1. CD 508 VOICE & VOICE DISORDERS

2. Chapter 1 The Voice and Voice Therapy: Introduction

3. Laryngeal Function w Biological prevents food from entering the airway w Emotional reflected in control of respiration, vertical position of larynx, relaxation of folds and oropharyngeal muscles w Linguistic suprasegmental phonation

4. Voice Disorders in Normal Population w General Population School-age - 7% Adults - 3% Brindle & Morris (1979) - 2.68% hoarseness, hypernasality most often cited w Special Groups Teachers - 20% Cheerleaders - 75%

5. Types of Voice Disorders w ORGANIC result of structural problems in vocal tract w NEUROGENIC result of compromise brainstem/spinal column w FUNCTIONAL nonbiological

6. w “… it is important that any voice problem that lasts more than a week be investigated medically for possible physical causation and treatment.” w Boone, p.7

7. Organic Disorders w RESPIRATION reduced lung volume/elasticity w PHONATION interference between folds w RESONANCE structural problem, e.g. cleft muscular weakness/incoordination

8. Neurogenic Disorders w RESPIRATION trauma to neck/brainstem; central motor problems; disease of CNS w PHONATION unilateral vocal fold paralysis; spasmodic dysphonia w RESONANCE alter function/shape of oropharynx, e.g. CVA

9. Functional Disorders w RESPIRATION inadequate/inefficient respiratory patterns w PHONATION altered vibratory characteristics of folds w RESONANCE altered size and configuration of oropharynx

10. VOCAL HYPERFUNCTION involvement of too much muscle force and physical effort in systems of respiration, phonation, and resonance w Excessive patterns of vocal misuse/abuse w Can lead to organic change w Voice therapy usually preferred Tx

11. Respiration w Speaking on inadequate expiration; improper use of expiration w Coordination of inspiration/expiration movement w Poor timing/control of expiration

12. Phonation w Inappropriate pitch level --> unnecessary energy to maintain w Hard glottal attack w Vocal abuse, e.g. clearing throat smoking excessive volume

13. w “Voice therapy techniques are primarily vehicles of facilitation; that is, we try a particular therapy approach to see if it facilitates production of a better voice.” Boone, p.15

14. Resonance w Hypernasality w Assimilative hypernasality w Cul-de-sac resonance w Baby voice

15. Management w Identify cause breathing/resonance longstanding phonation usually recent origin w Medical evaluation of organic and neurogenic problems

16. Management-2 w “… unless the patient is experience- ing hoarseness (dysphonia) as part of an allergy or severe upper respiratory infection (URI), he or she should wait no longer than seven days to have a medical evaluation of the problem.” w Boone, p.16

17. SLP Role w SLP to assess respiration-phonation- resonance components Clinical Instrumental w Refer for medical Dx/Rx w Voice therapy to Eliminate functional problems Conserve function and/or Compensate for organic or neurogenic problems

18. Useful Websites  National Center for Voice and Speech National Center for Voice and Speech http://ncvs.shc.uiowa.edu/ w Wake Forest Center for Voice Disorders Wake Forest Center for Voice Disorders http://www.bgsm.edu/voice/ w National Institute of Deafness & Communication Disorders National Institute of Deafness & Communication Disorders (http://www.nidcd.nih.gov/)