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Unit 6: Voice Evaluation

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Unit 6: Voice Evaluation

  1. 1. Voice Evaluation CDIS 700
  2. 2. Objectives of Voice Evals <ul><li>Primary objective- Discover whether the client has a voice disorder, and to evaluate the present symptoms. </li></ul><ul><li>Secondary objective- Patient education and motivation, as well as establishing your own credibility. </li></ul>
  3. 3. Referral Source <ul><li>Who referred the patient </li></ul><ul><ul><li>ENT </li></ul></ul><ul><ul><li>Neurologist </li></ul></ul><ul><ul><li>Physician </li></ul></ul><ul><ul><li>SLP </li></ul></ul><ul><ul><li>Family, friends, or self </li></ul></ul><ul><li>Will want to know if the patient understands why they have come or if they realize there is a problem. </li></ul>
  4. 4. Establish the reason for the referral <ul><li>Establish the exact reason for the patient referral. </li></ul><ul><li>Establish if the patient understands the reason for the referral. “What brings you to see me?” </li></ul><ul><li>Develop patient knowledge of the problem. </li></ul>
  5. 5. History of the Problem <ul><li>When was the onset of the problem? </li></ul><ul><li>What has the course of the problem been? </li></ul><ul><li>How does it change over time? </li></ul><ul><li>How does the patient define the problem? </li></ul><ul><li>How do others define the problem? </li></ul><ul><li>What is their motivation for change? </li></ul><ul><li>Identifying vocal abuses and misuse. </li></ul>
  6. 6. Medical History <ul><li>What illnesses may be related to the present voice problems? </li></ul><ul><li>Any known etiological factors? </li></ul><ul><li>Any medications that may be involved? </li></ul><ul><ul><li>http://www.uiowa.edu/~shcvoice/rx.html </li></ul></ul>
  7. 7. Social History <ul><li>Gather knowledge about patient’s work, home and social environment. </li></ul><ul><li>Discover emotional, social and family difficulties. </li></ul><ul><li>Establish an understanding of the patient’s personality. </li></ul><ul><li>Questions: </li></ul><ul><ul><li>What is the home and work environment? </li></ul></ul><ul><ul><li>Any social or emotional difficulties related to the voice? </li></ul></ul><ul><ul><li>Does the patient perceive any relation between the problems? </li></ul></ul>
  8. 8. Oral Mechanism Exam <ul><li>Determine the physical condition of the oral mechanism. </li></ul><ul><li>Observe the laryngeal area for tension. </li></ul><ul><li>Check for any physiological difference or signs of neurological involvement in the oral cavity. </li></ul><ul><li>Check for laryngeal sensations. </li></ul>
  9. 9. Voice Evaluation <ul><li>Describe the present vocal properties. </li></ul><ul><li>Examine inappropriate use of the voice. </li></ul><ul><li>Assess respiratory status </li></ul><ul><li>Note voice quality </li></ul><ul><ul><li>Self-report </li></ul></ul><ul><ul><li>Clinician observation </li></ul></ul><ul><ul><li>Non-instrumental measures </li></ul></ul><ul><ul><li>Instrumental measures </li></ul></ul>
  10. 10. Quality Assessment <ul><li>A multitude of scaling procedures </li></ul><ul><li>Reading, conversational speech, singing </li></ul><ul><li>Maximum phonation time /duration (MPT/MPD) </li></ul><ul><li>s/z ratio </li></ul><ul><li>Sorry my MPT and s/z ratios are so quiet on the audio narration – my video editing software dampened the sound. </li></ul>
  11. 11. Quality Assessment <ul><li>Quality during sustained vowels and speaking: </li></ul><ul><ul><li>Hoarse or raspy– warnings for language in this video; consider how you might educate this person </li></ul></ul><ul><ul><li>Breathy – voice is also a bit hoarse </li></ul></ul><ul><ul><li>Tremulous </li></ul></ul><ul><ul><li>Strained or tense </li></ul></ul><ul><ul><li>Diplophonia – I found a clip! </li></ul></ul><ul><ul><li>Aphonia – lack of voice/whisper </li></ul></ul>
  12. 12. Instrumental Assessment <ul><li>Laryngoscopy </li></ul><ul><ul><li>Flexible (nasal) – also see here for longer video </li></ul></ul><ul><ul><li>Rigid (oral) - a bit strange, but you can see pics of the scope </li></ul></ul><ul><ul><li>Note: stroboscopy is just the light source that can be attached to flexible or rigid scopes. It slows down the motion of the vocal folds so our eyes can see; otherwise they move too fast. </li></ul></ul><ul><ul><li>Mirror laryngoscopy – wear gloves! </li></ul></ul><ul><li>Electroglottograph </li></ul><ul><li>Visi-Pitch </li></ul><ul><li>Nasometer </li></ul><ul><li>Others </li></ul>
  13. 13. Direct Laryngeal Observation: <ul><li>Vocal Tract Visualization and Imaging: Position Statement </li></ul><ul><ul><li>http://www.asha.org/docs/html/PS2004-00121.html </li></ul></ul><ul><li>Knowledge and Skills for Speech-Language Pathologists With Respect to Vocal Tract Visualization and Imaging </li></ul><ul><ul><li>http://www.asha.org/docs/html/KS2004-00071.html </li></ul></ul><ul><li>Vocal Tract Visualization and Imaging: Technical Report </li></ul><ul><ul><li>http://www.asha.org/docs/html/TR2004-00156.html#r5 </li></ul></ul>
  14. 14. Keep in Mind… <ul><li>Rely on what you hear, not solely on instrumentation data. </li></ul><ul><li>During an evaluation, you are making a diagnosis of how the voice is performing, not a medical diagnosis. </li></ul><ul><li>Delay making recommendations for treatment unless an ENT has performed a medical evaluation and voice therapy is not contraindicated. </li></ul><ul><li>You can always educate patients on good vocal hygiene, even if you may not be able to make specific voice therapy recommendations. </li></ul>

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