Assessment of voice and Resonance

Classification

• Organic disorders –known physical cause– Includes neurological disorders

• Functional disorders – no known physical etiology

Classification

Assessment

• History– Procedures– Contributing factors

Assessment of voice

• Pitch

• Quality

• Resonance

• Loudness

Procedures

• Screening• Serial Tasks• Oral Reading• Speech Sampling• S/Z Ratio• Velopharyngeal Function• Stimulabilty of Improved Voice• Instrumentation

Other

• Oral-Facial Examination

• Hearing Assessment

Screening

• Imitate words and phrases of varying lengths• Count to ten• Recite the alphabet• Read a short passage• Talk conversationally for a couple of minutes• Prolong vowels for five seconds• Use Table 10-2 to evaluate. Any rating of 2 or

higher needs further evaluation or rescreening.

Table 10.2

Table 10.3

Need for medical evaluation

• All clients need a medical evaluation

• An Otolaryngologist will use an endoscope to visually examine larynx and related structures for ulcers, polyps, tumors or nodules.

• Do not begin treatment until the medical examination

Examining the Voice

• Collect Speech sample• Serial Tasks• Areas to assess

– Pitch, intensity and quality– Resonance– Prosody– Vocal habits (including abusive behaviors)– Respiratory support for speech

• Form 10.1 provides behaviors that lead to voice disorders

• From 10.2 is a vocal characteristics checklist

Form 10.1

Assessment Instrumentation

• These are objective measures• Include

– Electromyography– Aerodynamic Measures– Stroboscopy and videondoscopy– Acousitc Measures

• Fundamental Frequency• Intensity Measure• Spectral measures• Visi-Pitch III

Normal Fundamental Frequencies

• Sometimes called habitual pitch – the average pitch that a client uses during speaking and reading.

• It is the speech of the vocal fold vibration during sustained phonation.

• Use instruments or use audio tapes and compare to piano keys.

• Ask yes/no questions and the client responds with “mmm’hmmm”

Fundamental Freq. chart

Assessing Breathing and Breath Support

• Breathing patterns– Clavicular – least efficient for speech– Thoracic – most common and is adequate– Diaphragmatic-thoracic – most optimal for

speech

• From 10.3 is used to identify breathing patterns.

S/Z ratio• Ask client to sustain each phoneme as you use a stopwatch to

calculate the maximum number of seconds your client is able to produce each sound.

• /s/ Average for children is 10 seconds, for adults is 20-25 seconds.• Measure the sustained /s/ two times.• Repeat instructions with /z/• Compare both productions• Then divide the /s/ by the /z/ to get ratio.• Then use information page 324 to determine clinical significance.

– 1.0 ratio with normal duration (10 sec child, 20-25 for adults) = normal – 1.0 ratio with reduced duration of /s/ and /z/ =possible respiratory

inefficiency– 1.2 or greater with normal duration of /s/ indicates possible vocal fold

pathology.

Assessing Resonance

• Assess hyponasality, hypernasality and assimilation nasality.

• Ask client to count 60 – 100 and listen to each feature during each number grouping– 60-69 : nasal emission during /s/ production– 70-79: hypernasallity exposed because fo the

recurring /n/ phoneme– 80-89: listen for normal resonance– 90-99: hyponasality exposed by the substitution of /d/

for /n/.

Assessing Hypernasality

• Occlude client’s nares and instruct him to recite nonnasal words and phrases. If excessive nasal pressure is felt or if nasopharyngeal “snorting” is heard suspect hypernasality.

• Hold mirror while saying nonnasal words

Assimilation Nasality

• Occurs when sounds that precede or follow a nasal consonant are also nasalized.

• See page 325 for words and phrases.

Hyponasality

• Ask client to recite sentences with nasal sounds and then occlude nares and repeat the task. If they both sound the same then hyponasality is present.

• Ask client to say “maybe, baby, maybe, baby”. If both words sound like maybe then suspect hyponasality.

Assessing velopharyngeal function

• Use pressure consonants and modified tongue anchor procedure to assess.

• You are measuring intraoral air pressure.• Pressure consonant – nonnasal words, phrases and

sentences to detect nasal emissions and hypernasality.• Modified tongue anchor procedure

– Ask client to stick tongue out and puff air into cheeks while you hold nose to stop air from coming out.

– Ask client to continue holding air while you release nostrils.– Listen for nasal emissions.– Do this three times.