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A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location
A number of different systems are used for classifying voice disorders. For the purposes of this document, voice disorders are categorized as follows:
Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms
Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)
Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)
Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)
Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia.
The resulting voice disorders
psychogenic voice disorders
psychogenic conversion aphonia/dysphonia
SLPs refer individuals suspected of having a psychogenic voice disorder to other appropriate professionals (e.g., psychologist or psychiatrist) for diagnosis and may collaborate in subsequent treatment.
Voice disorders are not mutually exclusive, and overlap is common
Dysphonia encompasses the auditory-perceptual symptoms of voice disorders
Roughness (perception of aberrant vocal fold vibration)
Breathiness (perception of audible air escape in the sound signal or bursts of breathiness)
Strained quality (perception of increased effort; tense or harsh as if talking and lifting at the same time)
Strangled quality (as if talking with breath held)
Abnormal pitch (too high, too low, pitch breaks, decreased pitch range)
Abnormal loudness/volume (too high, too low, decreased range, unsteady volume)
Abnormal resonance (hypernasal, hyponasal, cul de sac resonance)
Aphonia (loss of voice)
Phonation breaks
Asthenia (weak voice)
Gurgly/wet sounding voice
Hoarse voice (raspy, audible aperiodicity in sound)
Pulsed voice (fry register, audible creaks or pulses in sound)
Shrill voice (high, piercing sound, as if stifling a scream)
Tremulous voice (shaky voice; rhythmic pitch and loudness undulations)
Increased vocal effort associated with speaking
Decreased vocal endurance or onset of fatigue with prolonged voice use
Variable vocal quality throughout the day or during speaking
Running out of breath quickly
Frequent coughing or throat clearing (may worsen with increased voice use)
Excessive throat or laryngeal tension/pain/tenderness
***Signs and symptoms can occur in isolation or in combination***
***Normal voice production depends on power and airflow supplied by the respiratory system; laryngeal muscle strength, balance, coordination, and stamina; and coordination among these and the supraglottic resonatory structures (pharynx, oral cavity, nasal cavity)***
A disturbance in one of the three subsystems of voice production (i.e., respiratory, laryngeal, and subglottal vocal tract) or in the physiological balance among the systems may lead to a voice disturbance.
Organic causes include the following
Structural
Vocal fold abnormalities (e.g., vocal nodules, edema, glottal stenosis, recurrent respiratory papilloma, sarcopenia [muscle atrophy associated with aging])
Inflammation of the larynx (e.g., arthritis of the cricoarytenoid or cricothyroid, laryngitis, laryngopharyngeal reflux)
Trauma to the larynx (e.g., from intubation, chemical exposure, or external trauma)
Neurologic
Recurrent laryngeal nerve paralysis
Adductor/abductor spasmodic dysphonia
Parkinson's disease
Multiple sclerosis
Functional causes include the following:
Phonotrauma (e.g., yelling, screaming, excessive throat-clearing)
Muscle tension dysphonia
Ventricular phonation
Vocal fatigue (e.g., due to effort or overuse)
Psychogenic causes include the following:
Chronic stress disorders
Anxiety
Depression
Conversion reaction (e.g., conversion aphonia and dysphonia)
Voice Client Case History
(Example- University of Central Missouri)
I. Identification
Name:
Last First Middle initial Gender: [ ] M [ ] F Date of Birth: / / MM DD YYYY
Age:
Phone #: H / W / C e-mail:
