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Chapter 11: Voice Disorders Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River,

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Presentation on theme: "Chapter 11: Voice Disorders Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River,"— Presentation transcript:

1 Chapter 11: Voice Disorders Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

2 Focus Questions What is a voice disorder? How are voice disorders classified? What are the defining characteristics of voice disorders? How are voice disorders identified? How are voice disorders treated? 11.1 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

3 Introduction – A Brief History 16 th century – the larynx studied on human cadavers – did not permit to see larynx at work 1600 – first book on laryngeal structures 18 th century – well-developed understanding how the vocal folds produce the voice 1829 – glottiscope: crude glimpses of the laryngeal cavity 1854 – laryngoscope: vast improvement in technology to examine the larynx Today, advanced technology (endoscopy, stroboscopy) allow examination of the vocal folds live in action 11.2 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

4 Overview of Voice Disorders Individual’s vocal quality is in some way compromised For some, disorder is mild, transient, and requires no treatment For others, disorder is severe, persistent, and requires ongoing treatment Most serious cases, larynx is removed for reasons such as cancer, and alternative methods of producing voice are necessary 11.3 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

5 Case Study #1: Kate 46-year old trauma surgeon and mother of four –two years ago was in a car accident, suffered a spinal cord injury and became a paraplegic –Unable to breathe and ventilator-dependent Did not speak at all until a year after her surgery, SLP has been working with her to increase her speech output and set up a voice-activated computer 11.4 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

6 Case Study #1 Questions What community activities might be possible for Dr. Mitchell now that she uses her voice? How might Dr. Mitchell be involved with her profession in the future as a quadriplegic? 11.5 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

7 Case Study #2: Anton 68-year old veteran diagnosed with laryngeal cancer six years ago Had his larynx removed two years ago, tried unsuccessfully to learn esophageal speech, now uses an artificial larynx Is interested in helping other laryngectomees Is interested in possibility of a laryngeal transplant 11.6 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

8 Case Study #2 Questions Given that Anton already has a way to produce speech via the artificial larynx, why would he desire a laryngeal transplant? Anton’s hobby after his laryngectomy was to counsel other laryngectomees. In what ways might Anton’s counseling be superior to that of a clinical professional, like a psychologist? 11.7 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

9 Case Study #3: Ms. Chin 42-year old television personality (co- anchor of news show) Experiencing intermittent problems with her voice in which it seems to start and stop and feels strangled Went to otolaryngologist, who gave her a preliminary diagnosis of spasmodic dysphonia Ms. Chin’s producer suggested she take disability leave until her voice is resolved 11.8 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

10 Case Study #3 Questions Do you agree with Ms. Chin’s producer that she should be “off the air” until her voice problems are resolved? Ms. Chin has an appointment soon with an SLP who may not be skilled in treating spasmodic dysphonia. How important is it to see a clinician who has worked with this condition before? What other professionals should be involved with Ms. Chin’s voice treatment? 11.9 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

11 I. What is Voice? Vocal fold vibration that provides sound source for spoken language Phonation: humans set their vocal folds into a vibratory pattern (say “oooo”) –Vocal folds are adducted (closed), air is exhaled upwards and blows apart the vocal folds setting them into a rapid vibratory pattern Voice is further modified by the processes of resonation and articulation Three vocal characteristics: frequency, intensity, and phonatory quality Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

12 Frequency Rate of vocal fold vibration (pitch) Fundamental frequency (F 0 ) – basic vibratory rate of the vocal folds (in Hertz) –Kindergarten girls and boys = 250 Hz –Adult women = 180 – 220 Hz –Adult men = 120 – 140 Hz F 0 relates to three characteristics: –Vocal fold length, mass, and tension Fundamental frequency changes as we age, especially between birth and puberty Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

13 Intensity Sound pressure reported in decibels (loudness) Relates to two features of vocal production: –Amount of airflow from the lungs –Amount of resistance to the airflow by the vocal folds (which contributes to their excursion, or how far apart the vocal folds move and come back together) Every person has a baseline intensity level that characterizes his/her conversational speech Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

14 Phonatory Quality How well the two vocal folds work together during the vibratory cycle –If vocal folds work symmetrically and harmoniously, voice is pleasant and clear –If compromised in some way (e.g., growth on one of the folds), phonatory quality is affected Also influenced by the resonation of the voice into the oral and nasal cavities (e.g., nasal voice quality) Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

