the process of collecting relevant data for clinical decision making.
assessment
an appraisal of the implications and significance of the assessment.
appraisal
Who's job is it to make a laryngeal diagnosis and establish and oversee a medical management plan?
laryngologist
Who's job is it to make a voice diagnosis and to establish and carry out a voice therapy plan?
SLP
The prevalence of voice disorders in school-age children is approximately _______
5% to 9%.
True/falso The vast majority of children with voice disorders are never seen by a SLP.
true
Children with voice disorders make up less than______of the typical clinician’s caseload.
5%
What screening form addresses respiration, phonation, and resonance, and can be administered relatively quickly, and is appropriate for students in all grades?
The Boone Voice Program for Children Voice Screening Form
In the Boone voice Program, when the clinician listens to natural samples of voice and speech, what are the five scale judgments he/she listens for?
In the boone voice program what does the SLP compare the child’s voice sounds to?
voices of peers of the same age, gender, and race.
To facilitate ease of scoring, a simple ______ system is used in the boone program to record perceptual judgments.
three-point
When should a child be rechecked in the Boone program?
If the child receives either a (-) or (+) on any of the five clinical parameters,
true/false ASHA mandates that all clients with voice disorders must be examined by a physician.
True
The _______examination may occur before or after the voice evaluation by the SLP.
physicians
Only the decision about whether to begin voice therapy need be deferred until all _________ is obtained.
medical information
What is the laryngologist’s primary role?
to identify and manage those conditions or diseases that interfere with normal voice production,
What is the SLP’s primary role?
to evaluate and facilitate voice production given the patient’s known medical status.
What is the most important procedure for understanding the cause of a voice disorder and its potential treatment?
Visual inspection of the larynx
Office-based visual examination of the larynx traditionally takes what two forms:
mirror laryngoscopy or endoscopic laryngoscopy (more commonly referred to as laryngeal endoscopy).
In ________ a small laryngeal mirror is placed at the back of the patient’s mouth and light is shined on the mirror from the physician’s headset.
mirror laryngoscopy,
What two scopes are used in laryngeal endoscopy?
either a rigid fiberoptic scope is placed in the mouth or a flexible fiberoptic scope is passed through the nasal passages.
The ________role is to describe the structure and function of the larynx and make recommendations regarding further testing needed to understand the etiology or maintenance of the voice problem and to make recommendations for treatment.
clinician’s
______ is important in monitoring and regulating one’s own voice production.
Hearing acuity
About_____ of persons in the US have hearing loss, which may vary from mild loss of sensitivity to total loss of hearing.
8%
The prevalence of hearing loss accelerates dramatically with -----.
age
What two other areas should be considered when evaluating the patient with a voice disorder?
hearing and visual acuity
What disorders usually pose a severe threat to a patient?
Acute and sudden onset of dysphonia
What would a history of slow onset of voice disorders sometimes suggest?
a gradually developing pathology, such as the development of Reinke’s edema of dysphonia that is an early developing symptom of a progressive neurological disease.
Which type of patient will usually present an additional challenge to the clinician and a more unfavorable prognosis? longer history or acute
longer history
Abuse, misuse, and overuse of the voice cause most _____ voice problems.
functional
If a patient has had previous voice therapy, do you start with the previously failed approach used?
no instead make every effort to present the appearance of a fresh and different approach to the patient who has experienced failure in previous voice therapy.
How can the clinician assess the voice?
instrumental or noninstrumental
The voice assessment approach relies on behavioral observation of the patient?
noninstrumental approach
In the ______ approach the emphasis is on obtaining indirect measures of voice production (e.g., visualization of the larynx, acoustic measures of the voice signal, aerodynamic measures of pressure and flow, physiological measurement of laryngeal muscle function, etc.).?
instrumental
true/false The use of instrumentation does not ensure more accurate results.
true
What are the most important skills when assessing?
be able to listen critically and carefully and to analyze objectively.
Careful assessment of the _________ is part of the voice assessment.
oral-peripheral mechanism
Often, _______ is closely associated with neck tension.
mandibular restriction
restricted jaw movement place most of the burden of speech articulation on the ______.
tongue
What are some externally observable hyperfunctions of the vocal tract?
neck tension ad mandibular restriction and an unusual downward or upward excursion of the larynx during production of various pitches.