Address
II. Voice History
A. Onset
1. What concerns you most about your voice?
2. Was the voice concern noticed suddenly or have you been aware of it for some time?
3. Who first noticed it?
4. Had you done any shouting, singing, extensive speaking, etc., before the concern was noticed?
5. Had you been ill, in an accident, or had any surgery about this time?
6. Is their any other factor that was associated with the onset? Explain
B. Etiology
1. What do you think caused the voice difficulty?
2. Does it vary in severity? If so, how?
3. Has it become better or worse recently? If so, explain.
4. Does it vary during the course of the day? If so, explain.
5. Do seasons or daily weather changes seem to affect your voice? If so, explain.
6. Does it vary with your feelings of happiness or discouragement? If so, how?
7. Does it vary significantly with the degree of fatigue? If so, how?
8. Do you feel pain when you use your voice?
C. Vocal Usage
1. Have you ever lost your voice? When and for how long? Why?
2. Has your breathing ever been noisy?
3. Do you ever run out of breath when talking?
4. Are you a singer?
5. How much talking do you do during the day (e.g., 1, 2, 3 hours)?
6. What types of situations do you use your voice?
D. Medical History
1. What injuries have you had (especially of your head and neck)? Nature:
Extent:
Date:
2. What operations have you had?
3. Have you been diagnosed with any specific medical condition? If so, what?
4. Do you have any allergies?
5. Do you feel tired without real cause?
6. Do you take any medications? What?
7. Do you have an abnormal dryness in your throat and nose?
8. Do you have sinus infections? How long?
E. Potential Contributing Factors to the Voice Disorder
Check and make any comments regarding any of the following that pertain to the patient
Vocal Behaviors
1. Shouting and yelling excessively to distant people; How often?
2. Talking over work, cafeteria, or barroom noise; How often?
3. Singing or talking in the car; How often?
4. Excessive talking at sporting events; How often?
5. Excessive talking on the telephone; How often?
6. Excessive coughing/clearing throat; How often?
7. Excessive crying/laughing; How often?
8. Other: Please indicate in the space below
Ingested Substances
1. Amount of alcohol ingested per week?
2. Amount of water and juices ingested per day?
3. Amount of cough drops with menthol, mint or anesthetic?
4. Amount of smoking per week?
5. Amount of caffeine products ingest per week?
6. How often do you use over the counter decongestants and antihistamines?
7. How often do you use cough medicines?
8. How often do you use aspirin/ibuprofen?
9. Do you use a mouthwash?
10. Do you use an inhaler for asthma?
11. Please list the typical foods that you each during the week for breakfast, lunch and dinner.
Breakfast Lunch Dinner
F. Other Observations (Circle observations below that apply to the specific patient)
1. Too small of breath
2. Too big of breath
3. In-coordination of chest wall and abdomen
4. Abrupt voice onset
5. Excessive tension in voice or throat
6. Too high or low of a pitch
7. Too closed or tense jaw
8. Poor tone focus, voice “in throat”
9. Facial or neck tension
10. Poor posture, bent from waist
11. Speaking with draw thrust
12. Talking too loudly
13. Inappropriate emphasis on vowel onset words
Assessment Information
Assessment Information
Screening
Screening
Screening may be conducted if a voice disorder is suspected. When deviations from normal voice are detected during screening, further evaluation is warranted.
Screening includes:
Vocal characteristics related to respiration, phonation, and resonance, as well as vocal range and flexibility
(e.g., pitch, loudness, pitch range, and endurance)
Formal Screening: Pediatrics
Formal Screening: Adults
Informal Screening:
Imitate words and phrases of varying lengths
Count to 20
Recite the alphabet
Read a short passage
Talk conversationally for a couple of minutes
Prolong the following vowels for 5 seconds each: /ɑ/, /æ/, /i/, /ʌ/, /u/
Additional Aerodynamic/Acoustic Measurements:
Produce sustained /s/ for calculating an S/Z ratio
Maximum phonation time (MPT) for glottic efficiency measurements
During the screening, listen carefully to the client’s resonance, tone, pitch, and loudness. Any perceived deviation from normal suggests that further evaluative measures should be pursued.
(Shipley, K. G., & McAfee, J. G. 2016)
Standardized/Norm-referenced test
Standardized/Norm-referenced test
GRBAS (grade, roughness, breathiness, asthenia, strain) scale
Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)
Voice Related Quality of Life (V-RQOL)
(ASHA, 2021)
(Shipley, K. G., & McAfee, J. G. 2016)
AREAS & PARAMTERS & SKILLS
Tremors- Rhythmic alternation or contraction of opposing muscles.
Results from oscillatory movement of the affected body part.
When it involves the voice it impacts vocal folds, muscles of the pharynx, palate, and back of the tongue
Jitters- Variation in Fo from cycle to cycle
Shimmer- Variation in amplitude from cycle to cycle
Harmonic to Ratio (HMN)- Ratio of periodic and non-periodic components of a speech sound.
