Voice Therapy for Neuropathological Voices
[Pages:48]Voice Therapy for Neuropathological Voices
Mary V. Andrianopoulos, Ph.D.
University of Massachusetts-Amherst
Phonation involves an interplay between.......
There is an integration, perfect timing and coordination between intellectual + physiological processes
Cognition ?
Motor Speech Programmer
Articulation ? shaping of sounds Resonation ?exhalation Supra-glottic + sub-glottic air flow Phonation ? vibration of vocal folds
Respiration ? juice!
Language semantics + syntax + phonology Programmer + Planner selection + sequencing motor speech motor speech precision shapes acoustic signal via nasal + vocal + oral cavities
voice + sound production
sets air flow in motion + sets vocal folds into vibration
Neuropathological Voices
Dysarthria = neuromotor speech/voice disorder
? Resonation ? Articulation ? Phonation ? Respiration
Dysphonia Dysarthria
? Non-neurologic voice problem (vocal nodules, etc.)
Dysarthrias with Dysphonias
Spastic? bilateral UMN ? Strained-strangled ? Hypernasality ? Regular, Slow rate
Hypokinetic? BG circuits ? Monoloudness. Monopitch ? Reduced volume (< drive) ? +/- Co-existing Tremor
Hyperkinetic? BG circuits Flaccid? LMN (Cranial +
? Fast vs. slow movement
cervical nerves)
? Regular vs. irregular
? Nasal resonation
? Phonation, Respiration ? Breathiness, hoarseness
? Reduced loudness
Ataxic? Cerebellar circuits ? Diplophonia ?Incoordination, timing issues
?Irregular bursts, silent periods
Dysarthrias also affect breathing Dyspneumia: Neurologic effects? Respiration
Spastic Spastic Dysneumia
Rigidity, slowness Central weakness
Hypokinetic Hypokinetic Dysneumia volume, initiation/drive
Flaccid
Hyperkinetic Respiratory Dystonia Other Hyperkinetic Dyspneumias Superimposed involuntary movements
Flaccid dysneumia Peripheral weakness
"flaccidity" MG, ALS,
VF paralysis
Ataxic
Ataxic dysneumia
Incoordination/timing Respiration? Phonation
Propathic + Epicritic Cranial Sensory Nerves
Pyramidal Tract
Left Hemisphere Inferior Frontal Lobe
Basal ganglia Cerebellum
Cranial + Spinal Motor Nerves
Extra-Pyramidal tract
Neural Networks for Voice and Speech
Duffy, 2005
The Final Common Pathway of Speech and Voice A system of tubes + valves
With Sensory + Motor networks
nares
soft palate
Adapted from Carrau, 2006
vocal folds
UES
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