The attached files has the question to the assignment and the problem scenario.Also attached is what i started working on, so you can look at it and have an idea about the questions and how to go about it. You should look for peer reviewed articles, journals or books to tackle this problem scenario.The sources should be referenced.
draft_for_pbl2.docx
spring_2019_slhs_421_phonation_pbl_module_phonation__4_.pdf
questions.docx
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Key words:
• Hoarseness
• Difficulty being heard
• Pitch breaks
• Deterioration of voice quality
• Bilateral vocal fold nodules
• Improve vocal hygiene before medical intervention
Consider:
• More detailed and more clear explanation of what is happening to her voice and voice
quality
• Will it affect her job?
• Long term implications to vocal quality
Trigger 1: How would you explain factors (anatomically and physiologically) the
relationship of vocal fold physiology on vocal registers and vocal quality?
Speech is created through a complicated process through the respiratory,
phonation and articulatory systems. When we start to form a word or a sentence, air
travels through our larynx which houses the vocal folds. When air goes through the
larynx the folds are forced open and shut rapidly enough to create vibrations within your
throat. These vibrations create the sound waves that are turned into speech through the
many articulators within the vocal tract. This includes the tongue, palates, lips, teeth,
etc.
The shape, size, tension, and speed in which the vocal folds vibrate affect the
pitch at which we speak. Males characteristically have lower voices, due to thicker and
larger vocal folds, while females have a higher speaking voice because their folds
generally have less mass. By shifting in shape and size, the vocal folds allow us to
speak in three different vocal registers. The first register is the one that we use most
commonly and causes the least amount of strain is called the modal register. The
second is our pulse register, which is very low tones that result in crackly voice quality.
This can sometimes cause damage if it’s used too often. The third and final is our
falsetto register, characterized by very high notes.
Any compromise or change to the vocal folds and/or their vibration can cause
hoarseness, breathiness, roughness or other dysfunctions related to vocal quality. Not
being able to completely adduct the vocal folds results in an audible escape of air,
creating breathy speech. If the folds are closing too tightly or too harsh, the voice comes
out tense and pressed. Obstacles created in the vocal tract can create a low, raspy
vocal quality, or roughness. Vocal fold stiffness from swelling or a combination of
roughness and breathiness is commonly referred to as a hoarse vocal quality. The vocal
registers can also be affected by the balance between the activity of the muscles within
the larynx, the balance between the opening and closing of the vocal folds, the amount
of vibration, and the shape of the vocal tract.
Lastly, there are six factors that create what we perceive as a “normal” voice.
The first is your maximum frequency range. This is how high and low your pitch can
reach. A lack of flexibility in this measure can result in speech that sounds monotone.
Second, is your speaking frequency. As mentioned before, this is the average rate at
which your vocal folds vibrate and different people will speak at higher and lower
pitches. Having a pitch that doesn’t correspond with your age, gender or size can be
considered abnormal. The third is your maximum phonation time. This is simply defined
as the length of time you can hold a sound (usually a vowel). This is usually about 15-25
seconds for an adult and 10 seconds for a child. Anything significantly lower than this
can suggest a respiratory problem or blockages/obstacles in the airway. The fourth
factor is your minimum and maximum intensity. There should be a minimum variance of
20-30 decibels and anything less would suggest a problem or could also result in
speech sounding monotone. The periodicity of vibrations is the fifth factor. Each
opening and closing of the vocal folds is considered one cycle. These cycles generally
take about the same amount of time, making them mostly periodic. This factor
measures jitter, which is the measurement of variation in cycle duration. Jitter measures
that are too high result in a rough or hoarse-sounding voice. The sixth and last factor is
obstacles and interference. As mentioned before, this can also cause voice qualities
characterized as breathy, hoarse or rough.
PBL Module #2A – Phonation and Voice Quality
A college history professor (age 45) has a history of vocal problems that has
grown progressively worse during the school year. She complains of hoarseness,
difficulty being heard by her students, pitch breaks, and deterioration of voice
quality throughout the day. Occasionally, she will be mistaken for a man when
talking on the phone or asked if she has a cold when she does not. She was seen
by an ear, nose and throat physician (ENT) and was diagnosed with bilateral vocal
fold nodules.
She was referred to the MSUM Speech and Hearing Clinic for voice therapy. The
professor commented to the clinic supervisor that she was confused by the
explanation she received from her physician to “improve vocal hygiene before
discussing medical interventions” and would like a more detailed, but easier to
understand explanation for what is happening with her voice and voice quality.
Her physician described her voice as breathy and raspy, but she just considers it
hoarse.
She is significantly concerned, however with the increasing frequency of her
symptoms and whether it will affect her ability do her job. She also does not
understand the long-term implications of vocal fold nodules to her vocal quality.
You are responsible for formulating an appropriate list of case history/interview
questions, collecting the baseline vocal function data using a Visipitch, and
applying your knowledge of the phonatory related speech science concepts (See
Ferrand) to this case.
Suggested Resources: Ferrand (2014) Chapter 5
Using Kay Visi-Pitch to Modify Pitch and Intonation
Using Technology to Help Modify voice
ASHA – Vocal cord nodules
The Voice Foundation
Trigger 1: How would you explain factors (anatomically and
physiologically) the relationship of vocal fold physiology on vocal
registers and vocal quality?
Trigger 2: How would instrumentation be used to collect baseline data
on vocal parameters?What are normal values? Describe what acoustic
measures you need to collect.
Recommendation: Is vocal hygiene an appropriate recommendation
based on her case history and instrumental examinations/data? Include
a list of appropriate Case History questions.
…
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