Slide 1 SWO SLP Stroke Network November 14, 2013 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Role of ENT in treating voice disorders Typical voice disorders associated with stroke Treatment strategies for various voice difficulties Signs that there may be “something else” going on ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 What is voice? Voice Disorders Associated With Stroke Instrumental assessment of Voice – need for visualization Developing a Clinical Framework for Assessment or Treatment Problem Solving Lori Holmes, M.Sc. Speech Language Pathologist & Voice Coach ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Transcript
Slide 1
SWO SLP Stroke Network
November 14, 2013
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Slide 2
Role of ENT in treating voice disorders
Typical voice disorders associated with stroke
Treatment strategies for various voice difficulties
Signs that there may be “something else” going on
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Slide 3
What is voice?
Voice Disorders Associated With Stroke
Instrumental assessment of Voice – need for visualization
Developing a Clinical Framework for Assessment or Treatment
Problem Solving
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 4
Considering Definitions and
Conceptualizing a structure for guiding assessment and treatment
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Slide 5
VOICE
Where art...
Meets science
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 6
Body (Position & Tension)
Respiration
Phonation
Resonance
Articulation
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 7
Knowledge of:◦ Anatomy
◦ Physiology
◦ Aerodynamics
◦ Acoustics
◦ Laryngeal Pathology
◦ Etiological Correlates
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 8
A voice is a human gift; it should
be cherished and used, to utter
fully human speech as possible.
Powerlessness and silence go
together. Margaret Atwood
Words mean more than what is set
down on paper. It takes the human
voice to infuse them with shades of
deeper meaning.” Maya Angelou
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 9
SLP needs knowledge of:◦ Broader importance of
communication
◦ Mind-body connection
◦ Counselling and Motivation techniques
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 10
Normal voicing◦ Balance in respiration, phonation, resonance
◦ Appropriate quality, pitch and loudness
Achieving the best possible sound with the least amount of effort
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 11
Voice Disorder◦ Quality, pitch and loudness
◦ Similar age, gender, cultural background or geographical location
◦ Structure, Function or Both no longer meet voicing requirements
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 12
Identify the causes of the Voice Disorder
Describe the present Vocal Components
Develop an Individualized Management Plan
Informed by knowledge of anatomy, physiology, pathology and etiological factors
Informed by patient factors
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 13
Setting goals based on the physical limitations of the mechanism
Setting goals based on the client
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 14
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Slide 15
Nothing specific for “stroke” Class 7000 – neurological disorders affecting
Reflux Smoking History Hearing (or accuracy of perception)
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 31
A word about “posture”
Ambulatory?
Trunk control
Spinal flexibility
Head/spine relationship
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 32
Issues of muscle tone Flaccidity
Spasticity
Issues of excess muscle tension in face of normal muscle tone
Positioning
Stretching
Massage
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 33
Respiratory compromise
Habitual patterns
Role of body
Role of tension – especially jaw
Karaoke anyone?
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 34
Defining resonance
Impact of nasal air escape on voice
Impact of nasal air escape on articulation
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 35
Articulation and voice relationships
Articulation, rate and tension
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 36
What are the indicators that something else may be going on?
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Slide 37
Therapy outcome Unexplained deterioration in vocal quality Increased effort to voice Changes in other aerodigestive areas
Increased mucus
c/o bad taste, sore throat, bad breath
Globus, need to throat clear, difficulty swallowing
Increased “asthma-like” symptoms
Voice “cutting out” or sensation of choking or being unable to breathe (especially overnight)
Other
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 38
Re-visiting the “boxes”
Patient factors
Background factors
Trusting your clinical intuition
Lori Holmes, M.Sc.
Speech Language Pathologist & Voice Coach
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Slide 39
www.ncvs.org – check your medications tab
www.voiceproblem.org – reliable information on voice pathology; good section on reflux as it relates to voice
Christina Shewell’s “Voice Work: Art and Science in Changing Voices” Published in 2009 by Wiley-Blackwell – excellent resource for therapy options
Meribeth Bunch Dayme’s “The Performer’s Voice: Realizing your vocal potential”. Published in 2005 by WW Norton & Company – great anatomy & systems review (simple drawings) and good basic vocal training
Colton, Casper & Leonard’s “Understanding Voice Problems: A physiolgoical perspective for diagnosis and treatment” (3rd ed). Published in 2006 by Lippincott Williams & Wilkins – more academic discussion of neuroanatomy of voice & discussion of voice issues in dysarthrias and other neurological disorders
