Voice 1 (anatomy, VF movement, evaluation)

What muscle contributes to abduction of the vocal folds?

Posterior cricoarytenoid

What muscles contribute to adduction?

Lateral cricoarytenoid and interarytenoid

What muscles contribute to pitch changes?

Cricothyroid muscle, thyrovocalis, and thyromuscularis

What layers make up the cover part of the cover-body model?

The epithelium, superficial lamina propria, and intermediate lamina propria

What layers make up the body part of the cover-body model?

The deep lamina propria and the muscle

True or false - the lamina propria are muscular layers

False - they are nonmuscular tissues

True or false - the vagus is contralaterally innervated

False - it is bilaterally innervated

Why it is important that the vocal folds are bilaterally innervated?

Redundancy provides airway protection

True or false - the CNS control of the voice is well understood

False

What are the three evaluation components that can be done prior to the evaluation by the SLP?

Patient questionnaire, patient survey, and visualization of the larynx.

What must be done before the SLP makes any conclusions/recommendations from a voice evaluation?

A comprehensive medical examination of the voice-disordered patient is necessary to confirm or rule out certain medical conditions that may require referrals to the appropriate specialists (this includes a general physical, thorough ear nose and throat evaluation, and visual inspection of the larynx)

What is the gold standard for laryngeal visualization?

Video stroboscopy

What should be done during the voice evaluation by the SLP?

Review of auditory and visual status, case history, behavioural observation, auditory perceptual ratings, voice related QoL, laryngoscopy, acoustic analysis, aerodynamic analysis, phonatory respiratory efficiency, voice dosage

True or false - dysphonia negatively impacts a child's educational development, psychosocial development, emotional health, and physical health

True

True or false - we should build a voice screener into our speech and language screeners for kids

True

Why is case history the key to successful voice management?

Because this is when you develop a client-clinician relationship that results in buy-in - which you absolutely need for voice therapy

What is the main goal of your first interaction with a client?

Client empowerment - empowerment is often highly correlated with perceived control and this is important for buy in

True or false - acoustic measures are diagnostic on their own

False - they are not diagnostic but can be supportive

True or false - a lower cepstral peak prominence measure is associated with a more dysphonic voice

True

If we have acoustics, why can't we get rid of the perceptual evaluation?

Because the relationship between acoustic and perceptual evaluation are largely inconclusive - essentially our perception is so complex we have not figured out how to model is mathematically yet

Talbot's Law (how stroboscopy works)

When the human eye is presented with an image, the image lingers on the retina for 0.2 seconds after exposure, because the eye can perceive no more than 5 distinct images per second, sequential images produced at intervals shorter than 0.2 seconds fuse with successive images to produce the optical illusion of apparent movement

True or false - judgements or vibratory behaviour must be made in glottal fry

False - judgements must be made in modal pitch

True or false - judgements about vibratory behaviours must be made at average loudnes

True

What are the six patterns of glottic closure?

Complete, incomplete, bowed, hourglass, anterior gap, posterior gap

What are the six terms we can use to describe vocal fold edges?

Smooth, rough, irregular, excrescence, edema, erythema

What is vocal fold amplitude?

The extent of lateral excursion from midline

What is the ballpark normal for vocal fold amplitude?

1/3 the width of visible portion of the vocal fold

What is the mucosal wave of a vocal fold?

The longitudinal flexibility of the fold

What is phase symmetry of the vocal folds?

The degree to which the two folds appear as mirror images of one another

What s phase closure of the vocal folds?

The ratio of open to closed phase

In what cases might open phase be increased?

Presbylarynx, glottal lesion, paralysis

In what cases might closed phase be increased?

Hyperfunction

What is vertical level approximation of the vocal folds?

How the vocal folds are meeting on a vertical level

In what cases might you see vertical discrepancy?

Unilateral paralysis and cricoarytenoid joint injury

If voice quality is worse in the morning what could this mean?

Post nasal drip or night time laryngopharyngeal reflux

True or false - detailed history often suggests the cause of a voice disorder

True

What is the most important procedure of a voice evaluation?

Visual inspection of the larynx

Why is it important to review the hearing acuity of a person with a voice disorder?

Hearing acuity is important in regulating one's own voice production, and hearing loss can alter respiration, phonation, resonance, and prosody

True or false - people with hearing loss are more likely to have dysphonia than those without hearing loss

True

Why is it important to review the visual acuity of a person with a voice disorder?

Decreased visual acuity may lead a patient to misjudge their distance from the listener and to alter their voice in ways that are detrimental, additionally, visual feedback is often important in voice therapy

What are the five stages in motivational interviewing?

Precontemplation, contemplation, preparation, action, and maintenance

What is the main goal of motivational interviewing for voice therapy?

Finding out what is intrinsically motivating to them - you don't want them doing therapy to get a "gold star" or there won't be long-term buy in

What is a patient's reality distance?

When a patient feels the problem is not consistent with the opinions of the clinician (can be due to lay background or reluctance to accept with real problem)

How do you use an oral mechanism exam to check for potential MTD?

Accessory muscles might stick out, mandibular restriction during speech, excessive elevation or lowering of the larynx, inability to move the larynx side to side upon palpation

What does the CAPE-V do?

A clinician uses it to judge six aspects of voice (overall severity, roughness, strain, breathiness, loudness, and pitch) by placing a tick mark on a 100 mm horizontal line

What three aspects of fundamental frequency are commonly assessed?

Average fundamental frequency (the number of cycles of vocal fold vibration per second), frequency variability (standard deviation from the average fundamental frequency), and maximum phonational frequency range (lowest tone of modal to highest tone of falsetto)

What is a spectrogram?

A visual representation of the frequency and intensity of the sound wave as a function of time

What is a person's "best pitch"?

A person's easiest and most compatible voice pitch level

Why should speaking fundamental frequency interpreted with consideration of how it was elicited?

SFF differs across social contexts and depending on the communication partner

Why would Fundamental frequency SD be greater in connected speech compared to sustained vowels?

Fundamental frequency SD in connected speech can be impacted by the speaker's mood causing it to be greater

What is a normal maximum phonational frequency range?

Two and a half to three octaves

Jitter

Short term variability in fundamental frequency

Shimmer

Short term variability in amplitude

Do you want a high or low harmonics to noise ratio?

High

What is the harmonics to noise ratio?

The ratio between periodic and aperiodic components of speech sound

Clavicular Breathing

Inefficient type of breathing where the patient elevates the shoulders on inspiration, using the neck accessory muscles as the primary muscles of inspiration, bad for voice

Thoracic Breathing

Expansion of the thorax and contraction of the abdomen during inspiration, reversed during expiration

Diaphragmatic-Abdominal Breathing

Abdominal and lower thoracic expansion upon inspiration with little to no upper chest movement

Electroglottogram

Summary information about vocal fold contact over time

What can an electroglottogram be used for?

To visualize various types of voice quality