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Voice Ch. 6 pt 1
Evaluation of the Voice
| Term | Definition |
|---|---|
| Voice Screening form (Boone Voice Program for Children) | - Screens for respiration, phonation, and resonance - Can be done in <10 mins - Not free |
| Quick Screen for Voice | - Screens for respiration, phonation, and resonance - Can be done in <10 mins - Free! |
| Post-assessment responsibilities | - Evaluate: assess. data, pts responses to therapeutic probes - Diagnose: the voice disorder - Formulate: Recs - Follow-up: w/ pt as needed to monitor voice status & ensure appropriate intervention |
| ENT | - All pts with a voice disorder must be seen by ENT or physician before or after SLP eval. - Clinician should make tx recs after physician info is obtained |
| ENT Exams | - Visual inspection of the larynx is perhaps the most important prod. to - understand the cause of the voice disorder 1. Mirror Laryngoscopy 2. Endoscopic Laryngoscopy (laryngeal endoscopy) |
| Hoarseness | - Seen medical attn. after 2 weeks - Causes can be benign or life-threatening - Pt. complaints may represent something different than what a physician defines it |
| Components of Voice Eval | - Background and hx - Patient interview - Non-instrumental assessment - Instrumental assessment (endoscopy, stroboscopy, PRAAT, visi-pitch) |
| Background & History | - Establish reasons for referral - Obtain preliminary info that contributes to hypothesis - Areas to focus on: + Pt overall med status + Education + Occup./vocation + Cultural/linguistic background |
| Patient Interview | - Description of voice problem & cause - Onset & duration of problem - Variability & consistency of problem - Description of voice - Psychological screening |
| Non-instrumental assessment | - Behavioral observation - Oral mech - Auditory-perceptual judgements - Voice-related quality of life |
| Hearing | - Hearing acuity is important in monitoring & regulating ones voice - Hearing loss has potential to alter respiration, phonation, resonance, and prosody - Hearing screen should be conducted when hearing difficulty is suspected |
| Listen to: | - Pitch - Loudness - Quality - Respiratory-phonatory control - Resonance (oral/nasal) - Overall Severity |
| Breathy Vocal Quality | - Whispery or airy - Associated w/hypoadduction (not able to close) |
| Harsh/rough vocal quality | - Perceived as raspy - Associated with hyper adduction (too much closure) |
| Hoarse vocal quality | - Simultaneously breathy and harsh/rough - Associated w/ compensatory hyperadduction (too much squeezing) |
| Strained vocal quality | - Choked and/or effortful - Associated with hyperadduction (too much closure) |
| Severity Labels | 1. Normal 2. Mild 3. Moderate 4. Severe |
| Mild Severity Label | - Trained listener considers the voice abnormal, but untrained listener would consider it unusual but normal - Not distracting to the listener, dysphonia doesn't interfere w/ phonation |
| Moderate Severity Label | - Both trained and untrained listener would consider abnormal - Distracting at times, ability to effectively communciate is impaired under certain circumstances (dysphonia does interfere with phonation) |
| Severe Severity Label | - Trained and untrained listeners would consider this voice extremely abnormal - Highly distracting, ability to effectively comm. is consistently impaired, dysphonia significantly interferes with phonation making it mainly absent or extremely effortful |
| Perceptual Rating Scales | GRBAS CAPE-V Journal of Voice |
| GRBAS | G: Overall grade of hoarseness R: Roughness B: Breathiness A: Asthenia (weakness) S: Strained quality |
| Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) | Visual analog scaling (L: normal, R: Deviant) - physically measured Sentences + 20-30 seconds of convo C: Consistent, I: Intermittent Rates: Overall severity, roughness, breathiness, strain, pitch, loudness |
| CAPE-V Sentences | A. Every vowel B. Easy voice onset C. All voiced D. Hard glottal attack E. Nasal attack F. Voiceless plosives |