Respiratory Skills
Respiratory pattern (abdominal, thoracic, clavicular)
Coordination of respiration with phonation (breath-holding patterns, habitual use of residual air, length of breath groups)
Maximum phonation time (MPT)
s/z ratio to assess for glottal insufficiency, which may be indicative of laryngeal pathology (Eckel & Boone, 1981; Stemple et al., 2010)
Eckel, F. C., & Boone, D. R. (1981). The s/z ratio as an indicator of laryngeal pathology. Journal of Speech and Hearing Disorders, 46, 147–149
Auditory-Perceptual Skills
Voice Quality
Consensus features assessed during production of sustained vowels, sentences, and running speech
Roughness—perceived irregularity in voicing source
Breathiness—audible air escape in voice
Strain—perception of excessive vocal effort
Pitch (perceptual correlate of fundamental frequency)—deviations from normal relative to age, gender, and referent culture
Loudness (perceptual correlate of sound intensity)—deviations from normal relative to age, gender, and referent culture
Overall severity—global, integrated impression of voice deviance
Additional perceptual features
Diplophonia, aphonia, pitch instability, tremor, vocal fry, falsetto, wet/gurgly
(Kemper, Gerratt, Abbott, Barkmeier-Kraemer, & Hillman, 2009; ASHA, 2002; ASHA , n.d.)
Vocal amplitude
Habitual sound pressure level (SPL) in decibels (dB)—typical sound level of voice during connected speech (standard reading passage)
Minimum and maximum vocal SPL (dB)—softest and loudest sustainable phonation
Vocal frequency
Mean vocal f0 (Hz)—average of the estimates of the f0 for acoustic signal recorded during connected speech (standard reading passage)
Vocal f0 standard deviation (SD; Hz)—SD of the estimates of the f0 for acoustic signal recorded during connected speech
Minimum and maximum vocal f0 (Hz)—f0 values for the lowest and highest pitched sustainable phonations
Vocal signal quality
Vocal cepstral peak prominence (CPP; dB)—relative amplitude of the peak in the spectrum that represents the dominant harmonic of the vocal acoustic signal (sustained vowels and connected speech samples)
Aerodynamic Aspects
Measures (using noninvasive procedures) of glottal aerodynamic parameters required for phonation
Glottal airflow
Average glottal airflow rate (L/sec or mL/sec)—estimated from oral airflow rate during vowel production
Subglottal air pressure
Average subglottal air pressure (cm of water [cmH2O] or kilopascals [kPa])—estimated for intraoral air pressure produced during repetition of stop consonants in syllable strings
Mean vocal SPL and f0—extracted from simultaneously recorded acoustic signal; facilitates interpretation of airflow and air pressure measurements
Table of Areas/Parameters/Skills typically assessed
Table of Areas/Parameters/Skills typically assessed
Resonance
Assess resonance quality (normal, hyponasal, hypernasal, cul-de-sac).
If abnormal, assess Stimulability for normal resonance.
If normal, evaluate the focus of resonance (oral, pharyngeal/laryngeal, nasal).
Phonation Skills
Voice onset/offset (e.g., delayed voice onset; quality of voice at onset)
Ability to sustain the voice to achieve appropriate phrasing during speaking
Ability to demonstrate strong and consistent rate of vocal fold valving during diadochokinesis
Rate Skills Vary
Deviations from normal relative to age, gender, and referent culture
Laryngeal Imaging
Measures of structure and gross function (using videoendoscopic) and measures of vocal fold vibration during phonation (using video-stroboscopy)
Videolaryngoendoscopy
Vocal fold edges—appearance of superior vocal fold edges during abduction
Vocal fold mobility—movement of vocal folds toward and away from midline at level of cricoarytenoid joint during laryngeal diadochokinetic task
Supraglottic activity—degree of compression of supraglottic structures during sustained phonation
Videolaryngostroboscopy
Regularity—consistency of successive glottic cycles
Amplitude—lateral movement of the vocal fold medial plane
Mucosal wave—independent lateral movement of mucosa over vocal fold
Left/right phase symmetry—symmetry of vocal folds (opening, closing, maximum lateral–medial excursion) during glottic cycle
Vertical level—level difference in vertical plane between vocal folds during maximum closed phase of glottic cycle
Glottal closure pattern—glottal configuration during maximum closure
Glottal closure duration—relative proportion of glottal cycle in which glottis is closed
STEWART, KLING, & ALLEN
CLINICAL VOICE EVALUATION FORM
Normative Data/Statistics
Normative Data/Statistics
S/Z Ration (Clinical Indicator of Laryngeal Pathology)
Normal Function:
1:0 ratio with normal duration
1:0 ratio with normal /s/ but shortened /z/ duration
Respiratory insufficiency
1:0 with reduced phonation on both sounds
Jitter:
0.2 to 1.0 %
Shimmer:
05.dB or less
Fundamental Frequency:
Male range 85 Hz- 195 Hz
Female range 155Hz- 334 Hz
Children range 280Hz- 440 Hz
Maximum Phonation Time (MPT):
Males 25-35s
Females 15-25s
Children 10-15s
Glottic insufficiency is a concern if MPT is less than 10m seconds
Vocal Intensity:
Whisper 10dB
Quiet voice 35 -40 dB
Normal Conversation 35-40 dB
Loud voice 80 dB
Screaming 100 db
Eckel FC, Boone DR. The S/Z ratio as an indicator of laryngeal pathology. J Speech Hear Disord. 1981 May;46(2):147-9. doi 10.1044/jshd.4602.147. PMID: 7253591.
