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Voice evaluation

Voice evaluation

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Voice evaluation

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  1. Voice evaluation

  2. TOpics • Definition of the terms assessment, evaluation and diagnosis • The screening process for voice disorders • Medical Evaluation for Voice Disorders • Assessment, Evaluation and Diagnosis for Voice Disorders by the clinician

  3. Definitions

  4. Assessment • The process of collecting relevant data for clinical decision making • Evaluation • It’s an appraisalof the implications and significance of the assessment • Diagnosis • Makinga decision as to whether a problem exists, and if so, differentiating it from other similar problems. Definition

  5. The screening process

  6. The Boone Voice Program for Children (Boone, 1993) • Addresses respiration, phonation and resonance • Is appropriate for students in all grades • Natural samples of voice and speech • Simple three-point system Screening forms

  7. The Quick Screen for Voice (Lee, Stemple and Glaze, 2005) • Addresses respiration, phonation and resonance • Is appropriate for students from preschool through high school • Samples of spontaneous conversation, picture description, imitated sentences, recited passages, counting and other natural samples of voice and speech Screening forms

  8. Medical Evaluation for Voice Disorders

  9. All patients/clients with voice disorders must be examined by a physician. The physician’s examination may occure before or after the voice evaluation by the clincian. Medical Evaluation for Voice Disorders

  10. Onlythe decision about whether to begin voice therapy need be deferred until all medical information is obtain. On completion of the medical examination, its is equally important for the laryngologist to communicate the findings to bout the patient and the referring clinician. Medical Evaluation for Voice Disorders

  11. Physical examination should include: • General physical condition • A thorough ear, nose and throat evaluation • Visual inspection of the larynx !!! • Mirror laryngoscopy • Endoscopic laryngoscopy Medical Evaluation for Voice Disorders

  12. Assessment, Evaluation and Diagnosis for Voice Disorders by the clinician

  13. The clinician’s role: • Describe the structure and function of the larynx • Make recommendations regarding • Further testing needed to understand the etiology of the voice problem • Maintenance of the voice problem • Treatment Assessment, Evaluation and Diagnosis

  14. The clinical process of the voice assessment: • Review of auditory and visual status • Relevant case history • Standard and nonstantndardized methods • Use of noninstrumental and/or instrumental measures • Perceptual ratings, acoustic analysis, aerodynamic measures, electroglottography and imaging tech Assessment, Evaluation and Diagnosis

  15. The clinical process of the voice assessment: • Selection of standardized measures for documented ecological validity • Monitor voice status and ensure support for patient Assessment, Evaluation and Diagnosis

  16. 1. Case history

  17. Case history

  18. 2. Noninstrumental assessment

  19. Includes: • Behavioral observation • The oral-peripheral mechanism examination • Auditory-perceptual assessment • Quality of life in persons with voice disorders Noninstrumental assessment

  20. This tells more about patients than their histories and assessment data. • We can see: • Extremely sweaty palms • Avoid eye contact with people • Use excessive postural changes • Demonstrate facial tics 1. Behavioral observation

  21. Examination of the face, oral and nasal cavities and pharynx is also required. • Mandibular restriction (下颌回缩) • Unusual downward or upward excursion of the larynx during the production of various pitches 2. The oral-peripheral mechanism examination

  22. Factors might influence judgment • The natural of the speaking task • Listener experience and training • The type of rating method used • GRBAS • CAPE-V(the Consensus Auditory Perceptual Evaluation of Voice) 3. Auditory-perceptual assessment

  23. GRBAS(Hirano, 1981) • G(grade):the overall severity of voice abnormality • R:rough • B:breathy • A:aesthenic(weakness) • S:stain • A four-point system 3. Auditory-perceptual assessment

  24. CAPE-V(Kempster,Gerratt, 2008) • 2 specific psychometric properties: • Visual analog scales • Unanchored • 6 aspects of voice: • Overall severity • Roughness • Breathiness • Strain • Pitch • loudness 3. Auditory-perceptual assessment

  25. Includes: • Overall health-related quality of life • Communication-related quality of life 4. Quality of life in persons with voice disorders

  26. 3. instrumental assessment

  27. Includes: • Laryngoscopy • Acoustic analyses • Aerodynamic measurements • Electroglottography instrumental assessment

  28. Appropriately trained clinicians may employ indirect laryngoscopy and other laryngeal visualization techniques 1. Laryngoscopy

  29. Valid acoustic measurements can: • Discrimination • Positive correlation • Sufficient stablilization 2. Acoustic analyses

  30. 5 acoustic properties of the vocal signal: • Frequency • Intensity • Perturbation • Sound spectrography • Signal(or harmonics)-to-noise ratio 2. Acoustic analyses

  31. Frequency • Speaking fundamental frequency(SFF) • Average F0 • Frequency variability • F0.SD • Phonational frequency range(PFR) • Maximum phonational frequency range(MPFR) • Voice range profile(VRP) 2. Acoustic analyses

  32. Intensity • Habitual intensity • Intensity variability • Int.SD • Intensity(dynamic)range • From softest nonwhisper to loudest shout • Voice range profile(VRP) 2. Acoustic analyses

  33. Perturbation • Jitter • Shimmer • Short-term cycle-to-cycle • Nonvolitional variability 2. Acoustic analyses

  34. Jitter

  35. Shimmer

  36. Sound spectrography • Harmonic structure of the glottal sound source • Resonant characteristics • Narrow-band filtering • Good frequency resolution • Wide-band filtering • Good time resolution 2. Acoustic analyses

  37. Signal(or harmonic)-to-Noise Ratio: • The lower the HNR, the more noise there is in the voice • Correlates well with the perception of dysphonia 2. Acoustic analyses

  38. 5 acoustic properties of the vocal signal: • Lung volumes and capacities • Air pressure • Airflow • Laryngeal resistant • Durational measures 3. Aerodynamic Measurements

  39. Lung volumes: • Tidal volume • Inspiratory reserve volume • Expiratory reserve volume • Residual volume 3. Aerodynamic Measurements

  40. Lung capacities: • Inspiratory capacity • Vital capacity • Functional residual capacity • Total lung capacity 3. Aerodynamic Measurements

  41. Air pressure: cm H2O • Inside lungs • Below the vocal folds • Indirect measure by /p/ • Inside oral cavity 3. Aerodynamic Measurements

  42. Airflow: CC or mL • Glottal resistance to airflow • Breathy vowel – higher airflow • Strained-strangled voice - lower airflow • Laryngeal resistance: • Repeat /pi/ at a rate of 1.5 syllables/sec • Peak intraoral pressure - /p/ • Peak airflow - /i/ 3. Aerodynamic Measurements

  43. Durational measures • MPT • S/Z ratio 3. Aerodynamic Measurements

  44. EGG: • Noninvasive Tech • An estimate of VF contact patterns 4. Electroglottogrphy

  45. EGG Hardware

  46. Use of EGG Hardware

  47. Stroboscopy vs. EGG wave

  48. Normal EGG wave

  49. A Complete Example Acoustic & EGG Assessment

  50. Real-time Two-channel Recording