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CD Midterm 1
Study Guides 3-5
193
Other
Undergraduate 3
10/06/2009
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Term
SPEECH PRODUCTION PROCESS
 Definition
• Phonation
– 1) vocal folds are adducted via muscle contraction
– 2) subglottic air pressure builds
– 3) vocal fold tissue is displaced upward and sideward (vocal folds are literally “blown apart”)
– 4) air rushes through the opening, increasing in velocity
– 5) negative air pressure (vacuum) results and pulls vocal folds together (Bernuoli Effect)
• Natural elasticity of vocal folds helps return to original position
• Contraction of adductor intrinsic laryngeal muscles
Term
Structures that form the vocal tract:
 Definition
– Pharyngeal cavity (neck area)
– Oral cavity3 3
- Nasal cavitiy
Term
3 PHYSIOLOGICAL SUBSYSTEMS
 Definition
– Respiratory—driving force behind speech
• Generates positive air pressure beneath the vocal folds
– Laryngeal—Produces sound
• Vocal folds vibrate at high rates of speed , setting air molecules into multiple frequencies of vibration
– Articulating/Resonating—acoustic filter
• Allows certain frequencies to pass, while blocking others
Term
Primary biological function of the respiratory system
 Definition
Supply oxygen to blood and remove excess carbon dioxide
Term
Physiology of quiet breathing
 Definition
– Rate and depth of breaths determined by body’s oxygen needs and amount of carbon dioxide in the blood
• Inhalation and exhalation durations are equal
– Muscles of inhalation expand thorax
– Passive recoil forces control exhalation
• Air pressure in lungs must equal atmospheric pressure
• ½ liter of air exchanged during tidal breathing
Term
During Quiet Breathing Rate and depth of breaths are determined by
 Definition
body’s oxygen needs and amount of carbon dioxide in the blood
Term
During Quiet Breathing inhalation and exhalation durations are
 Definition
equal
Term
During Quiet Breathing how much air is exchanged?
 Definition
1/2 Liter
Term
Physiology of speech breathing
 Definition
– Inhalations occur at major linguistic boundaries
– Duration of inhalations are much shorter than exhalations
– Up to 2 liters of air may be inhaled
– Active contraction of exhalation muscles required
Primary role of respiratory system during speech breathing
-more breaths per minute than quiet breathing
– Control vocal intensity (primary function of respiratory system during speech)
• Subglottal air pressure
Term
During Speech Breathing inhalations occur at
 Definition
major linguistic boundaries
Term
During speech breathing how much air may be inhaled?
 Definition
2 liters
Term
Active contraction of muscle is required during what type of breathing?
 Definition
Speech Breathing
Term
Which type of breathing has more breaths per minute?
 Definition
Speech Breathing
Term
What is the primary function of respiratory system during speech?
 Definition
Control vocal intensity
Term
THE LARYNGEAL SYSTEM
 Definition
• Larynx—organ of the laryngeal system
• Sound generator for speech production
• Biological functions
– Protects against foreign objects entering trachea and lungs (3 different mechanisms: arytenoids, vocal folds, epiglottis)
– Coughing
– Closes airway during physical exertion
• Lifting heavy objects
• Bearing down (defecation; childbirth)
• Vocal folds
– Ivory-colored bands of tissue
– Hyoid bone
Term
What generates sound for speech production?
 Definition
The Larynx
Term
Biological functions of the laryngeal system?
 Definition
– Protects against foreign objects entering trachea and lungs (3 different mechanisms: arytenoids, vocal folds, epiglottis)
– Coughing
– Closes airway during physical exertion
• Lifting heavy objects
• Bearing down (defecation; childbirth)
Term
The vocal folds are part of what system?
 Definition
The laryngeal system
Term
ARTICULATORY/RESONATING SYSTEM
 Definition
• Structures that form the vocal tract:
– Pharyngeal cavity (neck area)
– Oral cavity
• The tongue and teeth in oral cavity are important for speech production
– Nasal cavity
• Soft palate (velum) divides the oral and pharyngeal cavity from the nasal cavity
• Resonant acoustic tube
– All English sounds are formed in the vocal tract
Term
All english sounds are formed in...
 Definition
the vocal tract
Term
The tongue and teeth are important for
 Definition
speech production
Term
Soft Palate (velum) divides
 Definition
divides the oral and pharyngeal cavity from the nasal cavity
Term
Vocal folds are adducted via
 Definition
muscle contraction
Term
During phonation vocal fold tissue is displaced by
 Definition
subglottic pressure
Term
COMPLEX SOUND
 Definition
• Fundamental frequency (Fo)
– Lowest frequency component
– Directly related to rate of vocal fold vibration
– The slower the vibration of the vocal fold he lower the fundamental frequency.
