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Therapy for Special Populations

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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  
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Adults Seeking Tx   Adults 70+ are 2.5 times more likely than those under 70 to be diagnosed with a voice disorder  
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Presbyphonia   The clinical condition of elderly patients presenting to the ENT with gradual weakening of the voice  
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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  
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Auditory-Perceptial Features of Presbyphonia   - tremor - Hoarseness - Breathiness - Voice breaks - Decreased loudness - Slow speaking rate - change in habitual pitch  
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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  
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Management of Presbyphonia   1. Laryngoplasty 2. Thyroplasty 3. Voice therapy  
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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  
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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  
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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  
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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  
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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  
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Service Delivery Options   - Pull out - Collaborative method - Consultative method - Individual - Small-group  
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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  
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Vocal Hygiene   Identify vocal abuse Explore alternative methods Increase water intake Decrease coughing and throat clearing Quiet-time at home  
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"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  
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VFAs for Nodules in Children   Relaxation Yawn-sigh Chant Talk Focus Open Mouth Respiration Training Inhalation phonation  
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Areas to focus on in TG Voice therapy   Vocal characteristics Resonance/articulation Language and nonverbals Self-perception and QoL  
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Voice Features of Focus for MTF Clients   Increased pitch Upward intonation Slightly breathy vocal quality Slightly lighter voice onset  
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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)  
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Language Feats for MTF clients   Increased use of tag questions Increased used of adjective/verbs Increased use of hedges Increased emotionality Increased details  
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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  
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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  
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Psychosocial Issues   Need to address - Gender attribution and discrimination - Nature/nurture controversy - Shame and guilt - "coming out" - Struggles of partners and family - Employment  
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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  
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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  
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VFAs for TG Clients   Auditory feedback Change in loudness Counseling Focus Pitch Inflections Visual feedback Yawn-sigh  
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