Any really noticeable amount of lifting or lowering of the larynx, as well as the tipping forward of the thyroid cartilage in the production of high pitches, should be noted as possible _____ behavior.
hyperfunctional
What is a measure derived from peak intraoral pressure and peak airflow during production of the /pi/ syllable repeated at a rate of approximately 1.5 syllables/second?
Laryngeal Resistance
Peak intraoral pressure is estimated from the _____ portion of the syllable and peak _______ is measured from the /i/ portion of the syllable.
/p/
airflow
A breathy voice would suggest ______ laryngeal resistance, while a strain-strangled voice would suggest increased laryngeal resistance.
decreased
What is an indirect index of laryngeal airflow?
Maximum phonation duration (MPD)
MPD is the greatest length of time over which the ____ vowel can be sustained at the patient’s most comfortable pitch and loudness following a maximal inhalation.
/a/
If airflow is high, MPD is ______ than normal.
shorter
If airflow is ____, MPD may be longer than normal.
low
What is the Average MPD for six-year-olds?
is 10.5 seconds increasing to approximately 28 seconds for young adults, and declining to 13 seconds for the elderly. However, variability is large.
What is an indirect index of laryngeal airflow.?
The s/z ratio
What is the s/z ratio of normal subjects?
approximates 1.0, indicating that the voiceless exhalation time (the /s/) closely matches maximum phonation duration (the /z/).
What kind of s/z ratios may be a red flag to check the glottal edge of the vocal folds for an additive lesion, or to suspect glottis insufficiency due to vocal fold paralysis?
elevated
What is a noninvasive technique for obtaining an estimate of vocal fold contact patterns during phonation?
Electroglottography (EGG)
What is waveform of an EGG called?
electroglottogram or laryngogram
What reveals summary information about vocal fold contact over time, with peaks and troughs representing maximum points of open and closed phases?
EGG
Can clincical instrumentation replace the observation skills of a well-trained clinician.
NO
The piano and electric keyboard are relatively inexpensive clinical instruments for the measurement of ______.
pitch
The______ is a relatively inexpensive clinical instrument for the measurement of loudness-related parameters.
sound-level meter
Typically, the sound-level meter is held by the clinician at a distance of _____ from the speaker.
50 cm
What is a widely-used clinical instrument for measuring habitual pitch and loudness, frequency and intensity variability, and MPFR and dynamic range, among other things?
The Visi-Pitch
The ______extracts acoustic parameters during speech production and presents them in real time, providing clients with clear, intuitive visual displays.
The Visi-Pitch
What is a more comprehensive hardware system than the Visi-Pitch, with optional software and database options?
The Computerized Speech Lab (CSL)
What measures habitual pitch and loudness?
The Nagashima Phonatory Function Analyzer
The Nagashima Phonatory Function Analyzer is capable of five simultaneous acoustic and aerodynamic measures of voice. What are they?
average fundamental frequency, sound pressure level, mean flow rate, expiratory lung pressure, and airway resistance.
what is a portable device worn by clients to capture important parameters of vocal behavior over an entire day of normal activity?
The Ambulatory Phonation Monitor (APM)
what kind of feedback does the APM provide?
vibrotactile biofeedback
What enables visualization of vocal fold vibration irrespective of the degree of aperiodicity and level of dysphonia?
High-speed digital imaging (HSDI) of the larynx
What provides valuable information on vocal fold movement that is not available via laryngostroboscopy?
High-speed digital imaging (HSDI) of the larynx
What can be used to determine the aerodynamic capacities and volumes we need to measure?
wet or dry spirometers.
What measurements are used in the wet spirometer?
cubic centimeters or liters.
A flexible container enlarges on inspiratory tasks and decreases in volume on expiratory tasks, in both instances measuring the volume of displacement is called a ____?
dry spirometer
what is the latest pneumotachograph-based system for aerodynamic analysis?
The Phonatory Aerodynamic System (PAS)
The____allows the clinician to obtain measures of average phonatory flow rate, sound pressure level, fundamental frequency, vital capacity, subglottal pressure, glottal resistance, and vocal efficiency, among other parameters.
