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Now in a fully revised and updated third edition, Working with Voice Disorders offers practical insight and direction into all aspects of voice disorders, from assessment and diagnosis to intervention and case management. Using evidence-based material, it provides clinicians with pragmatic, accessible support, facilitating and informing decision-making along the clinical journey, from referral to discharge. Key features of this resource include: A wealth of new, up-to-date practical and theoretical information, covering topics such as the prevention, assessment, intervention and treatment of a wide spectrum of voice disorders. A multi-dimensional structure, allowing the clinician to consider both specific aspects of patient management and aspects such as clinical effectiveness, clinical efficiencies and service management. Photocopiable clinical resources, from an at-a-glance summary of voice disorders to treatment and assessment protocols, and practical exercises and advice sheets for patients. Sample programmes for voice information groups and teacher workshops. Checklists for patients on topics such as the environmental and acoustic challenges of the workplace. Self-assessed personalised voice review sheets and weekly voice diaries encourage patients to monitor their voice quality and utilise strategies to prevent vocal misuse. Combining the successful format of mixing theory and practice, this edition offers a patient-centred approach to voice disorders in a fully accessible and easy-to-read format and addresses the challenges of service provision in a changing world. This is an essential resource for speech and language therapists of varying levels of experience, from student to specialist.
Drawing on more than ten years' experience with children's voice disorders, the authors five practical advice onthe nature of children's voice problems, ideas for therapy, the aims of intervention and how best to achieve them, as well as an overview of the relevant literature.# Contains ideas for setting up treatment groups, together with case studies and suggestions on how to evaluate therapy and measure outcomes.# Includes ideas for working with groups as well as individuals.# Easily accessible and user-friendly# Contains photocopiable resources for setting up voice groups, including all essential paperwork.Contents:Introduction; Laryngeal and Voice Development in Children; The Origins of Paediatric Dysphonia; Assessment and Evaluation; principles of Therapy and Management; Developing a Programme of Vocal Hygiene for Children; Relaxation and Posture Modification; Breathing for Voice; Voice Therapy techniques; the Group Approach to Therapy and Therapy Evaluation; Appendices.
This book provides a step-by-step guide to understanding and treating psychogenic voice disorder by combining speech and language therapy with skills drawn from the field of cognitive behaviour therapy (CBT). Beginning with a new classification of psychogenic voice disorder, the authors then provide a description of the CBT model and give helpful and systematic guidelines on using this approach in combination with speech and language therapy skills. They provide invaluable guidance on how to extend the standard voice case history to include a psychosocial assessment, and how to apply symptomatic voice therapy principles and techniques for this patient population. Later chapters show how to assess and work with patients suffering from symptoms of anxiety and lowered mood, and how to understand and respond to various forms of psychopathology that may present in association with voice disorder. Finally, detailed case studies illustrate how an experienced therapist might respond to individual assessment and treatment challenges.
Introduction The concept of occupational voice disorders Philippe H. Dejonckere "People using their voice professionally are at risk for occupational voice diseases, and require specific prevention and treatment" was the topic focused on by the third Pan European Voice Conference, organized in August 1999 at Utrecht University. The present book includes the main tutorial lectures, with reviews of the most relevant research data and opinions regarding this specific area of concern. Occupational voice users include not only singers and actors, but also teachers, politicians, lawyers, clergymen, telephone operators, etc.(1). The pathogenesis of voice disorders in such patients can be primarily related to their occupation, and thus, after adequate differential diagnosis, these need to be recognized as true occupational diseases, in the same way as, for example, occupational hearing loss (2). A surfeit of information is available on the potential damage from exposure to excessive noise levels(3,4). Noise-induced hearing loss is generally recognized as a typical occupational disease. The relationship between dose and effect is clear, as is documented in publications by the International Organization of Standardization (ISO) (5). The dose combines intensity and duration, and therefore, the concept of dosimetry is of major importance. Also of importance is the definition of the safe limits for exposure to noise. However, factors regarding individual susceptibility to noise and the reversibility of early effects also have to be considered, as well as possible preventive indices of noise-induced hearing loss (6). In some - but not all - respects, noise-induced hearing loss may be considered as a useful model for occupational voice disorders. Epidemiology Titze (7) compared the percentage of the US working population and of the voice-clinic load for different occupation categories: for example, telephone marketers constitute only 0.78% of the total workforce, but 2.3% of the clinic load; teachers represent 4.2% of the US workforce and 20% of the voice-clinic load. Studies based on questionnaires have suggested that teachers and aerobic instructors are at high risk for disabilities from voice disorders, and that these health problems may have significant work-related and economic effects (8,9). For example, Russel et al.