comd 472 PPT 5 Voice Assessment (Pt. 2)

What are the components of clinical measurements? 

• Acoustic measurement 

• Physiological aerodynamic measurement 

• Neural control 

What are the different types of instrumental assessment?

• Acoustic assessment 

• Aerodynamic assessment 

• Videostroboscopy 

• Electroglottography EEG

• Electromyography EMG 

What are the principles of instrumental assessment? 

1. Calibration 

2. Standardization of measurement techniques 

3. Data interpretation

4. Reliability of measures

5. Examiner training 

6. Hygiene 

What are the equipment considerations for instrumental assessments?

1. Sound isolation, ambient room noise

2. Microphone choice

3. Sound level meter choice

4. Cable choice

5. Computer specifications 

6. Recording software 

7. Choice of video recorder and software 

What are the rationale for the choice of instruments?  

• Perceptual signs should be verified and supported by acoustic/aerodynamic methods 

• Noninvasive

• Good availability of relatively low cost 

• Correspondence with the underlying physiology of voice disorders 

• Good applicability to future therapy goals

• Allows for comparison of vocal performance to normative data 

What are some equipment and materials for acoustic and aerodynamic analysis?

• Computer

• Acoustic and aerodynamic analysis software 

• Aerodynamic hardware 

• A good quality microphone 

• A sound level meter (SLM)

• Stopwatch 

  • ruler/tape measure 

• Good quality digital recorder 

• Stimulation probes

• 
  

What are stimulation probes?

These are physical oral-motor tools used for tactile feedback, electrical stimulation devices for muscle or nerve activation, ultrasound imaging tools for tongue placement, or data collection tools to track student progress 

What are acoustic evaluations?

These are assessments of the voice using measurable sound characteristics to understand how a person produces their voice. They can help evaluate pitch, loudness, voice quality, and vocal function.

What is fundamental frequency and what does it tell us?

• Fundamental frequency is the rate at which the vocal folds vibrate per second, measured in Hertz (Hz).

• It is the main acoustic measure associated with how high or low a person's voice sounds.

What are the clinical measurements of fundamental frequency?

• Habitual pitch / Average Speaking Fundamental Frequency (SFF)

• Pitch range / Maximum Phonation Frequency Range (MPFR)

• Pitch variability

What is habitual pitch or the average speaking fundamental frequency?

• The average rate of vocal fold vibration during a person's normal, everyday speech.

• It reflects the pitch a person typically uses when speaking comfortably.

How would a clinician find the habitual pitch of their client?

A clinician may ask a person to speak naturally and measure the average pitch of their voice.

What is pitch range or a maximum phonation frequency range (MPFR)

• The range of frequencies a person can produce, from their lowest achievable pitch to their highest achievable pitch.

• It helps assess the flexibility and range of the person's voice.

• This is often used to refer to the frequency range measured during phonation; terminology can vary between clinical settings.

How is one way a clinician could find a client’s pitch range?

A clinician may ask the person to glide from their lowest pitch to their highest pitch.

What is pitch variability?

• The degree to which a person's pitch rises and falls during speech or singing.

• It reflects the ability to vary pitch to express emotion, emphasize words, and create natural speech intonation.

What is an example of pitch variability?

Saying a sentence with rising and falling pitch demonstrates pitch variability, while speaking with a nearly constant pitch demonstrates limited pitch variation.

What are some methods of eliciting speaking fundamental frequencies?

• Speaking tasks

• Speaking durations

• Social contexts

What are some speaking tasks?

• Ask the person to read a passage, repeat sentences, count, or speak spontaneously.

• Different tasks help determine whether speaking pitch changes depending on the activity.

how long are the speech samples and why choose different speaking sample durations?

• Collect speech samples lasting 1, 5, 15, 30, or 60 seconds.

• Short samples provide a brief snapshot of speaking pitch, while longer samples may provide a more representative average of habitual pitch.

• The duration selected depends on the clinical purpose and the person's ability to sustain the task.

What are some types of social contexts and why are social contexts important for speaking fundamental frequency?

