| Term | Definition |
| 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 |
