IB CSL
SPEECH ASSESSMENT
Ms. Amy Tsang
ENT
Fri 23-08-02
COMMUNICATION DISORDERS
- People having a high incidence of communication disorders:-
- Post- surgery (e.g.: laryngectomee, excision of oral, laryngeal pathologies)
- Stroke, head injury or other neurological disorders
- Mental retardation / Developmental delay
- Hearing loss / Cochlear Implantee
- Cerebral Palsy
- Cleft Palate / Oral Abnormalities
- Learning Disorders
- Autistic
LANGUAGE DISORDERS
- Language: understanding and use of words and sentences to formulate and express ideas symptoms:
- Not using single words ® by 18m
- Not using two word sentences ® 2½y
- Incorrect sentence structure (e.g. I apple eat)
- Difficulty understanding other’s speech
- Difficulty expressing oneself
ARTICULATION DISORDER
- Articulation: production of speech sounds (consonants, vowels) symptoms
- Child not using a wide variety of sounds ® by 18m
- Unintelligible speech
- Difficulty with "later-developing sounds" ® by 5y
Note: child must be treated before age 6-7y
POST TRAUMA, INFECTION, MALIGNANCY
Eg. Following CVA, head injury, cerebral anoxia, brain tumour, encephalitis or other neurological syndromes
- DYSPHASIA: difficulty in understanding/using spoken or written language
- DYSARTHRIA: muscular weakness and incoordination affecting speech, voice quality
STUTTERING (lau hau/)
- Fluency: smooth flow of speech
- Problems
- Excessive hesitation / repetition of sounds, words or phrases
- Prolongation of sounds
- Blocking on sounds (open mouth but no sounds comes out)
POST-LARYNGECTOMY & LARYNGECTOMEE REHABILITATION
- Note: permanent stoma \ no swimming, showering must wear bib (wai kwun/)
- Pre-op: counselling by Speech Therapist & visit by members of the New Voice Club, Hong Kong
- Post-op: acquisition of alaryngeal speech
- Options
- Oesophageal speech: sick do yu/ (no machine)
- Electronic larynx - Servox (deen jee my/ fa sing^), press under chin
- Pneumatic device (la ba^ jai/)
- Tracheo-oesophageal speech - Bloom-Singer valve, Provox, Voicemaster (speaking valve, tracheoesophageal puncture, replacement needed every 6m)
VOICE DISORDERS
- Voice: sound produced by vibrations in the larynx
- Symptoms
- Husky (saa^ seng^)/ breathy / nasal voice (bei yum^)
- Intermittent / complete loss of voice
- Inappropriately high / low / loud / soft voice
VOICE MISUSE and ABUSE (>70% of Pt's)
- Increased tension (hard glottal attack): larynx, neck
- Excessive talking
- Inappropriate pitch (puberphonia: voice doesn't deepen at puberty, glottal fry)
- Prolonged loudness
- Ventricular phonation (false vocal cord)
- Excessive throat clearing
- Smoking
- Vocal pathologies
- Nodules
- Chronic laryngitis
- Polyps
- Sulcus vocalis
- Intracordal cysts
- Contact ulcer
- Oedema
- Therapy
- Identify & eliminate vocally abusive behaviours
- Easy voice production
- Decrease of vocal loudness, amount of talking & laryngeal tension
NERVOUS SYSTEM INVOLVEMENT
- UMN disorders: pseudobulbar palsy / Parkinsonism / ALS
- LMN disorders: spastic dysphonia
- Cerebellar disorders: ataxic dysphonia
- Superior laryngeal nerve / recurrent laryngeal nerve
- Therapy
- No cure / alternative communication
- Unilateral vocal fold paralysis: adduction exercise / spontaneous recovery (6m-1y)
- Teflon injection / thyroplasty
ORGANIC DISEASE & TRAUMA
- Benign lesion
- Blunt or Penetrating Trauma
- Inhalation and Thermal
- Trauma
- Carcinoma and other Tumours
- Therapy: medical and surgical approaches followed by voice rehabilitation
PSYCHOGENIC VOICE DISORDERS
- Total aphonia / dysphonia / variable dysphonia
- Therapy : referral for psychiatric examination
SPECIAL VOICE PROBLEMS
- Transsexual Voice ® surgery then voice therapy
- Endocrine Disorders / Hormone Imbalance
DIFFERENTIAL DIAGNOSIS OF VOICE PROBLEMS
- Symptoms
- Breathiness, aphonia, pitch breaks, inappropriately high pitch, strain voice, tremor
- Signs
- Pitch (monopitch, inappropriate pitch, pitch breaks - jau/ yum^)
- Loudness (monoloudness, soft, loud, or uncontrolled)
- Quality (harshness, breathiness, tension, tremor - jun, diplophonia)
- Acoustic signs
- Fundamental frequency (phonational range, jitter)
- Amplitude (dynamic range , shimmer)
- Spectral noise, voice tremor, phonation time
- Intensity, harmonic-to-noise ratio, resonance
VOICE EXAMINATION
Case History
- Nature of the problem
- Effect of the voice problem
- Onset
- Duration
- Variability / consistency
- Associated symptoms & sensations
Patient History
- Voice use
- Health
- Vocational
- Social
- Psychological
Examination of the Voice
- Objective Assessment
- Laryngology : indirect / direct / flexible fibreoptic
- Stroboscopy
- Nasometry
- Acoustic Testing
- Spectrography (fundamental frequency, phonational range,
- Vocal intensity, perturbation, spectrograms, acoustic spectrum)
- Frequency, intensity, harmonic-to-noise ratio
- Computerised Speech Lab. (CSL)
- Videofluoroscopy
- Perceptual Voice Evaluation
- Auditory perception of voice quality
- Voice Profile / point scale / visual analogue scale
- Eg: pitch / loudness / diplophonia / breathiness)
- Laboratory Testing
- Physiological studies (electroglottography, electromyography)
- Respiratory studies (air volumes & capacities, respiratory movements)
GENERAL VOICE THERAPY APPROACHES
- Auditory Training
- Posture
- Relaxation or Release of Excess Tension
- Breathing
- Onset of Voicing
- Exploring Pitch
- Muscular Flexibility
- Resonance
- Control of Volume
VOICE THERAPY TECHNIQUES
- Breathy Phonation
- Sigh, Aspirate Initiation,
- Easy Initiation of Phonation
- Yawn / Sigh
- Chewing
- Chant-talk
- Hum & Nasal Consonants
- Digital Manipulation
- Imagery
- Pushing & Pulling: unilateral vocal cord paralysis (aka adduction exercise)
COCHLEAR IMPLANT: Video
- Considered in: (1) Bilateral hearing loss (2) Severe to profound hearing loss (3) Sensorineural hearing loss
- Surgery ® Mapping: audiologist - 'tuning' of implant ® Auditory training: speech therapist
- Paediatrics: 2y of intensive training with: (1) 1 h/w: therapist (2) 1 h/d: mother at home