(10) investigated the prevalence of self-reported voice problems in teachers: 16% of teachers reported voice problems on the day of the survey, 20% during the current teaching year, and 19% at some time during their career. Roughly speaking, we can conclude from the several studies published during the 1990s that about 20% of teachers experience voice disorders (11). Voice dosimetry Objective measurement of vocal use and vocal load is necessary for the identification of activities and working conditions that are at risk. Voice dosimeters can provide information on the total vocalization time and sound pressure level over a whole working day, in a real life situation (12-14). Just as noise dosimeters define acceptable levels of noise exposure, voice dosimeters help to define the average acceptable limits for vocal load. Hyperphonation Repeated mechanical vibrations transmitted to the body tissues by engines or machines are known to be able of eliciting - in certain conditions - specific kinds of pathology, which are also considered to be occupational diseases (15,16). The vibration may involve the whole body (e.g., in a vehicle) or mainly the hand, wrist, elbow, or shoulder (hand-held power tools). There are standards in the field of occupational health that stipulate the acceptable limits for tissue acceleration values, depending on the frequency (17). Titze's calculations suggest that the risk of damage from tissue vibration is exceeded by occupational vocalists, such as telephone marketers and teachers (18). In the last few years, much new and important information has materialized on the dangers of 'hyperphonation', i.e., loud and prolonged phonation beyond the physiological range. Laboratory experiments on canine larynges, hyper-phonated in vivo under anesthesia, demonstrated obvious damage to vocal fold epithelia (19). The basement membrane shows early lesions and seems to be particularly sensitive (20). A clinical study by Mann et al.(21) in drill sergeants, demonstrated significant increases in vocal fold edema, erythema and edge irregularity, and decreases in vocal fold mucosal wave and amplitude of excursion, following a five-day training period Voice fatigue, relief and recovery According to Titze (18) , two different aspects must be considered: Muscle fatigue: the muscle chemistry needs to be reset for the following contractions. Epithelial cells may die and be shed, due to repeated traumata. New cells have to develop underneath. Collagen and elastin fibers may have separated from the structural matrix of the lamina propria, and have to be removed and replaced by the fibroblasts. Detached protein debris will be removed and re-used by the fibroblasts to make new protein fibers that will support the connective tissue structure. Therefore, minor destruction and repair is continuous. Can the regenerative processes keep up with the destructive process, and what are the physiological time constants in these processes? When there is damage to the joints, ligaments, tendons, or other connective tissue, the recovery time will be proportional to the amount of localized tissue injury that has occurred. If muscle fatigue is the only complaint, the recovery period required will probably be shorter. Hypothetical curves for tissue injury and the recovery period for human phonation have been suggested by Titze (18). Nevertheless, vocal fatigue is still difficult to identify in practical and clinical situations, and Buekers has questioned the clinical relevance of voice endurance tests (13,14). Environmental factors The relative humidity of the air affects vocal function: the most common subjective complaints of teachers with regard to their working environment are the dryness and dustiness of the air. Professional singers note that singing is more difficult in a dry environment: dry air puts an increased strain on the phonatory apparatus and raises the demands on its efficacious and appropriate use (22). The human voice is very sensitive to decreases in the relative humidity of inhaled air because, in experimental conditions, even after short provocation, a significant increase in perturbation measures has been found (23). Noise is also a very common and relatively well-known risk factor in the working environment of professional voice users. It has been observed that the sound level of the speaking voice significantly increases in ambient noise levels starting from 40 dB (A) (about 3 dB for each 10 dB increase in ambient noise), due to the Lombard effect (24,25). In kindergartens, for example, noise levels have been found to vary between 75 and 80 dB (A) (26,27). Effects of stress Mendoza and Carballo investigated the effects of experimentally induced stress on voice characteristics (28). In conditions of stress, induced by means of a stressful environment and cognitive workload tasks, they observed: 1. an increase in F o with respect to baseline; 2. a decrease in pitch perturbation quotient and in amplitude perturbation quotient; 3. a lower presence of turbulent noise in the spectral zone in which the existence of harmonic components is not expected (2800-5800 Hz), with respect to harmonic energy in the 70-4500 Hz range; 4. an increase in harmonic energy in the 1600-4500 Hz range with respect to harmonic energy in the 70-1600 Hz range. The increase in F o seems to be considered a universal indicator of stress and of cognitive workload, as is the lowering of F o perturbation. The response to a stressful stimulus demands a high level of activation, which in turn produces elevated ergotropic arousal that would cause an increase in the tension of the vocal muscles, producing a higher and more tense voice. Mattiske et al. (29) report that teachers seem to experience a significant degree of stress during their work (30) , and there is some research evidence that anxiety and stress are associated with the development of voice problems (31). Marks (32) compares teachers' voices with those of nurses, and finds that psychological stress is reported more frequently by teachers. There are indications that stress, psychological tension, personality, and other psychological factors, may play an important role in voicing problems among teachers (30,33,34). Vocal fold lesions Phonotrauma may result in typical vocal fold lesions, to be interpreted as a direct consequence of mechanical stress and/or as tissue reaction to that stress. Vocal fold nodules and polyps are classical examples (35,36) , but also contact ulcerations/ granulomas of the vocal processes (35,36,37) , if not induced by acid re-flux. Vocal fold hemorrhage is generally consecutive to acute phonotrauma (35). Depending on reversibility and context, microsurgery may become indicated as an important element of the treatment (38,39). Care and cure Patients with occupational voice disorders should benefit from specific medical and paramedical treatments, as well as from technical aids, with respect to their particular pathogenesis. There are major economical aspects at stake, and occupational rehabilitation plays an important role. In a few cases, compensation and professional re-orientation is necessary. Outcomes of the various possible treatment strategies have still to be investigated. However, prevention is still essential. There are indications that vocal hygiene education programs could improve the voice by reducing vocal abuse in daily life and by practising specific strategies to maintain classroom order and to reduce the use of the voice during teaching (40). Further research is needed to demonstrate the usefulness of prevention strategies on the incidence of actual voice disorders.