Non-Standardized assessment Procedures
Non-Standardized assessment Procedures
Instrumental Assessment (Endoscopy)
-Gives clinician/institution visual of Vocal Folds and surrounding structures
-Only way to examine structural or organic cause
Electrolarynx "Sound Box"- Device for the throat substituting vocal cords and used for breathing, swallowing, and talking.
Rigid Scope “Telescopic"- Limited view but video has a better imaging quality, patients with gag reflexes are biased to this study
Flexible Scope “Nasopharyngoscopy"- Video camera inserted through nasal cavity, lower video quality but can view the subglottal and pharynx areas easily.
Stroboscope- The use of a strobe light to image movement of the vocal folds
(SLP's can perform and diagnose primary diagnosis along with a secondary diagnosis from a medical doctor)
Physical
Physically examining the circumlaryngeal region
Extrinsic/Intrinsic laryngeal muscles used during voice
Laryngeal elevation/depression restricted
Thyroid membrane
(Bridges, 2019)
*Voice Assesment Protocols differentiate bwetween clinicans and clinics*
Acoustic/Aerodynamic
-Measure respiratory flow
-Measures acoustics of the voice
Tasks May Include:
Connected Speech Sample
Narrative sample- "Tell me about your day?"
Sustained Vowels
Standardized-GRBAS Rating scale (An auditory-perceptual examination for scores 0-3 for grades of hoarseness; Roughness, Breathiness, Asthenia, and Strain, where 0 is within normal range, 1 is slight degree, 2 is a medium degree, and 3 is the highest grade)
(Omori Diagnosis of Voice Disorders 2011)
Analysis:
Speaking Fundamental Frequency
Sound Pressure Level
Maximum Phonation Time
Cepstral Peak Prominence
Noise-to-Harmonics Ratio
Voice RangeProfile
Electroglottography
Subglottal Air Pressure
Glottal Airflow
Phonation Threshold Pressure
Perceptual Examination
Perceptual Examination
Auditory Observation-Loudness of pitch, the quality
(breathy, stridor, harshness), strain (pressed phonation and perception),
resonance, severity (GRBAS rating scales)
Visual Observation-Posture of client, visible movements
of the larynx, motor speech and observation of respiration (rate, noise,
clavicular vs diaphragm)
Client Self-Report - *See Standardized/Norm-referenced Assessments*
Voice Handicap Index, Voice-Related Quality of Life and Voice Impact Profile
*If patient displays atypical symptoms this is a very important part of the clinician’s assessment
also important to note this is not a voice disorder*
(Shipley and McAffee, 2016)
Differential Diagnosis
Differential Diagnosis
Voice Disorders: Organic or Functional
Nodules and polyps are growths that form on vocal cords, impacting the way a person's voice sounds.
Resonance Disorders:
Occur in both adults and children; not to be confused or misdiagnosed as a voice disorder.
Hypernasality: sound energy in nasal cavity during production
Hyponasality: caused by blockage, results in lack of nasal resonance
Cul-de-sac resonance: trapped oral, nasal or pharyngeal sound
Mixed resonance: presence of the above mentioned disorders in same speech signal.
(Shipley. K.G. and McAffee J.G. 2016)
Signs and Symptoms:
The signs and symptoms of both nodules are polyps are similar:
Hoarseness or breathiness
shooting pain from ear to ear
vocal fatigue
Arduous and forced phonation
Neck pain and feeling like there is a lump in throat
Testing includes use of an endoscope, a strobascope and videoscrobascopy.
Other characteristics include:
frequent, non productive cough
frequent throat clearing
diminished gag reflect
diminished ability to change pitch
overall vocal and physical fatigue
Laryngospasms
Laryngospasms
Voice change/ hoarseness in communication
Stridor
Tightness of throat and trouble breathing
Can be confused with asthma especially in children that are highly active
Velopharyngeal Dysfunction: [VPD]
Falls into Cleft and non-cleft VPD
Cleft VPD: velopharyngeal insufficiency
Characterized by unrepaired cleft and/or surgical issues or deficiencies
Non-cleft VPD:
Velopharyngeal insufficiency
Velopharyngeal incompetency
Velopharyngeal mis-learning
VPD overall is characterized by:
-glottal stops,
-pharyngeal stops
-Velar fricatives
-nasal fricatives
-nasal grimaces
Assessment Summary
Assessment Summary
Diagnosis
Contributing factors (e.g., Environmental and behavioral, medical or neurological, motivation and concern, etc.)