15 What is a Voice Disorder? Pitch, loudness, or phonatory quality differs significantly from persons of a similar age, gender, cultural background, and racial and/or ethnic group, and Vocal quality detracts from the ability to function and achieve in society Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

16 Describing Voice Quality Dysphonia: umbrella term for a voice that is disordered in some way Aphonia: total loss or lack of voice Many other, mostly subjective terms… –Pitch and frequency: jitter or diplophonic –Loudness and intensity: pressed or strident –Resonance: nasal or ringing –Phonatory quality: flutter or creak Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

17 Describing Vocal Fold Functioning Hypofunction: vocal folds are under- functioning and have inadequate tension, so air escapes through –Breathiness or hoarseness, or no voice at all Hyperfunction: vocal folds are overly tense and compress too tightly together –Too loud, too high, and/or too strained –Sometimes spasticity of the voice Diplophonia: vocal folds produce two different pitches simultaneously Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

18 Voice without a Larynx Laryngectomy: surgically removing the larynx Two primary reasons: –laryngeal cancer: removed to stop spreading –laryngeal trauma: removed if too damaged to protect respiratory system or impede breathing Alaryngeal communication: an alternative way to produce speech Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

19 Prevalence and Incidence: Voice Disorders in Adults Prevalence = 29%, Incidence = 6% Higher prevalence for women, peak ages of years Higher prevalence among people with frequent allergies, asthma, colds, and sinus infections Higher prevalence among professions reliant on voice Common causes: vocal nodules, edema/swelling, polyps, carcinoma, and vocal fold paralysis Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

20 Prevalence and Incidence: Voice Disorders in Children 25% of children exhibit significant vocal problems, with 40% of these cases ongoing, not transient, problems For some it is a congenital problem, but most cases result from overuse or misuse of voice Most common cause: vocal nodules that impede smooth meeting of folds, resulting in breathy or hoarse voice Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

21 Prevalence and Treatment Rate of voice disorders for both children and adults is relatively high, but many cases go undiagnosed and/or untreated Several reasons for this: –Treatment access: e.g., disorder not considered to impact educational performance in school –Knowledge: e.g., person may believe that voice problem will disappear spontaneously –Social perception: e.g., the disordered voice (e.g., a breathy, hoarse voice) brings positive social attention Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

22 II. How are Voice Disorders Classified? Voice disorders are grouped based on their cause, an etiological classification Four different categories: A.Vocal abuse B.Neurogenic disorders C.Psychogenic disorders D.Alaryngeal communication Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

23 A. Vocal Abuse Chronic or intermittent overuse or misuse of the vocal apparatus Vocally abusive behaviors: –Talking in noisy environments –Frequent coughing or clearing of the throat –Using caffeine products –Yelling, screaming, and cheering –Giving speeches or lectures –Spending time in smoky environments Two common conditions: vocal nodules and contact ulcers and granuloma Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

24 Vocal Nodules Small bilateral protuberances or calloused growths on the inner edge of the vocal folds Acute nodules are similar to bruises on the vocal folds, but these can harden and thicken over time, which becomes a chronic condition Most prevalent in children and adults who engage in vocal misuse and abuse Additional factors: temperament and general health Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

25 Contact Ulcers and Granuloma Contact ulcers: inflamed lesions that develop on the cartilage in the larynx Granuloma: a mass of tissue generated by the body’s healing process at the site of the contact ulcer Mostly results from vocal abuse, but also from acidic irritation due to chronic reflux or tubal intubation (during surgery) Low, breathy voice quality Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

26 B. Neurogenic Disorders Result from illness, damage, or disease to the neurological systems associated with voice production One of the most important nerves: vagus nerve in peripheral nervous system –runs from cranium down around the heart, but has several branches that innervate the pharynx and larynx Pharyngeal nerve Superior laryngeal nerve Recurrent laryngeal nerve If any of these nerves are disrupted, a voice disorder may result Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

27 Vagus Nerve Lesions Can occur due to surgical damage, trauma, and viral infections Most serious outcome: vocal fold paralysis Mostly unilateral paralysis: –Abduction paralysis: one of the vocal folds cannot open, voice is not usually affected, but breathing may be difficult –Adduction paralysis: one of the vocal folds cannot close, so they cannot meet together, causing hoarse or breathy voice quality Complete paralysis: both vocal folds paralyzed, completely blocking airway – tracheostomy is necessary Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