• Assess speech in different situations, such as a formal conversation, casual conversation, or speaking with friends.

• This helps determine whether a person's pitch changes depending on the social setting.

What are some tools used to assess or estimate pitch?

• Piano or keyboard

• Pitch pipe

• Apps

• Visi-Pitch

• Praat

How is a piano or keyboard used to assess pitch?

• Used to compare a person's voice pitch with known musical notes.

• Each musical note corresponds to a specific frequency in Hz.

• This can help a clinician identify or approximate the pitch a person produces.

How is a pitch pipe used to to assess pitch

• Produces a reference pitch that the person can match with their voice.

• It can help with pitch matching and vocal exercises.

How can different apps assess pitch?

• Can estimate vocal pitch and display frequency measurements.

• Their accuracy depends on the app, recording conditions, and the type of voice sample.

What is Visi-pitch and how can it assess pitch?

• A computerized voice-analysis system used in clinical settings.

• It can provide visual feedback about vocal characteristics, including pitch and pitch variation, depending on the system and configuration.

What is Praat and how does it assess pitch?

• A speech-analysis software program used to analyze recorded voice samples.

• It can measure fundamental frequency, display pitch contours, and help clinicians examine how pitch changes over time.

What is habitual or conversational intensity?

• The typical loudness level a person uses during everyday speech and vocalizations.

• It is the person's usual or automatic speaking volume during normal conversation.

What is intensity variability?

• The degree to which a person's loudness changes during speech.

  • Example: A person may speak softly when sharing something personal and become louder when emphasizing an important point.

What is intensity stability?

• How consistently a person maintains their loudness during speech.

  • Example: A person who maintains a relatively even volume throughout a sentence

What is intensity range?

• The range between the softest and loudest vocal intensity a person can produce.

• It measures the person's ability to vary vocal loudness.

• Indicates the ability to produce both softer and louder vocalizations, although the expected range depends on the individual and testing conditions.

How do you measure intensity?

• Commonly measured in decibels (dB).

• Measurements can help clinicians evaluate conversational loudness, changes in loudness, and the minimum or maximum intensity a person can produce.

• Accurate measurements depend on factors such as microphone distance, background noise, room acoustics, and the equipment used.

What are some instruments used to measure intensity?

• Sound level meter

• Computer programs

• Nagashima Phonatory Function Analyzer

What does a sound level meter do?

• Measures the sound pressure level of a person's voice in decibels (dB).

• Can be used to assess how loud a person's voice is during speech.

• The distance between the speaker and the meter should be kept consistent for reliable comparisons.

How can clinicians use computer programs to measure intensity?

• Software can analyze recorded speech and display measurements of vocal intensity over time.

• Clinicians can use these measurements to examine loudness levels and variations during speech.

What is a Nagashima Phonatory Function Analyzer and what does it do?

• A specialized instrument used to assess aspects of vocal function.

• Depending on the model and setup, it can measure parameters such as sound pressure level (intensity), fundamental frequency, and airflow during phonation.

• These measurements help clinicians evaluate vocal performance and function.

What is perturbation?

• Small, rapid variations or irregularities in a signal or system.

• In voice: Refers to cycle-to-cycle variations in the vocal signal as the vocal folds vibrate.

• These measurements help clinicians evaluate the regularity of vocal fold vibration and identify possible abnormalities in voice production.

What are the types of perturbation?

• Jitter

• Shimmer

What’s a jitter?

• Small, rapid variations or irregularities in a signal or system.

• In voice: Refers to cycle-to-cycle variations in the vocal signal as the vocal folds vibrate.

• These measurements help clinicians evaluate the regularity of vocal fold vibration and identify possible abnormalities in voice production.

• Example: If the vocal fold vibration rate changes slightly between consecutive cycles, ____ increases.

What’s a shimmer?

• Measures small, cycle-to-cycle variations in the amplitude (intensity) of the vocal signal.

• In simple terms, it measures how consistently the loudness or amplitude of successive vocal cycles is maintained.

• Example: If the amplitude of each vocal cycle varies slightly, ___ increases.

