UNIT E- voice and fluency disorders

phonation

vocal fold vibration provides sounds of spoken language

parts of phonation

air from lungs → trachea → larynx

process of phonation

1. vocal folds close

2. air exhaled through trachea

3. vocal folds blown apart → vibration

voice is further modified by ___ and ___

resonance, articulation

# of vocal fold vibrations per second measured in ___

hertz

frequency

rate of vocal fold vibration, creates pitch

intensity

size of vibrations → loudness

two influences on loudness

1. amount of airflow from lungs

2. amount of vocal fold resistance

three voice descriptors

• breathy

• harsh

• hoarse

what causes breathy voice

vocal folds do not come together fully so air is escaping

harsh voice

VF push together too hard, makes voice grating and raspy

hoarse voice

breathy harshness

causes of resonance disorders

cleft palate, nasal blockage, velopharyngeal incompetence

main articulator for resonance

velum raises to close of nasal cavity for all english sounds except /m,n, n/j/

characteristics of a normal voice

• adequate volume

• good vocal hygiene

• good vocal quality

• flexible

• appropriate to age and gender

vocal hygiene

not putting excess strain on voice, drinking water, avoiding harmful substances such as smokin

disordered voice

anything that deviates from “normal voice”

• draws attention to itself

• result of faulty structure or function somewhere in vocal tract

dysphonia

general term for disordered voice

aphonia

total loss/lack of voice

hyperfunction

too much vocal fold tension or tightness

functional disorders

caused by how a person uses their voice, phonotrauma, conversion disorders

phonotrauma /vocal abuse

screaming, repetitive sounds, cause damage to vocal folds

conversion disorders

physical body reaction to emotional or physical stress

neurogenic disorders

nerve damage (nerve nicked during surgery) and degenerative disease (ALS, Parkinson’s, stroke

organic disorders

acquired/ not born with it

• gastroesophageal reflux

• intubation

• endocrine disorders (someone doesn’t go through puberty)

• cancer

when is surgical closure of cleft palate done in the US

between 9 and 18 months

things to consider in voice assessment

• case history (occupation, traumatic birth, habits of voice use)

• hearing screening

• auditory-perceptual assessment (does it sound appropriate?) 

voice therapy approaches

• focus on vocal hygiene

• eliminate vocal abuse

• auditory feedback (have client listen to voice)

• counseling

• compensatory techniques

normal disfluency

repeating, pausing, revising, interjecting

dysfluency (actual issue)

speech disorder characterized by disrupted rhythm or fluency, sever enough to affect life, AKA stuttering

characteristics of stuttering

• core behaviors=tension of articulators

  • repetition of sounds and syllables

  • prolongation of sounds (blocks and postural fixation)

block

air stuck at place of articulation

postural fixation

articulators are stuck, air still flows

secondary behaviors

eye blink, facial grimace, exaggerated body movement; adopted to get out of stuttering movement; may become permanently associated with stuttering.

associated underlying reactions

• emotional reactions of fear, anxiety, shame

• avoidance behaviors due to expected difficulty talking (avoiding public speaking or job interviews, avoiding certain words)

causes of stuttering

• genetic predisposition: family history, gender

• precipitating factors: enviro factors that trigger disorder like high stress and anxiety

• maintaining factors: panic, self-awareness, misconceptions (“that’s a hard word for me”)

Peters and Guitars 5-level system

1. normal disfluency (18mo-6yrs)

   1. tension free, intermittent

2. borderline stuttering (18mo-6yrs

   1. more freq than normal, unaware

3. beginning stuttering (2-8yrs)- true fluency disorder

   1. tension of articulators during stuttering, consistent, aware

4. intermediate (6-13 yrs)

   1. same as above but with underlying emotional effects

5. advanced (14yrs+)

   1. same as above with underlying dominant fear, life is affected