Symptoms And Treatment Of An Idiopathic Etiology

The opportunity to observe the work overview of a Speech Pathologist, has tremendously solidified my interest in this field. At the Diana Rogovin Speech Center at Brooklyn College, I observed clients of various ages with different speech language disorders including articulation, language, voice, fluency and accent modification. Observing clinicians at the speech center gave me the opportunity to learn how important client-clinician interaction is for the session and how essential it is to build a good relationship with the client. Although I learned the

The speech-language pathologists (SLPs) at Martin Health System (MHS) evaluate, diagnose, and treat a diverse patient population who present with a myriad of medical issues, the most common of which is a condition known as dysphagia. More than 80% of patients referred to an SLP at our facility present with this diagnosis. Broadly characterized by trouble swallowing, dysphagia includes everything from painful swallows, to coughing or choking while eating and drinking, or even a sensation of a lump in throat, . Complications of dysphagia can lead to dehydration, malnutrition, and respiratory problems such as aspiration pneumonia, fatigue, cognitive confusion, decreased quality of life, or even death.

CAPE-V is an auditory method of evaluating voice quality. The CAPE-V was created to provide a consistent scale and consistent parameters for professionals evaluating the voice while also allowing clinicians to identity differences among a client’s voice (Nagle, 2016, 47). Clinicians determine if a person has a voice disorder or if a person has a normal voice. Six voice qualities are specifically examined when a CAPE-V is used; however, the evaluation includes blank lines to allow a clinician to write additional voice features he or she perceives that are not originally listed on the CAPE-V form. Qualities examined by a professional utilizing a CAPE-V are overall severity, roughness, breathiness, pitch, and loudness. A tick mark is placed on a visual analog scale to denote the severity of each vocal quality; the left portion of the scale signifies a normal vocal quality, while the right portion of the scale represents an extreme deviance in voice parameters. The assessment requires the client sustain vowels /a/ and /i/, read six sentences, and speak in a conversational manner to the statement, “Tell me about your voice.” Prolonged vowels enable a clinical to hear a client’s voice with no articulatory influences, speaking the sentences permits a professional to evaluate specific voice qualities, and conversational speech allows a clinician to further assess a client’s voice for abnormalities (Kempster et al., 2009, pp. 126-127). Clinicians agree that

• Voice therapy. This includes resting your voice and working with a speech therapist. The speech therapist can show you how to use your voice more safely.

After listening to this individual’s voice, one could infer that this individual has an overall severe voice problem. I determined this because of voices I have heard on a daily basis. This individual’s voice seemed very rough and there was a lot of strain. This individual’s sounded exhausted and forced when they tried to produce

06/02/15 Progress report documented that the patient was unable to come to the appointment due to his physical condition and distance. Phone conversation with the patient was noted. He reported being frustrated that his Klonopin was not filled the last time and was feeling very anxious. He noted mild depression. He was sleeping poorly and noted 4-5 hours of sleep each night and was using a CPAP machine. He was hopeless about his future and had psychomotor agitation. However, he denied any suicidal ideations. His appetite was good and he weighed 427 pounds. He was keeping himself busy and was doing yoga. No side effects from his medications were noted. The patient was advised to continue Pristiq 100 mg daily for depression and was started on Valium 5 mg up to 2 times a day as needed for anxiety.

Unilateral vocal fold paralysis (UVFP) is the complete immobility of one vocal fold. According to Sapienza and Ruddy (2013), “90% of vocal fold paralysis that occurs is unilateral and caused by damage to the peripheral nervous system” (p. 189). Vocal fold paralysis is typically considered a symptom of a disease or neurologic disruption. In one study, it was found that vocal fold paralysis was caused by surgical trauma, tumors or neoplasms, unknown or idiopathic factors, trauma, central nervous system dysfunction, radiation, inflammatory, cardiovascular, and other causes (Chen, Jen, Wang, Lee, & Lin, 2007). Symptoms of unilateral vocal fold paralysis may include: aphonia, abnormal vocal quality (breathy, hoarse, and/or strained), and dysphagia. Onset of UVFP may be life altering as the individual has to find compensatory strategies for voicing or even alternative methods of communication. The individual is also left susceptible to aspiration due to the lack of airway protection. These factors make it critical to diagnose the impairment so as to provide the appropriate treatment.