• Harmonics
– Forty additional frequencies above the fundamental
– Whole-number multiples of the Fo
– Relative intensity decreases with increases in harmonic frequency
• Vocal tract is an acoustic resonator
– Modifies (reduces & enhances) certain frequencies
– Determined by the physical aspects of the resonator
• Movement of the tongue, lips, and larynx
Term
What is the lowest frequency component
 Definition
Fundamental frequency
Term
Fundamental Frequency is directly related to
 Definition
rate of vocal fold vibration
Term
The slower the vibration of the vocal fold he lower the
 Definition
fundamental frequency
Term
• Harmonics
 Definition
– Forty additional frequencies above the fundamental
– Whole-number multiples of the Fo
– Relative intensity decreases with increases in harmonic frequency
Term
Vocal tract is an acoustic resonator
 Definition
– Modifies (reduces & enhances) certain frequencies
– Determined by the physical aspects of the resonator
Term
CHANGES TO THE SPEECH MECHANISM THRU THE LIFESPAN
 Definition
Anatomical & physical changes impact speech production:
– Tidal breathing rate decreases with maturation
• Breaths/minute: 30-80 (infant); 20-30 (3 yrs.); 16-25 (older children); 12-20 (adults)
• (smaller lungs = more bpm)
• Respiratory system structures increase in size and lung capacities increase; several million alveoli by adult
– Position and size of larynx changes
• VF (vocal fold) length in mm: 3 (infant); 17-21 (adult male); 11-15 (adult female)
• (Larger your VF the lower your Fo)
• Significant changes in vocal folds during puberty for males
– Increase in length and volume of oral cavity impacts the resonance properties of vocal tract as one ages
• Development of primary and permanent teeth; growth of tongue, mandible; lengthening of pharynx (tongue matures @ about 16)
Term
With maturation tidal breathing rate
 Definition
decreases:
• Breaths/minute: 30-80 (infant); 20-30 (3 yrs.); 16-25 (older children); 12-20 (adults)
• (smaller lungs = more bpm)
• Respiratory system structures increase in size and lung capacities increase; several million alveoli by adult
Term
Position and size of larynx changes
 Definition
• VF (vocal fold) length in mm: 3 (infant); 17-21 (adult male); 11-15 (adult female)
• (Larger your VF the lower your Fo)
• Significant changes in vocal folds during puberty for males
Term
Increase in length and volume of oral cavity impacts
 Definition
the resonance properties of vocal tract as one ages
Term
Developmental stuttering
 Definition
 Involuntary repetitions of sounds and syllables
 Sound prolongations
 Broken words or blocks
Term
Charles Van Riper was a pioneer in
 Definition
the treatment of stuttering
Term
Reported lifetime incidence for stuttering
 Definition
5%
Term
vast majority of those that stutter
 Definition
spontaneously recover
Term
What % of population do not spontaneously recover?
 Definition
1%
Term
Male to female ratio for stuttering
 Definition
2.3-3:1
Term
What % of those that stutter report having a relative that stutters?
 Definition
50%
Term
In identical twins who stutter
 Definition
both are more likely to stutter than one.
Term
Recent research suggests that stuttering may be linked to
 Definition
a specific gene
Term
Normal Disfluencies
 Definition
 Commonly seen in children between 25 to 37 months of age
 whole-word repetitions
 interjections
 syllable repetitions
 revisions
 Normal disfluencies persist throughout life
Term
Normal disfluencies are commonly seen in children ages
 Definition
25-37 months
Term
What is stuttering and how is it defined?
 Definition
 No absolute answer … however, stuttering is characterized by abnormally high frequency and/ or duration of stoppages in the forward flow of speech, e.g.,
 Core behaviors (involuntary)
 Part-word repetitions
 Sound prolongations
 Monosyllabic whole-word repetitions
 Within-word pauses
 Tense pauses (blocks) and hesitations
 Concomitant (or secondary) behaviors (learned)
 Feelings and attitudes (awareness)
Term
Neurogenic stuttering
 Definition
1. Can occur at any age
2. Associated with disease or trauma
3. Disfluencies on function words (conjunctions, prepositions) and content words (nouns, verbs)
4. No secondary behaviors
5. Stuttering typically widely dispersed throughout the utterance
Term
Nuerogenic stuttering can occur at what age?