Characteristics of Voice (Pitch, Quality, Loudness)
Auditory-perceptual judgements, aerodynamic and acoustic measures.
Characteristics of Resonance
Auditory-perceptual judgements, velopharyngeal function, acoustic measures.
Identification or concerns from Speech-language evaluations
Underlying orofacial findings
Maintaining factors
Recommendation
Prognosis
Shipley et al. 2016
Treatment
Treatment
Note: Clinician should begin by
Identifying the behaviors (e.g., shouting, talking loudly over noise, coughing, throat clearing, and poor hydration) and
Then implement healthy vocal hygiene (e.g., using the appropriate volume for speech) practiced to reduce vocal trama.
Treatment Approaches:
Treatment Approaches:
Direct: Focus on manipulating the voice-producing mechanism (e.g., phonation, respiration, and musculoskeleton function) in order to modify vocal behaviors and establishing healthy voice production
Indirect: Modify the cognitive, behavioral, psychological, and physical environments. Two components:
Patient Education: Educating patient on normal physiology of voice production and the impact of voice disorders on funtion; providing information on vocal misuse and strategies for maintaining vocal health
Counseling: Identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect the vocal health.
Treatment Options
Treatment Options
Physiologic Voice Therapy: Works to balance the 3 subsystems of voice production (respiration, phonation, and resonance). Can be used for a variety of disorders.
Accent method: designed to increase pulmonary output, improve glottic efficiency, reduce excessive muscle tension, and normalize the vibratory pattern during phonation.
Conversation Training Therapy (CTT): Focuses on Voice Awareness and production in patient-driven conversational narrative. Goal is to achieve balanced phonation. Interchangable Components; A. clear speech, B. auditory and kinesthetic awareness, C. negative practice/labeling, D. embedding basic training gestures into speech, E. prosody, projection and pauses, and F. rapport building.
Cup Bubble (Lax Vox): aerodynamic building task aimed at improving ability to sustain phonation while speaking. Patient blows air initially into a cup of water without voice, then with voicing and eventually cup is removed.
Expiratory Muscle Strength Training (EMST): respiratory stengthening during phonation. Uses an external device to mechanically overload the expiratory muscles.
Lee Silverman Voice Treatment (LSVT): Designed to help maximize phonatory and respiratoy function using simple tasks. 5 principles; A. Individual should "think loud/think shout," B. Speech effort must be high, C. Treatment must be intensive, D. Patients must recalibrate their loudness level, and E. Improvements are quantified over time.
Manual Circumlaryngeal Techniques: Intended to reduce musculoskeletal tention and hyperfunction by re-postuing the larynx during phonation. 3 techniques; A. Push-back maneuver, B. Pull-down maneuver, and C. Medial compression and downward traction.
Phonation Resistance Training Exercise: Derived from LSVT and has 4 exercises; A. Producing /a/ with loud maximum sustained phonation, B. Producing /a/ with loud ascending pitch glides over entire pitch range C. Producing functional phrases using loud and high voice, and D. Producing the same functional phrases using loud and low voice.
Resonant Vice Therapy: Using oral senation and easy phonation to build from basic speech gestures through conversational speech. Program incorporates humming and both voiced and voiceless production.
Stretch and Flow phonation (Casper-Stone Flow Phonation): Used to treat functional dysphonia or aphonia. Focusing on airflow management by giving attention to a steady outflow of air during exhalation, biofeedback is used, then introducing voicing.
Flow phonation: Designed to facilitate increased airflow, ease of phonation, and forward oral resonance
Vocal Function Exercises (VFEs): Series of systematic voice manipulations designed to facilitate return to healthy voice function by strengthening and coordinating laryngeal musculature.
Asha, treatments
Symptomatic Voice Therapy: Strives to modify the deviant vocal symptoms (e.g., too high vs too low Pitch, too soft or too loud of a voice, breathy phonation, use of hard glottal attacks or glottal fry) or perceptual voice components. Uses direct or indirect methods.
Amplification: use of microphones- to function as a supportive tool. Helps to prevent vocal hyperfunction. from talking loudly for an extended period of time.