| Voice-Related Quality of Live (V-R QoL) | -Impact dysphonia has on QoL, including the individuals perception of their illness |
| Outcomes | - Outcome: the amount of change in the physical, mental, & social states which compromise health as a result of treatment or non-treatment - Patient-reported outcome measures (PROMs): Pt. derived instruments that measure any aspect of pts. health status |
| Adult Scales | 1. Voice Disability Index 2. VHI 3. VHI-10 4. Vocal performance questionnaire 5. Voice symptom scale 6. Voice activity and participation 7. Voice-related quality of life scale 8. Voice outcome survey 9. Voice disability & coping questionnaire |
| Pediatric Scales | 1. Ped. VHI 2. Ped. Voice outcomes survey 3. Pediatric voice-related QoL 4. Children's VHI-10 5. Children's VHI-10 for Parents 6. Pediatric voice symptom questionnaire |
| Scales for Special Populations | 1. Singing VHI (adult scale) 2. VHI-Partner (adult proxy raters) |
| Voice Handicap Index (VHI) | - 30-item scale with one total score and 3 sub scales: functional, physical, emotional -Uses equal-appearing interval scale - Max sub scale score is 40; max total score is 120 (higher the score, higher the handicap) - Critical diff. of 18 pts (8 SC) |
| Voice Handicap Index-10 (VHI-10) | - Derived from original VHI - 10 items from VHI with comparable validity to full VHI - Correlation between VHI and VHI-10 is >.90 |
| Vocal Performance Questionnaire (VPQ) | - Developed as part of study that eval'ed efficacy of no intervention v. indirect therapy v. direct therapy for pts with nonorganic dysphonia - VPQ ratings obtained at baseline and after 12 weeks - Pre/post VPQ diff. scores were used as outcome meas. |
| Voice Symptom Scale | - 30 item scale w/ 3 sub scales: impairment, emotional, related physical symptoms - Contains items related to upper airway complaints (throat clearing, throat infections, swollen glands) |
| Voice Activity and Participation Profile | - Evals perception of voice problem, activity limitation, and participation restriction using WHO-ICF - Moves beyond impairment-level model |
| Voice Related Quality of Live (V-R QoL) | - 10 item scale w/ 2 subtests (physical functioning, social-emotional) - Scores standardized to 100pt scale, the lower the score the lower of QoL |
| Voice Outcomes Survey (VOS) | - Evals the vocal status of patient with UVFP - 5 items derived initially from a list of pt complaints (no sub scales) - reports standard scores (0=best, 100=worst) |
| Voice Disability & Coping Questionnaire | - 15 item instrument to assess coping - Coping: the individuals cog. and behavioral efforts to manage the stress of illness - Coping behaviors directly related to physical and functional outcomes of illness |
| Pediatric Voice Outcomes Survey | - Modification of 5-item VOS allowing for parental/proxy ratings - No subscales - Standard scale of 100, lower score = lower QoL - Validated on parents of children with and without trachs |
| Pediatric Voice-Related QoL | - Modification of 10-item V-R QoL, allowing for parental/proxy ratings - 2 sub scales: physical functioning, social-emotional - Standardized 100pt scale, lower score = lower QoL |
| Pediatric VHI (pVHI) | - Modified VHI for patents perception of childs voice handicap - 21 items, 3 domains, 2 general items - Compared pVHI from 2 parent groups: normed control and children with dysphonia |
| VHI Partner (VHI-P) | - Mod of VHI to reflect partners perception of pts voice handicap - Compared pt VHI ratings to partners VHI-P - Also compared pts VHI ratings to SF-36 ratings |
| Singing VHI | - Assesses self-perceived voice handicap in singers - 36 statements derived from 81 suggested symptoms reported from singers - No subscales |
| Limited Health Literacy | Average comprehension level of English speaking adults in the US is estimated to be at the 7th and 8th grade level - explain things at the 5th or 6th grade level PROMs may not be written at a good comprehension level |
Created by:
jessicawalker
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