1. Assessment of voice and Resonance

2. Classification Organic disorders –known physical cause –Includes neurological disorders Functional disorders – no known physical etiology

3. Classification

4. Assessment History –Procedures –Contributing factors

5. Assessment of voice Pitch Quality Resonance Loudness

6. Procedures Screening Serial Tasks Oral Reading Speech Sampling S/Z Ratio Velopharyngeal Function Stimulabilty of Improved Voice Instrumentation

7. Other Oral-Facial Examination Hearing Assessment

8. Screening Imitate words and phrases of varying lengths Count to ten Recite the alphabet Read a short passage Talk conversationally for a couple of minutes Prolong vowels for five seconds Use Table 10-2 to evaluate. Any rating of 2 or higher needs further evaluation or rescreening.

9. Table 10.2

10. Table 10.3

11. Need for medical evaluation All clients need a medical evaluation An Otolaryngologist will use an endoscope to visually examine larynx and related structures for ulcers, polyps, tumors or nodules. Do not begin treatment until the medical examination

12. Examining the Voice Collect Speech sample Serial Tasks Areas to assess –Pitch, intensity and quality –Resonance –Prosody –Vocal habits (including abusive behaviors) –Respiratory support for speech Form 10.1 provides behaviors that lead to voice disorders From 10.2 is a vocal characteristics checklist

13. Form 10.1

14. Assessment Instrumentation These are objective measures Include –Electromyography –Aerodynamic Measures –Stroboscopy and videondoscopy –Acousitc Measures Fundamental Frequency Intensity Measure Spectral measures Visi-Pitch III

15. Normal Fundamental Frequencies Sometimes called habitual pitch – the average pitch that a client uses during speaking and reading. It is the speech of the vocal fold vibration during sustained phonation. Use instruments or use audio tapes and compare to piano keys. Ask yes/no questions and the client responds with “mmm’hmmm”

16. Fundamental Freq. chart

17. Assessing Breathing and Breath Support Breathing patterns –Clavicular – least efficient for speech –Thoracic – most common and is adequate –Diaphragmatic-thoracic – most optimal for speech From 10.3 is used to identify breathing patterns.

18. S/Z ratio Ask client to sustain each phoneme as you use a stopwatch to calculate the maximum number of seconds your client is able to produce each sound. /s/ Average for children is 10 seconds, for adults is 20-25 seconds. Measure the sustained /s/ two times. Repeat instructions with /z/ Compare both productions Then divide the /s/ by the /z/ to get ratio. Then use information page 324 to determine clinical significance. –1.0 ratio with normal duration (10 sec child, 20-25 for adults) = normal –1.0 ratio with reduced duration of /s/ and /z/ =possible respiratory inefficiency –1.2 or greater with normal duration of /s/ indicates possible vocal fold pathology.

19. Assessing Resonance Assess hyponasality, hypernasality and assimilation nasality. Ask client to count 60 – 100 and listen to each feature during each number grouping –60-69 : nasal emission during /s/ production –70-79: hypernasallity exposed because fo the recurring /n/ phoneme –80-89: listen for normal resonance –90-99: hyponasality exposed by the substitution of /d/ for /n/.

20. Assessing Hypernasality Occlude client’s nares and instruct him to recite nonnasal words and phrases. If excessive nasal pressure is felt or if nasopharyngeal “snorting” is heard suspect hypernasality. Hold mirror while saying nonnasal words

21. Assimilation Nasality Occurs when sounds that precede or follow a nasal consonant are also nasalized. See page 325 for words and phrases.

22. Hyponasality Ask client to recite sentences with nasal sounds and then occlude nares and repeat the task. If they both sound the same then hyponasality is present. Ask client to say “maybe, baby, maybe, baby”. If both words sound like maybe then suspect hyponasality.

23. Assessing velopharyngeal function Use pressure consonants and modified tongue anchor procedure to assess. You are measuring intraoral air pressure. Pressure consonant – nonnasal words, phrases and sentences to detect nasal emissions and hypernasality. Modified tongue anchor procedure –Ask client to stick tongue out and puff air into cheeks while you hold nose to stop air from coming out. –Ask client to continue holding air while you release nostrils. –Listen for nasal emissions. –Do this three times.