t want to use. Say that in the “creaky” voice

Embedding basic training gestures into speech →  Tell me about your work. When I give you the thumbs up, use the “clear” voice. When I give you the thumb down, use the “creaky” voice

Prosody, projection and pauses →  Great, now use that "clear" voice with some inflection and so I can hear you across the room

Rapport building  →  That is so interesting. I feel like that too. Tell me more.

 The following are main features of which therapy approach:

•  move clients to conversational practice sooner

•  segmentation may impede generalization

•  therapy tasks must be contextually relevant

 Accent method

 CTT

 RVT

 LSVT

CTT

T/F: A speech-language pathologist may begin voice therapy for a client with a voice disorder prior to a medical examination and laryngeal imaging.

False

 Lack of response to a stimulability technique may indicate

presence of an organic disorder

reduced ability to volitionally vary vocal features

inappropriate choice of approach, poor clinician instructions, or insufficient client training

all of the above

all of the above

LSVT LOUD focuses on increasing vocal loudness by safely increasing phonatory effort. Foundational principles of LSVT include [mark all that apply]

Simplicity, redundancy and intensity of practice may help with processing speed, memory and executive function deficits

Client's sensory perception of ‘effort’ is reduced and needs to be calibrated

Reduced amplitude of neural “drive” affecting the muscles of the speech mechanism can be increased

Recalibrated sense of speech/voice effort may help achieve appropriate levels of speech intensity

Simplicity, redundancy and intensity of practice may help with processing speed, memory and executive function deficits

Client's sensory perception of ‘effort’ is reduced and needs to be calibrated

Reduced amplitude of neural “drive” affecting the muscles of the speech mechanism can be increased

Recalibrated sense of speech/voice effort may help achieve appropriate levels of speech intensity

 LSVT LOUD addresses

 phonatory effort

 sensory perception

 amplitude of movement

 all of the above

all of the above

T/F: PhoRTE is an adapted LSVT program for pediatric populations.

False

 Match the session examples to the therapy strategy/teaching behavior.

"Do what I do... How is your day?" (in a loud voice) →  Direct Model

Using exaggerated pitch inflection when explaining activity targeting pitch variation →  Indirect Model

"Keep it smooth and flowy"  →  Cue

"That was good it sounded clear and precise"  →  Target-Specific Feedback

T/F: Research indicates that telehealth is an effective service delivery option for voice therapy.

True

Counseling

Requires that the patient admit that he or she is responsible for the voice disorder before remediation can begin

Is not appropriate during voice therapy

Is best done in large groups

Is important to combine with symptomatic voice therapy for optimal client outcomes

Is important to combine with symptomatic voice therapy for optimal client outcomes

T/F: Personal adjustment counseling (addressing feelings, emotions, thoughts, and beliefs expressed by individuals and their families/caregivers about voice) is within the scope of practice of the speech language pathologist.

True

 Referral to a licensed mental health professional may be indicated if

 Client reports reports recurrent thoughts of death

 Client shows signs of persistent depression

 Client has a conversion disorder

 All of the above

 All of the above

Progress in voice therapy is

Optimally measured with instrumentation

Primarily determined by laryngeal imaging

Supported by numerous group-controlled efficacy studies

Reflected through a battery of post assessments, the patient’s self-perception of voice and quality of life surveys

Reflected through a battery of post assessments, the patient’s self-perception of voice and quality of life surveys

T/F: Voice is not protected health information (PHI) if the individual doesn't say their last name.

False

Self-efficacy is the belief in one’s ability to successfully carry out or change a specific behavior. It is directly proportional to the likelihood that a person will seek treatment & complete a treatment program. Clinicians can encourage therapy attendance & successful outcomes by

scheduling clients for an evaluation at earliest date possible

using ‘empowering’ and non-judgmental language with clients

educating clients on the necessity of the voice therapy

all of the above

 all of the above

Self-efficacy is the belief in one’s ability to successfully carry out or change a specific behavior. 

 True

 False

True

Adherence to voice therapy may be improved by

use of ‘empowering’ and non-judgmental language when speaking with patient

patient education on the necessity of the voice therapy 

relating outcomes in voice therapy to therapy attendance/adherence 

all of the above

 all of the above

Which of the following is not considered a key to success in voice therapy?

 Client motivation

 Client self awareness of voice

 Sufficient anatomy

 Good understanding of voice by clinician

 All of these are important factors in a successful voice therapy program

All of these are important factors in a successful voice therapy program