28 Spasmodic Dysphonia Affects motor control of larynx, results in intermittent voice stoppages Jerky, grunting, squeezed, groaning, and stuttering-like voice quality Ranges from mild to severe Adductor type: most common, voice is strangled, strained, and squeezing Abductor type: less common, voice is breathy and open Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

29 Amyotrophic Lateral Sclerosis Also called Lou Gehrig’s Disease – progressive, degenerative, neuromuscular disease Cause is unknown, impact is significant, and most survive less than 10 year after diagnosis Voice is soft, breathy, low in pitch and loudness, limited variability, and hypernasal Difficulty clearly articulating speech sounds because cannot strongly coordinate motor processes Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

30 Parkinson’s Disease Progressive, degenerative neurological disease caused by depletion of dopamine Unable to produce a strong voice because of a weakened respiratory system Rigid muscular tone restricting movements of larynx; produces hoarseness and a monotonic pitch Lee Silverman Voice Treatment program – effective for improving voices of persons with Parkinson’s Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

31 C. Psychogenic Disorders Nonorganic disorders, resulting from emotional or psychological characteristics Our voices carry messages about our emotional or psychological state The voices of individuals who experience significant personality or psychological health disorders may be negatively impacted Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

32 Psychological or Emotional Triggers After someone recovers from a vocal injury because of overuse or misuse of the voice, may experience a sense of vulnerability and anxiety about using voice Other traumatic experiences, like cancer, being robbed or raped, and having surgery of the throat, can have the same effect Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

33 Psychopathology 1. Stress, Anxiety, and Depression Acute stress disorder: within one month of having a traumatic experience, exaggerated startle responses, motor restlessness; can be reflected in the voice Generalized anxiety and anxiety disorder: muscle tension, trembling, twitching; may lead to vocal tremors and voice breakages Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

34 2. Conversion Disorder Physical symptoms or deficits result from severe anxiety or stress Can result in a loss or disordered voice as one variety of conversion disorder 3. Vocal tics and Tourette’s Disorder Vocal tics produce sudden, rapid, recurrent vocalizations Tourette’s: vocal tics occuring simultaneously with other motor tics affecting the head, torso, and extremities Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

35 Mutational Falsetto and Juvenile Voice Vocal characteristics are not consistent with age and gender Mutational falsetto: male child or adolescent exhibits inappropriately high voice –Voice therapy and medical treatment are effective Juvenile voice: female companion to mutational falsetto, women maintain a child-like voice into adulthood Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

36 D. Alaryngeal Communication Producing voice without a larynx Two most common reasons: –Larynx is not available because of a tracheostomy –Larynx has been completely removed in a larnygectomy Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

37 Trachestomy When respiratory system is compromised, mechanical ventilation and respiration is needed –tracheostomy tube is inserted through the neck to direct air into the lungs Unable to talk because air is not going over vocal folds Passy-Muir Tracheostomy Speaking Valve: allows adults and children to speak even while ventilated Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

38 Laryngectomy Etiology: Laryngeal cancer is linked to tobacco and alcohol use, nutritional inadequacies and occupational exposures; affects African-American older males at the highest rates Symptoms: most consistent symptom is hoarseness –Any person exhibiting hoarseness should seek medical attention if persists for more than two weeks Treatment: Rid the body of the malignancy –most oncologists use conservation approaches, and prefer to only remove part of the larynx if possible Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

39 III. Defining Characteristics of Voice Disorders Voice disorders impact one or more of the following perceptual characteristics of voice: A.Resonance B.Loudness and pitch C.Phonatory quality Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

40 A. Resonance Velopharyngeal port controls the extent to which exhaled air enters the nasal and oral cavities The port typically rests in an open position, but when we speak, it is almost always closed (airflow channeled into the oral cavity) Voice disorders of resonance result from problems with control of port, called velopharyngeal inadequacy Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

41 Velopharyngeal Inadequacy Common causes: –Cleft palate and cranio-facial abnormalities –Iatrogenic (problems resulting from surgery) –Allergies –Neuromuscular impairment Results in either: –Hypernasality: port remains open to allow too much resonance and nasal emissions during speech –Hyponasality: too little nasal resonance, voice may sound stuffy and congested Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

42 B. Pitch and Loudness Pitch: frequency Loudness: intensity Too much or too little tension in voice production can cause abnormal pitch or loudness Of pitch and loudness, pitch changes are more common symptoms of voice disorders Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