What is a sound spectrography?

• A method used to visually analyze the characteristics of a person's voice.

• It creates a graphic representation of sound, showing how frequency and intensity change over time.

• Clinicians use it to examine speech sounds and identify patterns in the voice.

What is a spectrogram?

• The visual graph produced through sound spectrography.

• It shows the different components of a sound and how they change over time.

What are the three main parts of spectrogram?

• Vertical axis (up and down)

• Horizontal axis (left to right)

• Darkness of the trace

What does the vertical axis of a spectrogram represent?

• Measured in Hertz (Hz).

• Shows the frequencies present in the sound.

• Higher on the graph means higher frequency, while lower on the graph means lower frequency.

What does the horizontal axis of a spectrogram represent?

• Shows how the sound changes as time passes.

• Moving from left to right represents the progression of the sound during speech.

What does the darkness of the trace represent on a spectrogram?

• Shows the relative strength of the sound energy at different frequencies and times.

• Darker areas generally indicate stronger sound energy.

• Lighter areas indicate weaker sound energy.

What is the harmonic to noise ratio?

• HNR measures the amount of harmonic sound compared with noise in a person's voice.

• Think of it like listening to a clear song with background static. HNR tells us how much the clear sound stands out compared with the noise.

What are harmonics?

These are the regular vibrations that create the main, pitched part of the voice.

What does noise mean?

This is the irregular sound energy that can make the voice sound breathy, rough, or hoarse.

How would you measure the harmonics to noise ratio?

• This is measured in decibels (dB).

• It compares the strength of the harmonic components with the noise components in the voice signal.

What does a higher harmonics to noise ratio mean?

• Means there is more harmonic sound compared with noise.

• The voice signal is generally more periodic and less noisy.

• Example: A clear, steady “aaaaah” sound may have a ___ HNR.

What does a lower harmonic to noise ratio mean?

• Means there is more noise relative to the harmonic sound.

• The voice may sound breathy, hoarse, or rough.

• Example: A voice with a lot of audible breathiness may have a ___ HNR.

What are the normal values for the harmonics to noise ratio and what are some things to consider?

• A value of approximately 12 dB or greater is sometimes used as a general reference for a typical HNR.

• However, normal values depend on the measurement method, software, speech task, and individual.

• Children and older adults may have different HNR values because voice characteristics change with age; lower values are not automatically abnormal.

What are the clinical uses for the harmonics to noise ratio?

• Helps clinicians assess the noisiness and periodicity of a voice.

• It is often used alongside other acoustic measurements, such as jitter, shimmer, and fundamental frequency.

• Cannot alone diagnose a voice disorder or determine its severity.

What is the purpose for a physiological/aerodynamic evaluation, measuring lung volumes and capacities?

• Assesses how the body uses air to produce voice and speech.

• Clinicians examine breathing, airflow, and air pressure to understand how well a person supports their voice.

What is lung volume?

• The amount of air in the lungs at a particular time.

• Different volumes describe how much air is inhaled, exhaled, or remains in the lungs.

• Example: Taking a deep breath before speaking increases the amount of air in your lungs.

What is lung capacity?

• The total amount of air represented by a combination of two or more lung volumes.

• Varies depending on factors such as age, body size, sex, physical fitness, and respiratory health.

• Vocal training can help a person use their available air more efficiently when speaking or singing.

• Example: A trained singer learns to control their exhalation to sustain a long note.

What is the spirometry and what does it measure?

• A common medical test used to assess lung function.

• Measures how much air a person can inhale or exhale and how quickly they can move that air.

What is a wet spirometer?

• Uses a water-sealed chamber to measure the volume of air breathed in or out.

• Air entering the device moves the chamber, allowing the volume of air to be measured.

• Measures air volume using a water-based mechanism.

What is a dry spiral meter

• Measures the volume of air breathed in or out without using a water-sealed chamber.

• Uses a mechanical or electronic system, such as a movable piston, bellows, or flow sensor, to measure the air.

