CODI 555 Motor Speech Disorders
Lecture 11: Treatment of Motor Speech Disorders:  Phonation

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 Perceptual Evidence for Phonatory Problems

•  Pitch too high or too low, no variability, too much variability
•  Voice quality deviations
•  Breathiness, hoarseness, harshness, strained/strangled quality
•  Intensity too high or too low, excessive loudness variations
•  Tremors, audible inspiration, voice breaks

 Underlying Deficits

•  Over-adduction of vocal folds (associated with increased tone)
•  Under-adduction of vocal folds (decreased tone, weakness, decreased range of motion)
•  Poorly coordinated laryngeal movements (incoordination of laryngeal muscles or unpredictable movements)

 Assessment of Laryngeal Component

•  Perceptual
•  Judgements of loudness, pitch and voice quality during speech activities
•  Quality of cough, throat-clearing or hard glottal attack
•  Physiological
•  Airflow measures
•  Stroboscopic examination
•  Electroglottography
•  Acoustic (Visipitch or any other voice analysis package)
•  Coordination
•  Repeat /i,i,i/; production of voicing distinctions (VOT)

  Treatment options include

•  Surgical treatment
•  Augmentative devices
•  Pharmacological treatment
•  Behavioral treatment

 Surgical treatments for laryngeal involvement

•  Vocal fold augmentation with Teflon or collagen
•  Laryngoplasty(thyroplasty)
•  Botox injections
•  Nerve resection

 Augmentation/Pharmacological

•  Portable amplification systems
•  Artificial larynx
•  Pharmacological
•  No drugs that will cure Neurogenic voice disorders
•  Medications are used to relieve symptoms associated with underlying disease as in
•  Parkinson’s
•  Huntington’s
•  Dystonia
•  Essential tremor
•  Spasticity
•  Myasthenia gravis
•  Positive secondary effects on control & coordination

 Treatment Goals/Procedures: Flaccid

•  Myasthenia gravis
•  Drugs, surgery, palatal lift, voice tx not recommended
•  Others - goal is increase laryngeal adduction
•  Reflexive behaviors such as coughing, throat clear, grunting, laughing
•  Pair above with pressure applied to abdomen
•  Breath hold (increasing time)
•  Hard glottal attacks with vowels, vowel initiated words
•  Phonating while pushing/pulling
•  Pitch glides up and down, sustain highest pitch
•  Compensations
•  Head turn, external pressure to thyroid cartilage, maximize respiration

 Treatment Goals/Procedures: Spastic

•  Often resistant to behavioral treatment
•  Augmentative/alternative communication systems may be needed
•  Behavioral goal is to decrease adduction/induce hypoadduction
•  Relaxation of supralaryngeal tension - head rolls, relaxed throat breathing
•  Reduction in vocal fold adduction- yawn sigh, easy onset, continuous phonation (chant talk)
•  Botox, nerve resection - used for spasmodic dysphonia, efficacy for spastic dysarthria not given

 Treatment Goals/Procedures: Hypokinetic

•  Parkinson’s
•  Medications often reduce voice symptoms
•  Behavioral therapy includes
•  Respiratory - increase depth of inhalation, coordination of exhalation with voice onset
•  Adductory exercises as above plus increasing duration of vowels & voice continuants
•  Shouting, “thinking loud”
•  LSVT - high phonatory effort

 Treatment Goals/Procedures: Essential Tremor

•  Maximize respiration, resonance, articulation with emphasis on precise articulation
•  Relax musculature
•  Swallowing
•  Chewing exercises
•  Yawn-sigh
•  Chanting (maintaining pitch and loudness)
•  Firm adduction
•  Voice therapy not particularly successful in reducing tremor but may eliminate compensatory behaviors that make problem worse

 Treatment Goals/Procedures: Incoordination - ataxia, vocal apraxia

•  Aphonic patients ( brainstem involvement)
•  Reflexive/vegetative sounds with abdominal press
•  Supine position with abdominal press
•  Laryngeal adduction exercises
•  Phonating vowels to beat of metronome gradually increasing speed of repetition and moving from single vowel to 2 or 3 vowels
•  Continuous phonation with constant intensity and pitch stability beginning with sustained vowels, series of vowels, VCV sequences, phrases, conversation