| 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 |
