Transcript Muhammad Wasif Haq Masters Speech Pathology Definition • “Voice disorders which have arisen as a manifestation of psychological disequilibrium such as anxiety, depression, personality disorder.

Muhammad Wasif Haq
Masters Speech Pathology
Definition
• “Voice disorders which have arisen
as a manifestation of psychological
disequilibrium such as anxiety,
depression, personality disorder or
conversion reaction, to the extent
that normal volitional control of the
phonation is lost”. (Baker, 2002)
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Prevalence
• 4-5% of all voice disorders.
• 8: 1 ratio for females to
males.
• Females:40 yrs mean age.
• (Baker, 2002)
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• “It is more important to
know what sort of a person
has a disease than to know
what sort of a disease a
person has”- Hippocrates.
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Client’s Presentation
• T, a 38 yrs old woman presented with sudden voice loss.
• No organic lesion identified.
• Attended two sessions.
• Accompanied by mother.
• Introvert.
• Difficult to engage.
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Assessments & Findings
Assessments
Case history & medical notes
• Swallowing difficulties.
• Family history.
• Daughter in foster care.
• Wants to have another child
• History of depression.
• History of suicidal attempt.
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VHI-10 scores>11 indicates abnormality
(Rosen, Lee, Osborne, Zullo, Murry,2004)
Voice perceptual characteristics
• S: Z ratio: 4:2 seconds or 2
• Maximum phonation time:
2 seconds for /a/ and /i/ sounds.
• Involuntary cough and throat clearing produced short
bursts of phonation.
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Stroboscopic Examination
Supraglottic constriction and increased mucous deposition
between vocal folds.
Diagnosis
• Functional- Psychogenic voice disorder (Type 1)
• Breathy, strained voice, false vocal folds constriction,
sensation of lump in throat.
• No single feature diagnostic.
(Baker, 2008)
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It’s real and lasts longer than a dream
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Possible causes
• Pattern of inhibition in expression
• Traumatic/ abusive events
• Introversion.
• Combating stress
• Feelings of helplessness
• Relationship problems
• Conflict over speaking out
• Low level of emotional awareness
(Baker, 2002)
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(Royal college of speech and language therapists, 2009)
Management
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Addressing the real issue
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Keeping emotions under control is often a waste of energy.
Conventional therapy
• Vegetative voice functions.
• Inhalation on phonation
• Laryngeal massage & digital manipulation.
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Wherefrom here?
• Goals dictated by assessment results and client’s
communication goals.
•
Initial management plan
Evidence support
• Expert opinion vs randomized control trials. (Level 4)
(Baker, 2002)
• Role of transcranial magnetic stimulation of motor
cortex. (Feinstein, 2009)
• Local anaesthesia. (Kollbrunner, Menet, Seifert, 2010)
Intervention planning
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Principles & strategies
• Feedback and instructions.
• Provide encouragement for every effort.
• Involving mother in session plan activities.
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Missing connection
Roxette music video
‘The lack of understanding, whether be real or imagined, can cause
immense problems.’- Dr. Brian Roet
Reflection & learning
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What I learnt by this case
• Extended role of a speech pathologist.
• Empathy vs sympathy (Lussier & Richard, 2010)
• Accommodate for set-backs, rather than feeling emotionally
demoralized.
• Case history questions.
• The choice of right words.
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Valuable tips
• Allow patient to feel power & freedom to choose.
• Cultural differences.
• Importance of crying.
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Special thanks
• Stephanie Martin- Clinical educator
• Janet Baker
• Elle Finos
References
•
Baker, J. (2002). Psychogenic voice disorders--heroes or hysterics? A brief overview with
questions and discussion. Logopedics Phonatrics Vocology, 27(2), 84-91.
•
Baker, J. (2008). The role of psychogenic and psychosocial factors in the development of
functional voice disorders. International journal of speech-language pathology, 10(4),
210-230.
•
Feinstein, A. (2009). Psychogenic aphonia: spectacular recovery after motor cortex
transcranial magnetic stimulation. Journal of Neurology, Neurosurgery & Psychiatry,
80(1), 4-4.
•
Kollbrunner, J., Menet, A. D., & Seifert, E. (2010). Psychogenic aphonia: No fixation even
after a lengthy period of aphonia. Swiss Medical Weekly, 140(1), 12.
•
Lussier, M. T., & Richard, C. (2010). Should family physicians be empathetic? YES.
Canadian Family Physician, 56(8), 740-742.
•
Rosen, C. A., Lee, A. S., Osborne, J., Zullo, T., & Murry, T. (2004). Development and
Validation of the Voice Handicap Index‐10. The Laryngoscope, 114(9), 1549-1556.
•
Royal college of speech and language therapists. (2009). Resource manual for
commissioning and planning services for SLN. Retrieved from
http://www.rcslt.org/speech_and_language_therapy/commissioning/voice_plus_intro
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