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Voice Ch. 8

Therapy for Special Populations

TermDefinition
Older Americans 1 in 8 Americans are 65+, this number is increasing Going to see more aging voices in out caseloads because of this
Adults Seeking Tx Adults 70+ are 2.5 times more likely than those under 70 to be diagnosed with a voice disorder
Presbyphonia The clinical condition of elderly patients presenting to the ENT with gradual weakening of the voice
Laryngeal Signs in Presbyphonia - Mild bowing of VFs - Anteriorly placed glottal gaps - Prominent arytenoid cart. vocal processes - VF edema - Asymmetry of VF vibration - Predominant open phase
Auditory-Perceptial Features of Presbyphonia - tremor - Hoarseness - Breathiness - Voice breaks - Decreased loudness - Slow speaking rate - change in habitual pitch
Acoustic Features of Presbyphonia Increased F0 in males, decreased in females Decreased SPL (sound pressure level) Increased noise-to-harmonics ratio Inconclusive findings on jitter and shimmer changes
Management of Presbyphonia 1. Laryngoplasty 2. Thyroplasty 3. Voice therapy
Voice Disorders in Children Hard to determine due to methodological limitations about 7.5 million children have some level of dysphonia Childhood dysphonia has an adverse effect on listener's perceptions of child
Educational Risks in Children with Voice Disorders - Difficulty being heard - Limited participation/public speaking - Fear of oral reading - Fear of interpersonal interactions - Limited participation in music ed - Reluctance to participate in activities - Hinderance of academic goals on peers
Treating Vocal Hyperfunction in Children Hyperfunction has the ability to jeopardize function in classroom Behavioral tx is effective in either reducing size of nodules or eliminating them Prevention programs are effective
Barriers to School-Based tx for Voice Disorders - Restrictions for qualifying for services - Hard to obtain laryngoscope exams - Lack of parental/physician follow ups - Lack of resources in rural areas - Lack of education in staff - Need for better IP comm. between SLP and others
Role of School-Based SLP in voice Some students fail to get school-based services because of a lack of educational impact, but receiving services is not conditional upon academic performance
Service Delivery Options - Pull out - Collaborative method - Consultative method - Individual - Small-group
Voice Goals for IEPs - Awareness/discrimination - appropriate respiration - Relaxation strats - Use of appropriate voice quality - Understand oral mechanism - Use appropriate non-verbals - appropriate resonance, onset of voice, pitch/loudness/rate - Vocal hygiene
Vocal Hygiene Identify vocal abuse Explore alternative methods Increase water intake Decrease coughing and throat clearing Quiet-time at home
"Just Right" voice Incorporate the just right voice idea in therapy, school, and home Child identifies just right voice qualities Just right voice goals book given to child and everyone establishes goals
VFAs for Nodules in Children Relaxation Yawn-sigh Chant Talk Focus Open Mouth Respiration Training Inhalation phonation
Areas to focus on in TG Voice therapy Vocal characteristics Resonance/articulation Language and nonverbals Self-perception and QoL
Voice Features of Focus for MTF Clients Increased pitch Upward intonation Slightly breathy vocal quality Slightly lighter voice onset
Resonance or Arctic Features for MTF Clients Increasing formant frequencies Forward Tone focus Prolonged vowels Increased consonant precision Light articulatory contacts More fluent articulation (less choppy)
Language Feats for MTF clients Increased use of tag questions Increased used of adjective/verbs Increased use of hedges Increased emotionality Increased details
Selp-perception and QoL for MTF clients Acceptance of their new voice/speech are not the only factors Nonverbal behaviors including physical appearance, are equally as important
Phonosurgery for FTM clients Type III Thyroplasty: shortening of the anterior-posterior length of the thyroid cartilage May result in lowering the F0 by about 100 Hz
Psychosocial Issues Need to address - Gender attribution and discrimination - Nature/nurture controversy - Shame and guilt - "coming out" - Struggles of partners and family - Employment
Measuring QoL in TG Clients Transsexual Voice Questionnaire for MTF Transsexuals (TVQ) - self evaluation designed for use with TG women - Measures their experience with their voice - 30 items with a 4-point scale for responses
Therapy for the TG Client Clinician should consider - Clients needs - Biological constrains - Access to therapy - Goal -sequencing - Transfer and maintenance Groups and individual therapy can be used
VFAs for TG Clients Auditory feedback Change in loudness Counseling Focus Pitch Inflections Visual feedback Yawn-sigh
Created by: jessicawalker
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Voices

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