43 Pitch Important concepts: –Habitual pitch: pitch one uses normally –Optimal pitch: best pitch voice can produce –Basal pitch: lowest pitch one can produce –Ceiling pitch: highest pitch one can produce –Vocal range: difference between basal and ceiling Disordered pitch: –Habitual pitch differs significantly from optimal –Extremely limited vocal range Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

44 Loudness Over-loudness: air pressure builds up under vocal folds and produces wide excursion of folds Under-loudness: lack of respiratory force because of… –Neurological injury and disease –Social or psychogenic factors Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

45 C. Phonatory Quality When vocal folds do not work harmoniously, impairment in general quality of the voice Common types of impaired phonation: –Hard glottal attack –Glottal fry –Breathy phonation –Spasticity –Hoarseness Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

46 IV. How are Voice Disorders Identified? A.The Voice Care Team Close collaboration of a variety of professionals Medical professionals: primary care physician (PCP), otolayrngologist Allied health professionals: speech- language pathologist, psychologist or psychiatrist Possibly educators or voice coaches also Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

47 B. The Assessment Process Identification of warning signs Assessment Protocol: –Case history and interview –Oral-motor examination –Clinical voice observation –Instrumental voice observation Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

48 Warning Signs for Voice Disorders Children and adolescents: –Vocally abusive behaviors –Underlying medical condition –Psychological well-being Adults: –Change in phonatory quality for more than two weeks, consult physician Referrals: PCP will likely make at least two referrals: –Otolaryngologist –Speech-language pathologist Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

49 Assessment Protocol Speech-language pathologist’s goals: –Characterize the general features of the voice –Establish if any of these features differ from the norm –If disorder is present: Identify cause Identify intervention approach that will be the most beneficial to improving the voice Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

50 Case History and Interview Interview with the client to learn more about: –Medical history –Chronological history of problem –Symptoms and possible etiology of problem –Way in which client uses voice for daily living activities –Client’s motivation for seeking help Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

51 Oral-Motor Examination Identify conditions of structures involved with producing voice Study amount of tension and sensation involved in speech and voicing Examine possible swallowing problems Study the appearance and functioning of the velum Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

52 Clinical Observation Perceptual observation of characteristics of voice during a variety of speaking and vocal activities Example activities: counting from 1 to 40 softly then loudly, sustaining a vowel sound for as long as possible, engaging in normal conversation Also studies systems that support vocal production, like respiration Relies heavily on the listener, so need to be properly trained and experienced Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

53 Instrumental Observation Objective measures of vocal functioning: –Acoustic assessment: measures frequency, intensity, and resonance characteristics –Aerodynamic assessment: measures airflow, air pressure, and vocal fold resistance –Electroglottography: measures vocal fold contact during voicing –Videostroboscopy: examines laryngeal system and measures vocal fold movement Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

54 V. How are Voice Disorders Treated? Elimination of the cause of the disorder (e.g., vocally abusive behavior) Compensation for a disorder (cause cannot be eliminated) Three possible goals: –Teach a vocal behavior that is absent –Substitute vocal behavior for inappropriate one –Strengthen vocal behaviors that are weak or inconsistent Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

55 A. Treatment for Vocal Abuse Several options: Surgery (e.g., removal of vocal nodules) Vocal hygiene programs Voice therapies Computer programs Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

56 B. Treatment for Neurogenic Disorders Combination of medical interventions and voice therapies Medical interventions: –Phonosurgery: improvement, alteration, or restoration of the voice (e.g., thyroplasty) –Injections into the vocal folds (e.g., Teflon, botox) Voice therapies: –e.g., Lee Silverman Voice Treatment program Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

57 C. Treatment of Psychogenic Disorders Multidisciplinary approach including speech-language pathologist and mental health professionals Goal: determine emotional or psychosocial cause of voice disturbance Therapy usually focus on reducing tension, counseling, and eliminating any voice abuses or misuses Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

58 D. Treatment of Alaryngeal Communication Communication counseling: explore all alternative options for producing voice –Artificial larynx: vibrating power source placed against the neck, often mechanical sounding voice –Esophageal speech: learn to trap air in the esophagus and then use that for voice, often very difficult for most people –Tracheoesophageal speech: surgical puncture between the trachea and esophagus provides an air source for speaking Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.


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