 Definition
Any
Term
Type of stuttering associated with disease or trauma
 Definition
neurogenic
Term
Type of stuttering with disfluencies on both function words and content words
 Definition
neurogenic
Term
Which type of stuttering is not associated with secondary behaviors?
 Definition
Neurogenic
Term
In what type of stuttering is 5. Stuttering typically widely dispersed throughout the utterance?
 Definition
Neurogenic
Term
Developmental Stuttering
 Definition
1. Begins in preschool years
2. Associated with learning speech & language
3. Disfluencies on content words (nouns, verbs)
4. Secondary behaviors
5. Stuttering typically on initial syllables
Term
Developmental stuttering typically begins in
 Definition
preschool years
Term
Type of stuttering associated with learning speech & language
 Definition
Developmental
Term
Type of stuttering associated with secondary behaviors.
 Definition
Developmental
Term
Developmental Stuttering known for disfluencies on
 Definition
content words
Term
Type of stuttering typically on initial syllables
 Definition
developmental
Term
Developmental Framework: Bloodstein’s 4 Phases
PHASE 1
 Definition
 Episodic: Periods of stuttering followed by periods of relative fluency
  stuttering when upset/excited
 Sound/syllable repetitions most frequent
Child unaware of stuttering
Term
Developmental Framework: Bloodstein’s 4 Phases
PHASE 2
 Definition
 Stuttering chronic/habitual
  stuttering on content words (nouns, verbs)
 Self-concept as a person who stutters, but little or no concern
Term
Developmental Framework: Bloodstein’s 4 Phases
PHASE 3
 Definition
 Specific situations are regarded as more difficult (telephone, presentations)
 Certain words identified as more difficult to say
 Circumlocutions/word substitutions frequent
 Fear/embarrassment but will not avoid situations
Term
Developmental Framework: Bloodstein’s 4 Phases
PHASE 4
 Definition
 Stuttering fully developed (most advanced form)
 Vivid and fearful anticipation of stuttering
 Avoidance of certain sounds/words/speaking situations
  circumlocutions and word substitutions
Term
Effects of Stuttering
 Definition
 World Health Organization (WHO)
 Handicap or a handicapping condition
 “the disadvantages that result from reactions to the audible and visible events of a person’s stuttering, including those of the person who stutters” (Conture, 1996, p. S20)
 Can have a negative effect on variety of daily activities
 Children’s school performance
 Workplace
 Social interactions
Term
Theories & Conceptualizations of Stuttering: Organic Theory
 Definition
 Suggests a physical cause
Term
Which theory of stuttering suggests a physical cause?
 Definition
Organic theory
Term
Theories & Conceptualizations of Stuttering: Theory of cerebral dominance
 Definition
 Failure of left hemisphere to develop dominance for language
 Discoordination between right/left halves of speech musculature
 Modified vocalization hypothesis
 Whispering/singing/DAF =  stuttering
 Discoordination between muscles of phonation
Term
Which Theory of Stuttering:
 Failure of left hemisphere to develop dominance for language
 Discoordination between right/left halves of speech musculature
 Modified vocalization hypothesis
 Whispering/singing/DAF =  stuttering
 Discoordination between muscles of phonation
 Definition
 Theory of cerebral dominance
Term
Theory of cerebral dominance: New developments in medical technology
 Definition
 Brain imaging used to study the CNS, e.g., CT, MRI, rCBF, PET
 Preliminary findings: stuttering may be linked to failure of neurophysiological system that integrates motor, linguistic, and cognitive processes
Term
Theories & Conceptualizations of Stuttering: Behavioral Theory
 Definition
 Suggests a learned response to external conditions
 Wendell Johnson—diagnosogenic theory
 Originally diagnosed by lay person (parents)
 Stuttering begins in the parent’s ear not the child’s mouth
 Behaviors the child exhibits are, by and large, hesitations and repetitions normal for their age
 Stuttering disorder occurs after being diagnosed
 Parents react with  criticism and punishment
 Child reacts with  anxiety and  disfluent speech behaviors
Term
Which Theory & Conceptualization of Stuttering:
 Suggests a learned response to external conditions
 Wendell Johnson—diagnosogenic theory
 Originally diagnosed by lay person (parents)
 Stuttering begins in the parent’s ear not the child’s mouth
 Behaviors the child exhibits are, by and large, hesitations and repetitions normal for their age
 Stuttering disorder occurs after being diagnosed
 Parents react with  criticism and punishment
 Child reacts with  anxiety and  disfluent speech behaviors
 Definition
Behavioral Therapy
Term
Theories & Conceptualizations of Stuttering: Psychological Theory
 Definition
 Suggests a neurotic symptom with ties to unconscious needs and internal conflicts