• Many modern ___ spirometers can also calculate airflow speed and display results electronically.

• Measures air volume using a non-water-based mechanism.

Why is it important to measure lung function?

• The lungs provide the airflow needed for speaking and singing.

• Helps clinicians understand whether a person has adequate respiratory support for voice production.

What is air pressure?

The force created by air moving from the lungs through the respiratory system to produce voice..

How is air pressure relevant to speech?

The air pressure below the vocal folds helps them vibrate and create sound

What are the different types of breathing patterns?

• Clavicular breathing

• Thoracic breathing

• Abdominal/diaphragmatic

What is clavicular breathing?

Breathing that involves noticeable movement of the upper chest and shoulders.

What is thoracic breathing?

Breathing that primarily involves movement of the chest or rib cage.

What is abdominal/diaphragmatic breathing

Breathing that involves movement of the diaphragm and abdomen, allowing the lungs to expand efficiently.

How do you measure air pressure for Speech?

• Air pressure is commonly measured in cm H₂O (centimeters of water).

• The pressure required for speech depends on the task, including syllable stress and loudness demands.

• Example: Saying a strongly emphasized syllable or speaking loudly generally requires greater subglottal pressure than speaking softly.

What is an esophageal balloon

• A small balloon catheter is placed in the esophagus to estimate pressure changes inside the chest.

• These pressure changes can be used to estimate subglottal pressure (Ps) during certain speech tasks.

• This is an indirect measurement; the balloon does not directly measure pressure beneath the vocal folds.

What is airflow in speech?

• The amount of air moving through the vocal tract per unit of time during speech or voice production.

• It helps clinicians understand how efficiently a person uses air to produce sound.

How would you measure airflow?

• Commonly measured in cc/sec (cubic centimeters per second), also written as mL/s.

• It is often measured while a person sustains the vowel /a/ (as in “ah”).

• Children and older adults: May show higher airflow under some conditions, depending on age, vocal development, and vocal-fold function.

What is translating airflow and how does it help clinicians?

• The air that passes through the opening between the vocal folds (the glottis).

• Measuring it helps clinicians determine how much air escapes during voice production.

How does pressure difference influence, Speech?

• Voice production depends on the pressure difference between the air below the vocal folds and the air above them.

• During certain speech tasks, such as producing /p/ in a suitable syllable, oral pressure can help estimate sub-glottal pressure when the vocal folds are appropriately open.

• Ps is higher than Po, meaning pressure below the vocal folds exceeds pressure in the mouth and drives airflow outward.

What is Ps?

Subglottal pressure: Air pressure below the vocal folds.

What is Po?

Oral pressure: Air pressure inside the mouth.

What are a couple ways to measure air pressure and airflow?

• High–quiet singing or the “Happy Birthday” song

• Subglottal pressure (Ps) and airflow instrumentation

How does high quiet singing or the “happy birthday song” measure air pressure and airflow?

• These tasks may be used to examine how a person coordinates breathing, airflow, and vocal-fold function.

• Sustained vowels and carefully selected speech syllables are often more suitable for specific aerodynamic measurements.

• The clinician observes how well the person balances the air pressure from the lungs with the resistance created by the vocal folds.

What are subglottic pressure and airflow instruments and what do they do?

• Specialized equipment measures pressure and airflow during speech or sustained phonation.

• These measurements help evaluate the balance between subglottal air pressure (the force pushing air upward) and glottal resistance (the resistance created by the vocal folds as they come together).

What are some instruments used to measure air pressure and airflow in speech?

• Kay Elemetrics Aerophone

• Glottal Enterprises systems

• Pneumotachograph

• Rothenberg mask

 What is a Kay Elemetrics Aerophone and what does it measure?

• A voice-analysis system used to assess aerodynamic aspects of voice production, depending on the model and configuration.

• Can be used to measure or analyze airflow and pressure-related measures

What are Glottal Enterprises systems and what do they measure?

• Specialized equipment used for aerodynamic voice assessment.

• Can measure parameters such as airflow, oral pressure, and estimated subglottal pressure, depending on the setup.

