Lecture 4

Pregunta	Respuesta
The voice evaluation	1. case history 2. assessment - perceptual & instrumental 3. written report
interview process	relationship nature and history of Ps problem Attentive and sensitive listening
What does P bring to interview	anxiety personal history of problems previous contact with health professionals personal needs culture need for support and guidance
responsibilities of SP	conduct interview smooth focus sensitivity no personal feelings open and accepting
Case history	bibliographic info P description of problem, and cause general health status, onset of problem, duration, symptoms, variability vs consistency, voice use, social, recreational, vocational, effect of VD on life, peoples reactions
psychological assessment	assess Ps perception of the the impact of VD on daily life
VHI subscales	(voice handicap index) functional - describe impact on daily life Physical - represent self-perceptions of discomfort and voice emotional - represent Ps affective response to VD
VHI scoring	0=never 1=almost never 2=sometimes 3=almost always 4=always
PVHI	paediatric voice handicap index
S/Z ratio	calculated by averaging 3 trials of each sound and s/z
maximum duration sustained phonation	holding sounds for as long as you can
sound judgement	computer program designed for training perceptual assessment skills in voice
pitch	high or low speed of vibration intonation=normal variations abnormal=monotone or excess variability modal & Variability- oral reading and conversational tasks pitch range
loudness	interaction between subglottal pressure and degree of VF adduction. soft voice=subglottal pressure + inadequate aduction modal & variability - same as pitch range - count to 20 increasing vol.
quality	clarity of voice conversation or oral reading
breathy	audible escape of air during phonation incomplete adduction of VF whisper=breathy+strained hoarseness=breathy+strained+rough
strained	sounds like excessive vocal effort increased laryngeal muscle tension and constriction harsh=strained+rough
rough	lack of clarity irregular vibration of VF
glottal fry	rapid series of low pitch "pops" or "taps" creaky complex and not well understood longer than normal VF closure low frequency tightly adducted VF with free edges flacid low subglottal pressure
falstetto	high pitched, thin impression of immaturity perception of excess air escape high VF frequency thinning of VF edge incomplete closure along length of VF
pitch breaks	sudden, short, unexpected and uncontrolled changes in pitch
diplophonia	2 pitches simultaneously not understood
Phonation breaks	sudden, short, unexpected, uncontrolled breaks in voice. moment of turbulent air escape with no voice sudden cessation of VF vibration
Voice arrests	voice stoppages uncontrolled adduction of VF
Tremor	regular, rhythmical variation in pitch or loudness due to neurological impairment alternating contractions of ad and ab muscles of VF oscillatory movements of entire larynx in a vertical direction
alternate tools for clinical auditory perceptual assessment	CAPE-V GRBAS
CAPE-V	describes severity - sustained vowels (3-5sec) - sentence production -spontaneous speech (response to "tell me about your weekend") Scored by placing a mark on 100mm line 75mm along=75% severity
GRBAS (aspects)	Grade - (hoarseness/voice abnormality) Roughness - irregularity of vibration Breathiness - air leakage Asthenia - vocal intensity and energy Strain - hyperfunction
GRBAS (scoring)	0=absent 1=slightly represented 2=moderately represented 3=extremely represented

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