Upgrade to remove ads
Only $35.99/year

Voice Assessments

Terms in this set (71)

Case History
vital to determine the nature of the problem, why it is occurring and best method to remediate it
Case History: Can serve 2 functions
1. Allows SLP to gain insight about problem
2. Provides SLP period of informal observation
-Questions regarding vocal, medical and social history are asked
Case History important questions
1. When and under what circumstances was problem originally noticed?
2. Has problem changed since onset?
3. Does voice vary?
4. Describe your voice?
5. How does patient use their voice?
6. Does patient engage in phonotraumatic behavior?
7. Patient have pain/discomfort?
8. How does patient react to their voice?
Vocal Case History
1. How does voice disorder affect patient's daily life on a functional basis?
2. If patient could change their voice how would they sound?
Quality of life measurements
emerging area in healthcare field is patient's perception of disease's impact on quality of life (QOL)
-defined in terms of ADLs, communication, and QOL
Handicap scales
should be performed at initial assessment session and throughout treatment regimen
-if treatment is short it may not be beneficial
Patients with........ are better candidates for therapy
high handicap scores and mild hoarseness
No ___________ for handicap scales
gold standard
Voice Handicap Index (VHI-10)
-30 item survey designed to be used by adults (also a peds and singers form)
-10 items in each subscale
-Uses a 0-4 ordinal scale
-Measures how much voice problem influences QOL
VHI-10: 3 major areas evaluated
1. Physical subscale=how voice disorders affects other physical functions
2. Functional subscale= how voice disorder affects other ADLs, such as work, family, and friends
3. Emotional subscale= how pt feels about voice disorder
VHI score of _______ is considered significant and is used as a cut-off from one administration point to next
18
Voice Related Quality of Life (V-RQOL)
-self completed paper/pencil survey
-10 item questionaire with 6 questions in the physical domain and 4 questions in social/emotional domain
-use scale of 1-5 (score 1=none,score 5=bad as it could be)
-scores are place into formula
-results in STANDARD SCORE
Vocal Disability Coping Questionaire
-15 item questionaire
-paper/pencil based
-heavily emotional based about disorder and how patient is coping
-has been shown that if patient can cope better, he/she will more engaged in therapy
Someone is coping well=
therapy effects will be minimal
Glottal Function Index
-Simple and easy to use
-Paper and pencil based
-4 questions
-0-5 point scale
-Evaluates patient's self-perception of vocal disability
-Short but powerful instrument
International Classification of Functioning, Disability and Health (ICF)
3 interconnected areas to classify problems with human function
Includes:
1. Impairments= evaluates difficulties with bodily function
2. Activity limitations= evaluates diff. executing certain activities
3. Participation restrictions=assesses difficulties in participation in various activities in any area of life
Functional Communication Measure (FCM)
-developed by ASHA
- 7 point scale
-Evaluates vocal capacity and quality
-Reflects functional capability
Laryngeal Function testing
Several different tasks:
1. Hard glottal attack
2. Coughing
3. Laughing
4. Clearing throat
5. Shouting
6. Soft/high pitch phonation
7. Gliding pitch up and down
-performed to assess normal biological functions of larynx
-provides clues about adduction
-discriminate organic/functional form psychogenic disorders
Hard glottal attack
patient initiates beginning of word
-patient with paresis might not be able to perform hard, glottal attack
-may present with very breathy and weak attack
Coughing
evaluate extent of glottal attack
Laughter
sound is more natural and uninhibited
Shout
assess patient's loudness
Soft, high phonation
known as vocal fold swelling tests
-/i/ and singing
-patient can't produce high soft sounds= might have swelling
swelling=VF unable to vibrate
Glide pitch up and down
assessed breaks in pitch and dysphonia
GRBAS
-most common assessment tool
-used worldwide
-Grade: rough, breathy, asthenic, and strained
Grade
degree of hoarseness (i.e. severity)