 Research: Psychotherapy is not an effective method for treating stuttering
Term
Which Theory & Conceptualization of Stuttering  Suggests a neurotic symptom with ties to unconscious needs and internal conflicts
 Definition
Psychological Theory
Term
Current Conceptual Models of Stuttering
 Definition
 Covert repair hypothesis:
 Stuttering is a “normal” repair reaction to an abnormal phonetic plan of speech

 Demands and capacities model (DCM):
 Imbalance between environmental demands placed on child to produce fluent speech and child’s physical and learned capacities (motor skills, language production skills, emotional maturity, cognitive development)

 EXPLAN model
 Stuttering occurs due to failure in normal interactions between PLAN and EX processes, e.g., linguistic plans (PLAN) are sent too slowly to the motor system (EX)
Term
Covert repair hypothesis:
 Definition
Stuttering is a “normal” repair reaction to an abnormal phonetic plan of speech
Term
Stuttering is a “normal” repair reaction to an abnormal phonetic plan of speech
 Definition
 Covert repair hypothesis:
Term
Demands and capacities model (DCM):
 Definition
 Imbalance between environmental demands placed on child to produce fluent speech and child’s physical and learned capacities (motor skills, language production skills, emotional maturity, cognitive development)
Term
 Imbalance between environmental demands placed on child to produce fluent speech and child’s physical and learned capacities (motor skills, language production skills, emotional maturity, cognitive development)
 Definition
Demands and capacities model (DCM):
Term
EXPLAN model
 Definition
 Stuttering occurs due to failure in normal interactions between PLAN and EX processes, e.g., linguistic plans (PLAN) are sent too slowly to the motor system (EX)
Term
 Stuttering occurs due to failure in normal interactions between PLAN and EX processes, e.g., linguistic plans (PLAN) are sent too slowly to the motor system (EX)
 Definition
EXPLAN model
Term
Evaluation of Stuttering in Young Children
 Definition
 Observation of parent-child interactions
 Examples that may signal concern:
 Parental speech rates exceeding 200 wpm
 Parental use of complex linguistic structures
 Frequent parental interruptions
Term
Analysis of child’s speech behaviors: stuttering
 Definition
 Types of dysfluencies (repetitions, prolongations, blocks)
 High incidence of sound prolongations
 Longer durations and/or multiple sound/syllable repetitions

 Frequency of each type of dysfluency (percentage)
 Duration of each type of disfluency
 Examples that may signal concern:
 3+ within-word disfluencies/100 words spoken
 10 disfluencies/100 words spoken
Term
Observation of types of secondary symptoms: stuttering
 Definition
 Examples that may signal concern:
 Eye blinks, hand gestures, facial twitching
 Increased tension in lips, tongue, jaw
 Avoidance of talking
 Awareness/Emotions
 Fear, guilt, shame re: talking
Term
Therapy for stuttering may be recommended if 2 or more of the following behaviors are observed:
 Definition
 Therapy may be recommended if 2 or more of the following behaviors are observed:
 Sound prolongations constitute 25%+ of the total disfluencies produced by the child;
 Instances of sound or syllable repetitions or sound prolongations on the first syllable of words during iterative speech tasks (e.g., puh-tuh-kuh);
 Loss of eye contact on 50% + of child’s utterances;
 A score of 18+ on the Stuttering Prediction Instrument (SPI).
Term
Indirect Approach for stuttering intervention
 Definition
Mild stuttering; newly begun
 GOAL: “facilitate fluency through environmental manipulation”
 No explicit discussions with the child
 Information sharing and counseling with parents
 Reduce communicative pressure on child
 Provide a slow, relaxed speech model for the child
 Use play-oriented activities that encourage slow and relaxed speech
Term
Which approach for stuttering intervention should be taken if there is newly begun mild stuttering?
 Definition
Indirect Approach
Term
Which approach to stuttering intervention aims to facilitate fluency through environmental manipulation?
 Definition
Indirect Approach
Term
Which approach to stuttering intervention involves no explicit discussion with the child?
 Definition
indirect approach
Term
Which approach to stuttering intervention involves information sharing and counseling with parents/
 Definition
Indirect Approach
Term
Which approach to stuttering intervention reduce communicative pressure on the child?
 Definition
Indirect Approach
Term
Which approach to stuttering intervention provides a slow relaxed model for the child/
 Definition
Indirect Approach
Term
Which approach to stuttering intervention use play-oriented activities that encourage slow and relaxed speech?
