《嗓音障礙》特殊兒童教育課件Voice11

1、Kinds of Voice DisordersImportance of Voice6 out of 100 people have voice disCommunication 7%; what to say 93%; how you say itYour titles SLPs with a specialty in voiceVoice specialistVoice pathologist Voice therapistVoice teacherSinging teacherVoice coach, drama coachWho can you help?Clients lookin

2、g for better image makingPoliticiansCEOsEntrepreneursReal problemsWho can you help? (Continued)Real Voice Patients (Functional Problems 功能性問題)Professional Voice Users 1) clergymen 2) teachers (females esp English), physical ed teacher 3) coaches in a prof sports team (esp football) 4) Singers 5) SLP

3、sPts w hyperfunctional（功能亢進(jìn)） voice usage (mostly kids)Pts w emotional problem (females)Who can you help? (Continued)Real Voice Patients (Organic Problems 器質(zhì)性問題)Organic VF lesionsCancer （癌癥）papilloma （乳頭狀瘤）webbing（喉蹼）Reflux（返流）Physical trauma on the neck 1) a youngster who had a motorcycle accident 2

4、) a pt who had a fall by her neck 3) a lady who got strangled by her neck by a robber - arytenoid cartilage was dislocatedWho can you help? (Continued)Real Voice Patients (Neurogenic Problems 神經(jīng)性問題)Neurogenic pts CVA（Cerebrovascular Accident 腦血管意外）TBI（Traumatic Brain Injury 外傷性腦損傷）Parkinsons dis （帕金

5、森氏病）Vocal Ford Paralysis（聲帶麻痹）HOW TO DIAGNOSE (f, O VS N)?1、Voice History, Examination and TestingCase HistoryVariety of types 不同類型Observations 觀察Waiting room 候診室Office/clinic room 診室During evaluation 評估過程Case History ContinuedInformation to gainDescription of problem 描述問題Onset and progression 起病及發(fā)展

6、過程Variability and consistency 可變性和穩(wěn)定性Symptoms and sensations 癥狀及患者感覺Case History ContinuedPatients voice use 病人用嗓情況Health 健康Vocational 職業(yè)Recreational 愛好Psychological 心理Examination of the VoiceIndirect Laryngoscopy 間接喉鏡Flexible fiberoptic laryngoscopy 纖維喉鏡Stroboscopy 動態(tài)喉鏡Lab Testing 實驗室檢查Acoustic Stu

7、dies 聲學(xué)檢查Fundamental frequencies 基頻Phonational range 發(fā)聲范圍Vocal intensity 聲音強(qiáng)度Perturbation 微擾Spectrogram 頻譜圖Physiological Studies 生理學(xué)檢查Electroglottography 電聲門圖Subglottal Air Pressure 聲門下壓Electromyography 肌電圖Critical Listening 聽感Pitch 音調(diào)Loudness 響度Voice quality 音質(zhì)Unusual vocal characteristics 異常聲音的特征T

8、asksSustained vowels 連續(xù)元音Syllables and sentences 音節(jié)及句子Frequency range and intensity range 基頻及強(qiáng)度的范圍Rainbow Passage 短文Sample of conversational speech 簡單的交流語言Diagnostic Testing Probes 診斷性測試Reflexive sounds 反射性聲音如哭、咳嗽Altering pitch 改變音調(diào)Sustaining steady, prolonged phonation 持續(xù)穩(wěn)定的發(fā)聲Altering vocal loudnes

9、s 改變聲音的強(qiáng)度Phonation with effortful glottal closure 努力閉合聲帶發(fā)聲Placing the voice 找到最好的共鳴腔Noninstrumental Objective Measurements非設(shè)備客觀檢查Maximum phonation time 最長聲時s/z ratio s/z比2、Differential Diagnosis of Voice ProblemsProceduresInterviewExamination of medical recordsRating of auditory perceptual character

10、isticsMeasurement of acoustic, aerodynamic, vibratory, and muscle action eventsExamination of the laryngeal structures and their functionEvaluation of other bodily functions and systems as deemed appropriateExperimental therapy, or treatment probingSymptoms vs SignsA symptom（癥狀） is a complaint or pe

11、rceptual characteristics of the voiceA sign （體征）is a characteristic of the voice that can be observed or testedPrimary symptoms of voice problemsHoarseness 粗糙聲Vocal fatigue 聲帶疲勞Breathy voice 氣息聲Reduced phonation range 發(fā)聲范圍減小Aphonia 失聲Pitch breaks or inappropriate high pitch 怪聲怪調(diào)Strain/struggle with

12、voice 聲音發(fā)緊Tremor 聲顫Pain and other physical sensation 發(fā)聲痛Major signs of voice problemsPitchMonopitch 音調(diào)單一Inappropriate pitch 怪聲怪調(diào)Pitch breaks 音調(diào)變化過大Reduced pitch range 音調(diào)范圍減小LoudnessMonoloudness 響度單一Loudness variation 響度變化大Reduced loudness range響度變化范圍減小QualityHoarse or rough 嘶啞或粗糙聲Breathy 氣息聲Tension

13、聲音緊刺Tremor 聲顫Strain/struggle聲音發(fā)緊Sudden interruption of voicing 突然失聲Diplophonia 復(fù)音Other behaviorsStridor 尖銳聲Excessive throat clearing 清嗓過度Aphonia失聲Consistent 持續(xù)失聲Episodic 偶發(fā)失聲Acoustic Assessment 聲學(xué)評估FrequencyFundamental frequency 基頻Phonational range 基頻變化范圍Frequency perturbations Jitter 基頻微擾IntensityM

14、ean intensity level 平均強(qiáng)度Dynamic range 強(qiáng)度變化范圍Amplitude perturbation Shimmer 振幅微擾Acoustic Assessment ContinuedRespiratory and Laryngeal ControlMaximum phonation time (MPT)S/Z ratioNoise related measuresSignal to noise ratio 信噪比Spectral analysis 頻譜分析Dr SpeechCSLMDVPPraatLets experience!1) Dr. Speech me

15、asurements (next 2 slides) very useful both in assessment and in Rx 2) CSL info is in the DVD clip3) Praat Please download the program! Its free! Experience it yourself! Its more of a research tool than clinical tool. Voice Disorders TreatmentThyroplasty (Before & After Surgery)Voice Disorders Treat

16、mentThyroplasty (Before & After Surgery)Aerodynamic Measurements空氣動力學(xué)測試Airflow 空氣流量Subglottal pressure 聲門下壓Respiratory movements 呼吸運(yùn)動PASVocal Function Tests continuedElectroglottography 電聲門圖Electromyography 肌電圖Dr SpeechCSL Stroboscopic Observations 動態(tài)鏡觀察Degree of glottal closure 聲門關(guān)閉程度Phase closure 關(guān)閉相Vertical level 室?guī)紸mplitude of vibration 振幅Mucosal wave 粘膜波Vibratory behavior 振動Phase symmetry 兩邊聲帶時否同步運(yùn)動Periodicity 周期性Laryngoscopic Signs 喉鏡檢查 Vocal fold approximation 聲帶靠近程度Vocal fold movement 聲帶運(yùn)動Tissue changes 組織變化Pyriform changes 梨狀窩改變Anteroposterior laryngeal di