CSD 115 1st EditionLecture 19Outline of Last Lecture I. AphasiaII. Expressive Language Deficits Associated with AphasiaIII. Deficits of Comprehension Associated with AphasiaIV. Deficits in Reading and Writing Associated with AphasiaV. Broca’s AphasiaVI. Wernicke’s AphasiaVII. Global AphasiaVIII. Traumatic Brain InjuryIX. DementiaX. DysarthiaXI. Apraxia of SpeechOutline of Current Lecture – Voice Disorders and Swallowing DisordersI. 4 Characteristics of Voice Production (chapter 8)a. Pitchb. Intensityc. Resonanced. Vocal qualityII. Classification of Voice Disordersa. Phonotraumab. Neurologicalc. Organic DiseaseIII. Types of Phonotrauma a. Hard Glottal Attackb. Puberphoniac. Glottal Fryd. Excessive Talkinge. Disordersi. Traumatic Laryngitisii. Vocal Nodules or PolypsIV. Neurological Disordersa. Vocal Fold Paralysisb. Spasmodic DysphoniaV. Organic Diseasea. Granulomasb. Papillomac. CarcinomaVI. LaryngectomyThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.VII. Swallowing Disorders (chapter 9)a. Deglutionb. DysphagiaVIII. 4 Phases of Swallowinga. Oral Prepb. Oral Phasec. Pharyngeal Phased. Esophageal PhaseIX. Organic Conditions that Affect the Swallowa. Strokeb. Amyotrophic Lateral Sclerosisc. Parkinson’s DiseaseX. TreatmentCurrent Lecture4 Characteristics of Voice Production- Pitcho How high or low a person’s voice iso Related to length, thickness, and vibration rate of vocal folds- Intensityo How loud or soft an individual’s voice iso Related to amount of subglottal air pressure- changed by altering tension in vocalfolds or amount of air flow- Resonanceo How much nasality in the voiceo Determined by shape and size of vocal tract (oral, nasal, and pharyngeal cavities)- Vocal Qualityo Whether the voice is rough or breathyo Related to laryngeal tensionClassification of Voice Disorders- Defined by our perception of the voice. If pitch, loudness, resonance or quality of the voice is inappropriate for the persons age and/or gender- Voice disorders based on phonotraumao Misuse or abuse of vocal foldso Phonotrauma: trauma to the phonator- Neurologically based voice disorderso Damage to cranial or vagus nerve- Organic diseaseo Medical conditions that impact voice productionTypes of Phonotrauma- Hard Glottal Attack: abrupt, hard to start speech- Puberphonia: maintaining high pitched voice after puberty- Glottal Fry: consistently speaking with too little vocal tension- Excessive Talking- Disorders caused by Phonotraumao Traumatic Laryngitis Red swollen vocal folds caused by excessive screaming, yelling, talking, drinking, and/or smoking Symptoms: voice is hoarse, pitch loudness breaks Treatment: eliminate abuse, rest folds If abuse persists, it can lead to noduleso Vocal Nodules or Polyps Benign growths or vocal folds Symptoms: voice is breathy and hoarse Treatment: surgical removal and/or voice therapyNeurological Disorders- Vocal Fold Paralysis (folds can’t open or close)o If bilateral it is life threatening If folds can’t close: risk for aspiration If folds can’t open: patient can’t breatheo Treatment: immediate surgical correction- Spasmodynamic Dysphoniao Too much laryngeal adduction; spasms of the vocal foldso Symptoms: struggle and strain; occasional stoppages of voice; choked or “squeezed” voice qualityo Treatment: Surgical interventions not permanent (botox, sever laryngeal nerve)Organic Disease- Granulomaso Inflammations caused by tissue irritation o Common causes:  trachea tube during surgery (trachea tube) gastroesophageal reflux (stomach acids) o Symptoms: breathy, hoarse vocal quality, low pitch, vocal fatigue, frequent throat clearing o Treatment – Remove irritant and granuloma will heal- Papillomao wartlike tumor that grows and obstructs airway - caused by a viruso Treatment: surgical removalo Recurrent nature of papilloma often results in repeated surgeries, with scar tissue causing hoarseness, low pitch and breathiness- Carcinomao Cancer of the larynxo Most common cause: smoking and alcohol consumption; environmental irritants o First sign - persistent hoarseness (more than 2 weeks) o Other symptoms - lump or tenderness in neck, swallowing problems.o Treatment: chemotherapy, laryngeal radiation, partial or complete laryngectomy (removal of larynx)Laryngectomy- PROCEDURE:o Cancerous structures of the larynx are removed.o Trachea is redirected to the front of the necko Opening is created (stoma)- No longer have use of vocal folds to create sound.- Alternative Speaking Methodso artificial/electro- larynx - creates vibration at neck or in the moutho esophageal speech - trapping air in the esophagus and "burping" to create vibrationo tracheoesophageal puncture - directs air from the trachea to the esophagus through a tube. Patient covers stoma to speak o Therapy is needed to train and generalize all three methods Swallowing Disorders- DEGLUTIONo the normal process of swallowingo two functions performed during swallowing: o protecting airway o moving food and liquid to the stomach- DYSPHAGIA o difficulty moving food from the mouth to the stomach o Typical symptoms: inability to control food or saliva in the mouth coughing before during or after swallowing sensation that food is sticking in the throat inability to swallow food4 Phases of Swallowing- Oral Prepo Function: food and liquid in the mouth is formed into a bolus (ball) for transporto Active Structures:  velum lowers to allow respiration through the nose while eating,  lips seal food in the mouth,  tongue gathers food into bolus- Oral Phaseo Function: move the bolus to the back of the mouth o Active Structures: lips seal food in the mouth,  velum lowers to allow nasal breathing while eating,  tongue elevates, pushing against the hard palate to force bolus back in the mouth.- Pharyngeal Phaseo Function: moving the bolus from the back of the oral cavity through the pharynx to the opening of the esophaguso Triggered by sensory receptors in the vocal tract; trigger delayed in older personso Active Structures:  velum raises to close off nasal cavity from oral cavity,  larynx is raised and moved forward to open the esophageal sphincter (opening at the top of the esophagus to accept the bolus),  vocal folds close and protect airway,  tongue and pharyngeal