 Definition
Indirect Approach
Term
Direct Approach to stuttering Intervention
 Definition
 Direct/explicit attempts to modify child’s speech via identification/ monitoring of “hard” versus “easy” speech
 Teach strategies that help increase occurrence of “easy” speech
Term
Which approach to stuttering intervention is appropriate for moderate to severe stuttering that has been present for 1 yr +.
 Definition
Direct Approach
Term
Which approach to stuttering intervention  Teach strategies that help increase occurrence of “easy” speech
 Definition
Direct Approach
Term
Parental Counseling re: Young Children and Stuttering
 Definition
 Provide information about normal speech and language development as well as stuttering
 Suggest ways to help child speak with ease
 Model slow, relaxed speech
 Prolonging vowels, frequent pauses, delaying response time
 Each parent spend one-to-one time with child
 Reduce general level of excitement in the home
 Avoid negative verbal interactions
 Do not pressure child to talk or perform
Term
Therapy Techniques with Older Children and Adults
 Definition
 Goal: modify stuttering behaviors
 Fluency-shaping techniques
 Changing overall speech timing patterns
 Lengthen durations of sounds/words
 Slow down overall rate of speech
Term
Stuttering modification techniques
 Definition
 Change stuttering behaviors
 Lengthen duration of or modify only stuttered speech segment
Term
Modifying the Timing of Speech Movements
 Definition
 Prolonged Speech (reduces rate of speech)
 Delayed auditory feedback (DAF)
 Start speaking at 30-60 syllables/minute to achieve fluency
 Gradual increase to 120-200 syllables/minute while fluent
Term
Van Riper
 Definition
 Cancellations
 Pull-outs
 Preparatory sets
Term
Pausing/phrasing
 Definition
 Lengthen naturally occurring pauses
 Limit utterance length to 2-5 syllables before pausing
Term
Modifying the Physical Tension of Speech Movements/Fluency Shaping
 Definition
 Light articulatory contacts
 Stop consonants (/p/, /b/, /t/, /d/, /k/, & /g/)
 Reducing tension in articulators
 Gentle voicing onsets (GVOs)
 Gentle onset of voicing that gradually increases in intensity
 Speaking after exhalation has begun
Term
Effectiveness of Stuttering Intervention
 Definition
 Average improvement rate of 70%; highest rate among preschoolers.
 Studies link success to early diagnosis and treatment of stuttering
 Preschoolers: 91-100% maintained fluent speech 2-5 years following dismissal from treatment
 School-age: Cautious optimism re: improvement
 Adolescents/Adults: 60-80% improvement regardless of therapeutic technique used
 Most effective in short- and long-term reductions of stuttering: prolonged speech and/or gentle voicing onset
Term
what percentage of preschoolers show improvement in stuttering with therapy?
 Definition
70%
Term
Studies link success with stuttering preschoolers to
 Definition
early diagnosis and treatment
Term
During normal voice production
 Definition
• The VFs appear white to pinkish, glisten, and have normal structure and function without pathology.
• Voice quality, pitch, loudness, and flexibility are pleasing and audible to the listener.
Term
Voice Changes in Life: Infancy
 Definition
 crying = primary method of communication
 differentiated crying = expression of pain, pleasure, displeasure, and hunger
 larynx is located high in the neck at the base of the tongue
 vocal apparatus is pliable with little neuro-muscular coordination
 Small, short vocal folds = high pitch
 Limited control of tension in vocal folds
 Limited control of air pressure (short bursts of sound, rather loud)
 With maturation (finer motor control), infant learns to control vocal pitch and loudness (“vocal play”)
Term
During infancy what is our primary form of communication/
 Definition
Crying
Term
Infants use what as an expression of pain, pleasure, displeasure, and hunger?
 Definition
differentiated
Term
In an infant the larynx is located
 Definition
high in the neck at the base of the tongue
Term
What do infants have such a high high pitch?