COPD (Chronic Obstructive Pulmonary Disease) is a lung disease where an obstruction impacts the flow of air and normal breathing pattern. The term encompasses pathologies for emphysema and chronic bronchitis. When coding COPD in ICD-10-CM there are codes for acute exacerbation and uncomplicated cases. An acute exacerbation is when a condition is worsening or decompensating. In category J44 there is a code for COPD with acute lower respiratory infection (J44.0), COPD with (acute) exacerbation (J44.1) and COPD unspecified (J44.9). There are lots of exclusions listed in Category J44 and additional codes need which can make coding COPD difficult. There are separate codes used when the condition involves chronic tracheitis, bronchiectasis,

The objective of the therapy secession that took place on February 4, 2016 was to work on articulation and voice with E.S, who was eight years and five months. The severity of ES’s articulation and voice diagnosis was mild. The Clinician who led this therapy secession was Kasten. E.S was well behaved and engaged. She asked questions, and demonstrated knowledge of the objectives by acknowledging when she did something wrong and how she could correct it.

Vicky has returned for review six weeks since the last appointment. Overall she has been quite well during that time, but having paid closer attention, is reporting intermittent episodes of laryngospasm/vocal cord dysfunction. Specifically after extended periods of talking, Vicky is noticing some tightness in her larynx and at times dysphonia. She may also become slightly breathless, but with slow breathing and resting her voice, her symptoms settle within a few minutes. Separate to this, she has also noted intermittent retrosternal tightness and mild dyspnoea that is consistently relieved with belching. She is no reporting any exertional symptoms.

Ms. Noid will have a constrained phonational frequency range of approximately 1-2 octaves, reflecting a physiological limitation and impaired vocal mechanism, due to a unilateral vocal fold paralysis. She will be unable to transition between low to high frequency ranges, and exhibit a vocal quality characterized as breathy and hoarse.

Muscle tension dysphonia is perceptually characterized by a harsh-hoarse-shrill vocal quality and can range in severity from mild to severe (Dworkin, Meleca, & Abkarian, 2000). Unlike other dysphonias, muscle tension dysphonia is not caused by pathology of the vocal folds, but hyperfunction of the intrinsic and extrinsic muscles of the larynx. The hyperfunction of these muscles is often a manifestation of psychological stressors, since these muscles appear to be highly responsive to emotional triggers. Causal relationships have been determined between muscle tension dysphonia and involved emotional, psychological, and social histories. Muscle tension dysphonia may also occur secondary to an underlying vocal fold pathology. Subsidiary muscle

To compare data and evaluate acoustic characteristics, a total number of 14 participants were used. That being said, seven of the participants were healthy females while the latter were seven female patients who had Parkinson disease. The main features of these subjects were recorded including their age, duration after diagnosis, mini-mental state examination, functional independence measure, ambulatory function, and ratings on the Hahn and Yahr scale (Bang, Min, Sohn, & Cho 2013). Each subject was analyzed according to their vocalization of four vowel sounds that are on the corners of the vowel quadrilateral including /a/ the low back unrounded vowel, /e/ the low front unrounded vowel, /i/ the high front unrounded vowel, and /u/ the high back rounded vowel. The procedure consisted of a

Despite him trying out various vocal exercises with different therapists, it is made obvious to us that the

The last option is surgical voice restoration which was introduced by Singer & Blom in 1980(Blom,1995) Not all patients are suitable for this however, It involves a tracheoesophageal speaking valve, a small fistula is surgically created through the tracheal wall into the oesophagus. A small, one way valve is inserted into the fistula and it allows air to be shunted from the trachea to the oesophagus and up through the pharyngo-oesophageal segment creating an acoustic wave form and voice. A longer flow of voice can be achieved as pulmonary air is used as the initiator for voice.