What is a Pneumotachograph and what does it measure?

• A device that measures airflow as air passes through a tube containing a resistance element, such as a mesh screen.

• The pressure difference across the resistance is used to calculate airflow.

• Measures how much air moves and how quickly it moves.

What is a Rothenberg mask and how does it help clinicians?

• A mask placed over the nose and mouth that can be fitted with pressure and airflow sensors.

• Measures airflow and, with appropriate instrumentation, pressure-related signals during speech.

• Helps clinicians study how air is used during voice production.

What is the main idea of aerodynamic evaluations?

They examine how breathing, air pressure, airflow, and vocal-fold resistance work together to produce voice efficiently.

Why do clinicians take duration measurements of a client‘s voice?

• Measure how long a person can sustain a sound or perform a vocal task.

• Help clinicians assess glottic competence and the coordination between the respiratory system (breathing) and the phonatory system (voice production).

What is glottal competence?

Refers to how effectively the vocal folds come together to control airflow during voice production.

What are some clinical tasks to measure duration?

• Coughing

• Throat clearing

• Hard glottal attacks

How does a patient coughing help clinicians?

Helps the clinician observe how effectively the vocal folds close and how air pressure is released.

How does a patient clearing their throat help clinicians?

• Allows the clinician to observe vocal-fold closure and coordination.

How does a patient performing a hard attack help clinicians?

• The patient begins a vowel sound with a firm, abrupt closure of the vocal folds followed by the release of sound.

• Helps the clinician assess how the vocal folds come together at the start of phonation.

What is maximum phonation time?

The longest amount of time a person can sustain a vowel sound using one breath.

How do you measure the maximum phonation time?

• Ask the patient to take a deep breath.

• Have them sustain the vowel /a/ (as in “ah”) for as long as comfortably possible.

• Record the duration in seconds.

• Usually, the task is repeated, and the clinician records the best or otherwise specified trial.

What does the maximum phonation time tell us?

• Provides information about breath support and how efficiently the respiratory and phonatory systems work together.

• A shorter-than-expected MPT may be associated with reduced breath support, air leaking through the vocal folds, or other respiratory or voice-related factors.

Is there a normal maximum phonation time? Why or why not?

Varies with age, sex, body size, respiratory health, and testing procedures, so there is no single normal value for everyone.

What is the S/Z Ratio?

• A screening measure that compares how long a person can sustain the sounds /s/ and /z/.

• It is sometimes used to screen for possible difficulties with vocal-fold function.

How do you measure a S/Z Ratio?

• Ask the patient to take a deep breath and sustain /s/ for as long as possible.

• Repeat the task twice and calculate the average duration.

• Repeat the process with /z/.

• Divide the average /s/ duration by the average /z/ duration.

Why use /s/ and /z/ in the ratio?

• /s/ is an unvoiced sound, so the vocal folds do not vibrate during its production.

• /z/ is a voiced sound, so the vocal folds vibrate while air passes through them.

• Comparing the two provides a rough way to examine the relationship between airflow, breath support, and phonation.

What are the limitations to the S/Z Ratio?

• This is a simple screening measure, not a definitive diagnostic test.

• It has limited accuracy when used alone and is not considered a reliable standalone measure of vocal-fold pathology.

• It is best interpreted alongside MPT, perceptual voice assessment, and other clinical findings.

What does a neural control evaluation assess and how does it help clinicians?

• Assesses how well the nervous system controls the muscles involved in speech and voice production.

• Helps clinicians evaluate the speed, coordination, and accuracy of laryngeal movements.

What is Laryngeal DDK (Diadochokinesis) and what does it help with?

• The ability to produce rapid, repeated movements or sounds in a coordinated way.

• It helps assess how quickly and accurately the vocal folds can coordinate their movements.

How is Laryngeal DDK performed?

• The clinician asks the patient to rapidly repeat vowel sounds such as /a/ and /i/.

• The clinician listens to the sounds and observes how consistently and smoothly the patient produces them.

• The clinician may assess the speed, regularity, and coordination of the vocal activity.