 Definition
Small, short vocal folds
Term
Infants have limited control of
 Definition
tension in vocal folds and air pressure
Term
With maturation infants learn to
 Definition
control vocal pitch and loudness
Term
Voice Changes in Life: Childhood
 Definition
 voice production of speech sounds
 use of voice to express ideas and moods
 differentiated vocal use based on listeners and locations
 voice reflects physical, cognitive, and emotional maturation
 vocal folds lengthen, larynx begins descent in neck = lower pitch/loudness control
Term
Vocal Changes in Life: Adult
 Definition
 Mature, adult stage = 18 years
 Fundamental frequency (pitch) stabilized
 Full control over dynamic range (loudness) with variations of pitch and voice quality
 Voice use based on demands of situation
 Opportunities for abuse via smoking and alcohol; misuse via loud or excessive talking, inappropriate pitch
Term
Voice Changes in Life: Aged
 Definition
 65+, voice may begin decline via changes in vocal pitch, quality, and/or loudness related to diminished physical status
 Voice may be affected by physiological changes in larynx
 With age usually comes reduced demand on the communication system (e.g., retirement) although communication is still important to human contact
Term
At what stage in life do we develop the ability to produce speech sounds.
 Definition
childhood
Term
At what stage of life do we begin to use our voice to express ideas and moods?
 Definition
childhood
Term
At what stage of life do we begin to differentiate vocal use based on listeners and locations?
 Definition
childhood
Term
At what stage in life does our voice begin to reflect physical, cognitive, and emotional maturation
 Definition
childhood
Term
At what age is our voice mature
 Definition
18
Term
At what stage in life is our fundamental frequency (pitch) stabilized?
 Definition
adulthood
Term
At what stage of life do we reach full control over dynamic range (loudness) with variations of pitch and voice quality
 Definition
adulthood
Term
Vocal Fold Development in infancy:
 Definition
Larynx high in neck @ C3
VF length = 3 mm
Average Fo = 400 Hz
Term
Vocal Fold Development in Childhood:
 Definition
Larynx at C6
Gradual  in VF length (male/female) ~ 10 mm

Average Fo = similar in both sexes
 gradually w/age ~ 250 Hz
Term
Vocal Fold Development During Puberty:
 Definition
VF length =
Males: 10 mm
Females:  4 mm

Males:  1 octave (8 notes; from about 250 Hz to 125 Hz)
Females:  3 tones (from about 250 to 225 Hz)
Term
Vocal Fold Development in Adulthood
 Definition
Larynx at C7
VF length =
Males: 17-20 mm
Females: 12.5-17 mm

Males: 125-130 Hz (average)
Females: 225-250 Hz (average)
Term
Pitch
 Definition
– perceptual counterpart of fundamental frequency (Fo)
– measured in hertz (Hz)
Term
Habitual pitch
 Definition
– speaker’s average fundamental frequency (Fo)
– is the pitch you use “all the time”
Term
Optimal pitch
 Definition
– most suitable pitch for an individual
– determined by vocal fold structure (length/mass)
Term
Two Ways to View Pitch Change
 Definition
• Pitch changes related to maturation (growth)
– As length of VFs increases, pitch decreases
– As thickness (mass) of VFs increases, pitch decreases

• Pitch changes related to laryngeal muscle contraction
– When muscles contract, VFs are stretched & pitch increases
• VFs become longer (length)
• VFs become “thinner” (mass)
– When muscles relax, pitch decreases
• VFs become shorter (length)
• VFs become “thicker” (mass)
Term
As the length and thickness of the vocal fold increase pitch...
 Definition
decreases.
Term
Pitch changes related to laryngeal muscle contraction
 Definition
– When muscles contract, VFs are stretched & pitch increases
• VFs become longer (length)
• VFs become “thinner” (mass)
– When muscles relax, pitch decreases
• VFs become shorter (length)
• VFs become “thicker” (mass)
Term
Loudness is the perceptual counterpart to
 Definition
vocal intensity
Term
Vocal Intensity is measured in
 Definition
decibels (dB)
Term
Average "normal loudness" =
 Definition
60 dB
Term
Vocal Intensity increases with an increase in...
 Definition
subglottic pressure
Term
Subglottic Pressure
 Definition
the pressure from the lungs placed below the closed vocal folds
Term
Kinds of Voice Disorders
 Definition
Organic Voice Disorders
• Re: structural deviations of vocal tract
• Lungs, muscles of respiration, larynx, pharynx, and oral cavity
• Cleft palate, papilloma, cancer
Neurogenic Voice Disorders
• Re: impaired muscle control and innervation of muscles of respiration, phonation, resonance, and articulation
• Cerebral palsy, motor speech disorder, Parkinson’s disease
Functional Voice Disorders
• Re: misuse of vocal mechanism resulting in vocal hyperfunction
• loud talking, hard glottal attack, inappropriate pitch levels, excessive talking, yelling, coughing, smoking, throat clearing, excessive crying
• Vocal nodules, vocal polyps, contact ulcers
Term
Organic Voice Disorders
 Definition
• Re: structural deviations of vocal tract
• Lungs, muscles of respiration, larynx, pharynx, and oral cavity
• Cleft palate, papilloma, cancer
Term
Which type of voice disorder is associated with structural deviations of the vocal tract?