Rough
irregularity of VF vibration and depicts fluctuations in FF and/or amplitude
Breathy
how much air leakage is occurring through glottis
Asthenic
weakness or lack of power
Strained
hyperfunctional phonation
Acoustic Measurements
-mean values are fx of age, gender, and overall health status
- values may change depending on how elicited
-best for pre- and post- therapy comparisons
-used as objective data for third party payors to justify reimbursement
-used as biofeedback
-fundamental frequency, intensity, jitter, shimmer, and noise measurements
Fundamental frequency (F0)
-number times VF open and close within one second
- determined by thickness (mass) and tension (stiffness) of VF
- time it takes to complete one cycle of VF vibration
Fundamental frequency (F0): average for men
120 Hz
-range of 100-140 Hz
Fundamental frequency (F0): average for women
240 Hz
-range of 200-250 Hz
Fundamental frequency (F0): average for children
300 Hz
Fundamental frequency (F0): average for infants
500 Hz
Frequency
-Perceptual correlate is pitch
-Relationship between frequency and pitch is not linear
Intensity
-Sound pressure level generated by acoustic shock wave traveling through the vocal track
-amplitude of vocal energy
-taken as average across conversation, reading, or autonomic speech tasks
-determined by amount of subglottic air pressure
Average loudness for convo
50-70 dB
Whisper
10 dB
Intensity evaluation
can be tricky
-distance between source and microphone recording signal must be consistent
-taken minimum and maximum
-classified on continuum of soft to hard
Soft voices
hypophonic
Loud, tenses voices
hyperphonic
Jitter
amount of frequency perturbation
-defined as cycle to cycle variance in frequency
-measured by evaluating fundamental frequency
Average values:
1. Men=0.59%
2. Women=0.63%
3. Children=1.24%
Known as pitch perturbation
Shimmer
amount of intensity perturbation
-defined as cycle to cycle change in intensity
- estimated by using formulas
Average values:
1. Men=2.53%
2. Women=1.99%
3. Children=3.4%
Jitter and Shimmer
-Both are highly variable within subjects and across time
-values will never be a true zero
-largest disadvantages= measurement must be take with a sustained vowel
-cannot be determined with fundamental speech
-not correlated with perception of dysphonia
-not used diagnostically
-used to demonstrate change over time
Harmonic to Noise Ratio (HNR)
-measurement of additional noise in voice
-mean average values=
1. Men= 0.12
2. Women= 0.11
3. Children= 0.11
-Lower HNR= more dysphonic voice
-correlated to dysphonia severity more than jitter/shitter
-Can be seen on spectogram:
1. Harmonics=very clear for no pathology
2. Voice disorders= blurry harmonics
Consenus Auditory-Perceptual Evaluation of Voice (CAPE-V)
is perceptual evaluation protocol
-Clinician rate vocal quality in 3 different contexts:
1. Prolonging a vowel=/a/ and /i/
2. Six specified sequences
3. Conversational level on a 100 mm visual analog scale
Overall qualities rated include:
1. Overall severity=global impression of voice
2. Roughness= perceived irregularity in voice
3. Breathiness= audible emission form voice
4. Strain= amount of hyperfunction
5. Pitch=based on gender, age, and referent culture
6. Loudness= based on gender, age, and culture
Acoustic measures
-mean values are fx of age, gender and overall health status
-values may change depending on how elicited
-Best for pre- and post-therapy comparisons
-Used as objective data for third party payors to justify reimbursement
-can be used as form of biofeedback
Include:
1. fundamental frequency
2. intensity, jitter, shimmer, and noise measurements
Noise measurements
-determine abnormal variation of noise to harmony
-can be indication of pathological adduction
1. noise ratio
2. average spectrum
3. cepstral measures
4. soft phonation index
5. voice turbulence
Spectral noise
sound distortion as result of variability on acoustic spectrum as result of inadequate or abnormal adduction
Soft phonation index
measures of vocal fold adduction and glottal closure during phonation
-a high value of SPI is correlated with incomplete vocal fold adduction and a better indicator of breathiness than EGG
Cepstral measures
