Vocal Anatomy
List the 3 divisions of the Pharynx
What are the nasopharynx, oropharynx, and laryngopharynx?
3 Functions of the Larynx
What are airway protection, airway preservation for ventilation, and phonation?
Tx for Head and Neck Cancer
Surgery, radiation, chemotherapy, both, immunological therapy, voice/swallow therapy, counseling by SLP before and after
It is likely that stuttering is caused by
a mix of factors, including environmental and developmental factors
Components of a non-instrumental voice exam
Case History, Medical History, Interview, Voice Handicap Index, CAPE-V, Perceptual Analysis, Posture Analysis, Look at Breathing Mechanics, Examine Quality, Pitch, Loudness, Oral-Peripheral Exam
The three levels of laryngeal folds
What are the aryepiglottic, ventricular, and true vocal folds?
Describe "normal" voicing
A balance of 3 subsystems of voice production (respiration, phonation, resonance) to permit appropriate quality, pitch, and loudness.
3 goals of voice therapy
1: modify/eliminate etiological factors
2: rebalance the 3 subsystems
3: improve overall perception of voice and communication
Core Behaviors of Stuttering
Repetitions: a sound, syllable, or word that is repeated several times (greater than 2)
Prolongations: sound/air flow continues; movement of the articulators appears stopped (as short as 1/2 a second)
Blocks: last to appear; inappropriately stops airflow or voice and movement of articulators
Staying in the Stutter
going right into the stutter, and prolonging the articulatory posture and sound associated with the moment of stuckness
Skeletal Structures of Respiration
3 Tasks for Assessing Respiration
1 - have the patient take a deep breath through the nose and mouth
2 - examine the patients posture
3 - have patient read a passage
Stuttering Modification vs. Fluency Enhancing
Fluency Enhancing: prevent stuttering by teaching new patterns (easy onset, stretchy speech, light contact)
Stuttering Modification: focuses on helping individuals directly manage and change moments (cancellations, pull-outs, preparatory sets)
Secondary Behaviors of Stuttering
Escape: when a speaker is stuttering and attempts to terminate the stutter and finish the word (eye blinks, head nods, 'uh')
Avoidance: are learned when speakers anticipate stutter and do something to keep from stuttering (eye blink, filler before word)
Five Layers of Vocal Folds
Epithelium, superficial lamina propria, intermediate lamina propria, deep lamina propria, vocalis muscle
Muscles of inspiration
What are the Diaphragm, External Intercostals, Sternocleidomastoids, Scales, Pectoralis Major/Minor?
5 ways to injure the voice
vocal abuse, poor physical condition, smoking or alcohol consumption, practice habit errors, poor vocal hygiene
Instruments used to assess stuttering
SSI-4
Severity Rating Scale for Parents of Preschoolers
Test of Childhood Stuttering
OASES
Borderline: greater than 6-10 per 100 words, greater than 2 units in repetitions
Beginning: muscle tension and escape behaviors/awareness
Intermediate: blocks, fear/embarassment/shame
Advanced: tense blocks/tremor, avoidance and escape, negative feelings
Malingering
The intentional fabrication or exaggeration of speech disfluencies to achieve an external goal (i.e., avoiding legal consequences)
Muscle that opens and Muscle that closes the vocal folds
Opens: Posterior Cricoarytenoid
Closes: Lateral Cricoarytenoid
Types of Voice Disorders (3) and Example:
Functional: Muscle Tension Dysphonia
Organic: Laryngeal Carcinoma
Neurogenic: Spasmodic Dysphonia
Types of Voice Treatment
Physiologic: direct physical exercise and manipulations to improve
Symptomatic: modifying deviant behaviors
Hygienic: modifying behavioral causes
Eclectic: combination of any or all
Psychogenic: emotional and psychosocial status that led to and maintained voice
Non Stutter Like Disfluencies A Clincian Should Look For to Distinguish between Typical Disfluency and Stuttering
- Multisyllable Word Repetitions
- Phrase Repetitions
- Interjections
- Revisions in Which A Phrase is Incomplete
9 Cartilages of the Larynx
Epiglottis
Thyroid
Cricoid
Arytenoid (2)
Cuneiform (2)
Corniculate (2)