 Definition
Organic
Term
Cleft palate, papilloma, cancer, are examples of what type of voice disorder?
 Definition
organic
Term
Neurogenic Voice Disorders
 Definition
• Re: impaired muscle control and innervation of muscles of respiration, phonation, resonance, and articulation
• Cerebral palsy, motor speech disorder, Parkinson’s disease
Term
Cerebral palsy, motor speech disorder, Parkinson’s disease, are examples of what type of voice disorder?
 Definition
Neurogenic
Term
Functional Voice Disorders
 Definition
• Re: misuse of vocal mechanism resulting in vocal hyperfunction
• loud talking, hard glottal attack, inappropriate pitch levels, excessive talking, yelling, coughing, smoking, throat clearing, excessive crying
• Vocal nodules, vocal polyps, contact ulcers
Term
vocal hyperfunction is a result of
 Definition
misuse of vocal mechanism
Term
Vocal nodules, vocal polyps, contact ulcers are examples of what type of voice disorder?
 Definition
Functional Voice Disorder
Term
Lloud talking, hard glottal attack, inappropriate pitch levels, excessive talking, yelling, coughing, smoking, throat clearing, excessive crying can result in what type of vocal disorder?
 Definition
Functional
Term
Voice Disorders Associated With Vocal Abuse/Misuse:
 Definition
Laryngitis, Vocal Nodules, Contact Ulcers, Vocal Polyps
Term
Vocal Nodules
 Definition
• Benign growths; usually bilateral
• Acute: soft/pliable; or Chronic: hard/fibrous
• Located at anterior 1/3 - posterior 2/3 juncture
• Most common in adult females &
prepubescent males
• Symptoms
– Hoarseness & breathiness
– Sore throat
– Lowered pitch; loss of  range
• Treatment
– Vocal rest
– Voice education/therapy to  vocal abuse
– Chronic cases may require surgical removal of nodules
Term
Vocal Nodules are usually uni- or bi- lateral?
 Definition
bilateral
Term
What tope of vocal fold growths can be either Acute: soft/pliable; or Chronic: hard/fibrous?
 Definition
Vocal nodules
Term
Vocal fold nodules are usually either located at
 Definition
either the anterior 1/3 or posterior 2/3 juncture
Term
Vocal nodules are most common in
 Definition
adult females & prepubescent males
Term
Symptoms of voice nodules?
 Definition
– Hoarseness & breathiness
– Sore throat
– Lowered pitch; loss of  range
Term
Treatment for voice nodules
 Definition
– Vocal rest
– Voice education/therapy to  vocal abuse
– Chronic cases may require surgical removal of nodules
Term
Causes of laryngitis
 Definition
– Tobacco smoke
– Alcohol
– Infection
– Vocal abuse/misuse
Term
Inflammation of vocal folds =
 Definition
laryngitis
Term
Symptoms of laryngitis
 Definition
– Thickening of VFs
– Red; swollen
– Dry and sticky
– “My throat hurts”
– Mild hoarsenesss⇒near aphonia
Term
Treatment for laryngitis:
 Definition
– Voice rest
– Vocal education/therapy to reduce/eliminate vocal abuse
Term
Contact ulcers are usually unilateral or bilateral?
 Definition
bilateral
Term
Build up of granulated tissue on the vocal folds?
 Definition
contact ulcers
Term
Contact ulcers are located
 Definition
posterior VFs on arytenoid cartilages
Term
Contact ulcers are most common in adult males due to
 Definition
forceful, aggressive talking
Term
Symptoms of Contact Ulcers include
 Definition
– Hoarseness & breathiness
– Throat clearing/vocal fatigue
– Pain radiating to ear
Term
treatment of contact ulcers
 Definition
– Medical intervention for GERD
– Voice education/therapy to 
vocal abuse (if present)
– May require surgical removal
Term
Ruptured and swollen blood vessels in the VF's
 Definition
vocal polyps
Term
Larger, polyps or nodules?
 Definition
polyps
Term
Polyps are unilateral or bilateral?