-emphasis off freq and places it on time
-measured with vowel or connected speech
-used to describe degree of dysphonia
-Calculated by estimated height of cepstral peak correlates to fundamental frequency and comparing it to noise
-reported in dB
Which measure evaluates the amount of breathiness in the voice and is a component of the MDVP
Voice turbulence index
Dysphonia Severity Index
is a weighted combination of maximum phonation time, highest frequency and lowest intensity values and the percentage of jitter to reflect perceived voice quality
Normal voice= +5
Extremely poor voice= -5
Multidimensional Voice Profile (MDVP)
computerized acoustic analysis program
-compares individuals production to predetermined thresholds and norms
Aerodynamic Measures
requires special equipment
-lung volumes= measured in ml
3 measurements:
1. vital capacity= 5000 ml
2. tidal volume= 500 ml
3. speech breathing volume= 1000 ml
Subglottic pressure (Psub)
-pressure measured below VF, usually during vibration
-related to degree of adduction of closed vocal folds
-To measure= directly needle pressure transducer into trachea right below larynx; SLP is not one to do this
Glottal resistance
ratio of air pressure to flow of air through glottis (pressure/flow)
-measured in units of c of H2) per cc per second
-associated with intensity at low and middle freq
Maximum phonation time (MPT)
-maximum times subject can produce vowel following deep inhalation
-reflect phonation type in addition to characteristics of breath support for speech
-measurement of glottal competence
S/Z ratio
/s/= voiceless lingu-alveolar fricative
/z/= voiced lingu-alveolar fricative
-both minimal and cognate pairsshould be 1.0
-vocal pathology be not be able to produce the /z/
-just because they have it doesn't mean they have a pathology
Must see a ------ to de diagnosed with a vocal pathology
physician
S/Z ration __________ is crucial to ability to prolong both /s/ and /z/
breath support
Electroglottography (EGG)
is performed by placing sensors on either side of the thyroid lamina and low voltages is sent across larynx
-It is good for showing changes in glottal contact and also alterations during registar changes
Electromyography
insertion of needle electrode to measure activity of specific laryngeal muscles
-can help slp make diagnosis and treatment decisions regarding vocal fold paralysis/paresis
-helps guide injections (e.g. botox)
-most slps never use this
Direct Laryngoscopy
-laryngoscope is inserted
-tube with handle
-patient's head is leaned back and airway is straightened
-allows vf to be viewed directly
-under anesthesia
-performed before tracheostomy or intubation
Oral Rigid Laryngoscopy
-a long scope
-inserted to directly view VF
-light is carried by fiberoptic bundle and directed downward to view larynx
-adv: increased magnification
-some do not recommend therapy
Transnasal endoscopy
more natural than rigid
-endoscope is passed through nasal cavity
-water based gel is used to help with mvmt
- anesthetic can be placed
Adv:
1. allows visualization of VF during complex tasks
-connected speech and singing can be eval, which may help with diagnosis
Stroboscopy
-may be paired with rigid and flexible endoscope
-evaluates mvmt of VF
-can assess level of adduction and abduction
-strobing light is used (make objects appear slower)
Stroboscopy: throat microphone
detects fundamental frequency
-additive in nature and does not represent consecutive cycles
Biggest adv:
1. allows anatomic and physiologic characteristics of VF to be captured, allows for pre- and post-comparison
Stroboscopy: Areas to evaluate
1. glottic closure-degree VF close during maximum adduction
2. Suprglottic activity- degree of anterposterior and lateral compressiom during phonation
3. vocal fold edge- evaluate for clean edges of vf
4. vertical level of VF approximation
5. vocal fold mobility
6. amplitude of vibration-should be symmetrical with equal mvmts
7. mucosal wvae- amount of wave present
8. nonvibration portion-whether there are portions which are not moving
9. phase closure- VF predominately closed or open
10. phase symmetry- whether both folds are meeting
11. Appearance of VF is described
12. Overall laryngeal function
Sets with similar terms