Auditory Masking: used in cases of functional aphonia/dysphonia. Individuals talk or read aloud while wearing headphones that are producing loud noise in the background, this will increase the volume.
Biofeedback: Individuals are trained to become aware of physical sensations (e.g., repiration, body position, and vibratory sensation.)
Chant Speech: Using pitch fluctuations and coordination among respiratory, phonatory and resonance subsystems.
Confidential Voice: Designed to reduce laryngeal tension/hyperfunction and increase air flow. Intended to address excessive vocal tenstion and facilitate relaxation in the muscles of the larynx
Glottal Fry: Used for patients with nodules or other hyperfunction problems (e.g., polyps, spasmodic dysphonia.
Inhalation phonation: Used to facilitate true vocal vibration in the presence of habitual ventricular fold phonation, functional aphonia, and muscle tension dysphonia.
Semi-Occluded Vocal tract (SOVT) Exercises: Involved in narraowing at the supraglottic point along the vocal tract to maximize interations between the vocal fold vibration (Source) and vocal tract (Filter) and produce resonant voice.
Straw Phonation: Most frequently used method to create SOVT: Use a straw for phonating which will semi-occlude the vocal tract. Practice sustaining vowels, performaing pitch glides, humming, etc.
lip Trill: Involves smooth movement of air through the oral cavity and over the lips, causing lip buzz (vibration) . Focused in improving breath support and produce voicing without tension.
posture: sitting in an upright postion with shoulders in a low and relaxed manner to facilitate voice production.
relaxation: techniques focused on reducing both the whole-body and laryngeal area tension.
Twang Therapy: Used for individuals with hypophonic voice. Focused on narrowing the aryepiglottic sphincter using a "twang" voice to create high-intensity voice quality with low effort.
Yawn-sigh: Using natural yawn and sign to overcome symptoms of vocal hyperfunction. Intended to lower position of the larynx and widen the supraglottal space. This may allow for more relaxed voice and natural pitch.
Masako Maneuver: stick out your tongue out and then swallow. Voiceless to begin then add /mhm/ ensure that there is a breath before each trail. Helps to release tightness of the jaw area.
Asha, treatments
Exercise Samples
Exercise Samples
Stewart, C. (2021)
Resonant Voice Therapy - Lessac & Madsen; professor Dr. Kitty Verdolini (teaches this)
Vocal Function Exercises - Joe Stemple
Vocal Function Exercises - Joe Stemple
Vocal Function Exercises - Joe Stemple
Visuals and Other Resources
Visuals and Other Resources
Click For further Resources
Anatomy and Physicology Of the Vocal Fold
Shipley et al. 2016
References
References
https://provo.edu/wp-content/uploads/2017/04/Voice-PDF-Form-Quick-Screen-for-Voice.pdf
https://www.asha.org/siteassets/uploadedFiles/ASHA/SIG/03/CAPE-V-Procedures-and-Form.pdf
https://melbentgroup.com.au/wp-content/uploads/2016/10/MEG-Voice-Symptom-Score-VoiSS-SCORING.pdf
ASHA. (2021). Voice disorders. American Speech-Language-Hearing Association. Retrieved October 10, 2021, from https://www.asha.org/practice-portal/clinical-topics/voice-disorders/#collapse_3
ASHA. (2021). Vocal cord nodules and polyps. American Speech-Language-Hearing Association. Retrieved October 10, 2021, from https://www.asha.org/public/speech/disorders/vocal-cord-nodules-and-polyps/.
ASHA. (2021). Resonance disorders. American Speech-Language-Hearing Association. Retrieved October 10, 2021, from https://www.asha.org/practice-portal/clinical-topics/resonance-disorders/#collapse_6.
Voice Disorders (2021). Treatment. American Speech-Language-Hearing Association. Retrieved October 10, 2021, from https://www.asha.org/practice-portal/clinical-topics/voice-disorders/#collapse_6
Shipley, K. G., & McAfee, J. G. (2016). Assessment in speech-language pathology: A resource manual (6th ed.). Plural Publishing, Inc.
Stewart, C. Voice Disorders. 2NYU. https://2nyu.speech.steinhardt.nyu.edu/ap/courses/1018/sections/c211a469-61a6-4fe8-a2a7-d8d15480c1f7/coursework/courseModule/336721c7-dc41-4bf0-9395-6c771a6abedb
Omori , K. (2011, August). Diagnosis of voice disorders. Retrieved October 11, 2021, from https://www.med.or.jp/english/journal/pdf/2011_04/248_253.pdf.
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