 Definition
unilateral or bilateral but not symmetrical
Term
Sessile Polyps are attached
 Definition
attached along VF edge
Term
Pedunculated polyps are attached
 Definition
via stalk
Term
Symptoms of polyps include:
 Definition
– Hoarseness, breathiness, roughness
– “Something in my throat” sensation
Term
Treatment for polyps:
 Definition
– Voice education/therapy to  vocal abuse
– May require surgical removal of polyp
Term
Voice Disorders Associated With Medical/Physical Conditions
HYPOADDUCTION
 Definition
Parkinson's disease, VF paralysis, (adductory)
Term
Vocal Symptoms of Parkinson's Disease?
 Definition
• Monopitch
• Monoloudness
• Harshness
• Breathiness
Term
Treatment for vocal symptoms of Parkinson's
 Definition
• Medication
• Intensive voice therapy to  loudness & intelligibility
Term
VF paralysis is unilateral or bilateral?
 Definition
Either
Term
Caused by Damage to the recurrent branch of vagus Nerve
 Definition
Vocal Fold paralysis (adduction)
Term
Symptoms of vocal fold Paralysis (adductory)
 Definition
• Hoarse, weak, breathy
• diplophonia
Term
Treatment for VF Paralsis (Adductory)
 Definition
• Voice therapy to  adduction & loudness
• Collagen injection
Term
Voice Disorders Associated With Medical/Physical Conditions
HYPOADDUCTION
 Definition
• Pseudobulbar palsy
• Huntington’s chorea
Term
Pseudobulbar palsy
 Definition
– CNS damage (spastic)
• Stroke, TBI, MS
Term
Vocal Symptoms of Pseudobulbar palsey
 Definition
• Hoarseness
• Pitch breaks
• Strained/strangled
Term
Huntington’s chorea
 Definition
• Huntington’s chorea
– CNS (basal ganglia) damage
– Vocal symptoms
• Harshness
• Monopitch
• Strained/strangled
• Sudden phonatory arrests
Term
Spastic Dysphonia
 Definition
– Neurological origin; Psychological component?
– Vocal symptoms
• Strained/strangled
• Episodic stoppages
• Hoarseness
• Harshness
• Vocal tremor
– Treatment
• Surgical intervention
– Cut recurrent laryngeal nerve (RLN)
– Inject Botox into the VF
Term
Other Conditions That Affect Voice Production
 Definition
• Laryngeal papilloma
– Benign, wart-like viral growths

– Children 0 to 6 years
– Vocal symptoms
• Stridor (airway obstruction); aphonia
– Treatment
• Multiple surgical removals
• Congenital laryngeal web
– Present at birth; VFs fail to separate in utero
– Vocal symptoms
– Stridor; high-pitched, hoarse quality
– Treatment
• Surgical splitting and repair

Laryngeal Cancer
The Artificial Larynx
Esophageal Speech
Tracheoesophageal Speech
Term
Voice Disorders Associated With Psychological or Stress Conditions
 Definition
• Conversion Voice Disorders
– Emotional conflicts expressed in physical symptoms
– VF = normal structure; normal physiology
– Conversion Aphonia
• “Flight response” to personal conflict or unpleasant condition in a person’s life
• Voice is a whisper, however vegetative functions (coughing, throat clearing) present
• May require psychotherapy/psychiatric treatment
Term
Professional Protocol
 Definition
 The voice client must always be referred for laryngological examination prior to the initiation of voice therapy.
 Additional information may be sought from the referring physician.
Term
The Role of the SLP in the voice team
 Definition
• Case history
– Nature of the voice disorder
– How it affects daily life activities
– Developmental history and duration of the disorder
– Social and vocational use of the voice
– Overall physical and psychological condition
• Perceptual evaluation (pitch, loudness, quality)
• Acoustic measurements (fundamental frequency, loudness, via Visi-Pitch)
• Establish therapeutic plan
Term
Understanding How the Voice Works
 Definition
 Important to the success of voice therapy is the clinician’s and client’s knowledge of the normal anatomy and physiology of the vocal mechanism.
 The goal of voice therapy is the restoration of normal function, or the closest possible approximation of it.
Term
The goal of therapy...
 Definition
is the restoration of normal function, or the closest possible approximation of it.
Term
Treatment of voice disorders includes:
 Definition
– surgical intervention
– behavioral voice therapy
– drug treatment
– psychological counseling
Term
Intervention goals:
 Definition
– restore healthy vocal fold tissue
– regain clear and full vocal function
– eliminate abusive habits
– establish improved vocal habits (good vocal hygiene
Term
Therapeutic Effectiveness
 Definition
• Difficult to assess due to variety of disorders
• Research indicates effectiveness with voice disorders associated with:
– vocal abuse/misuse
– medical/physical conditions, e.g., Parkinson’s disease
– psychological or stress conditions
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