The Voice Box offers a complete resource of instantly accessible ideas for use by voice specialists including professional voice users, teachers, speech and language therapists, actors and occupational voice users. It is intended as a practical resource for use in clinics and classrooms, in studio and on stage. Voice exercises, which may be used both for remedial and training purposes are provided on accessible A5 cards. Each exercise is carefully explained and supported by sound theoretical knowledge where appropriate. Vocal Information cards are also included and provide invaluable information and advice on remediation, intervention and voice training. The cards are comprehensive and unique and are intended to be part of the practical resources of every voice practitioner. Contents: Vocal Hygiene; Posture; Relaxation; De-constriction; Breathing; Voicing; Onset of the Note; Exploration of Pitch; Muscular Flexibility; Projection; Safe Shouting; Working for Variety; Resonance; Development and Control of Volume; and Role Play.
"The field of speech-language pathology is rapidly evolving into a diverse profession with sub-specialties in many areas of education and rehabilitation. This trend is highlighted by the institution of ASHA's special interest divisions and the current trends toward specialty recognition. Over the past 20 years, there has been a dramatic increase in the involvement of speech-language pathologists (SLPs) in the evaluation and treatment of voice disorders. Collaboration between ENT physicians and SLPs is now the gold standard of care for patients presenting with a wide variety of conditions that may affect the voice. As this trend develops, many SLPs are obtaining continuing education to gain current knowledge in a rapidly changing field. It is vital that we have a working knowledge of disorders and pathologies that we are now being asked to treat. This "working knowledge" calls upon our ability to incorporate anatomy, neurology, speech science, and voice training. There are many current texts in the area of evaluation and treatment of voice; however, there are few available resources for treatment ideas and stimulus tasks. Many clinicians are adapting therapy materials and stimuli from motor speech manuals/workbooks to target voice goals. The Source® Voice Disorders was designed to assist clinicians with both the evaluative tools and therapy tasks to provide services to patients with both functional and medical (organic/neurological) diagnoses. It is a functional, clinical manual useful for clinicians with varying degrees of experience with voice disorders"--
To date, there are 300 disorders associated with voice, but until now there has never been a published reference manual that classifies these disorders. Borrowing from the successful organization schema of the American Psychiatric Association’s Diagnostic Statistical Manual (DSM), the Classification Manual for Voice Disorders-I provides the framework for classifying voice disorders using the following criteria for each disorder: essential and associated features; vocal impairment; clinical history and demographic profile; course and complications; medical and voice differential diagnosis; and severity criteria. Classification Manual for Voice Disorders-I is a project of ASHA’s Special Interest Division 3, Voice and Voice Disorders (DIV 3), originally directed by contributing authors Moya Andrews, Diane Bless, Daniel Boone, Janina Casper, Leslie Glaze, Mike Karnell, Christy Ludlow, and Joe Stemple. The text was edited over a period of several years by the authoritative group of voice disorders professionals, including Katherine Verdolini, Clark Rosen, and Ryan Branski. This version represents the fields of speech-language pathology, voice science, and otolaryngology. CMVD-I lists most conditions that may negatively affect the ability to produce voice, based on the most current knowledge. These conditions comprise 30 structural pathologies, 25 neurological disorders, 20 aerodigestive conditions, 13 psychological disturbances, 15 systemic diseases, four inflammatory processes, four traumatic conditions, and five miscellaneous voice disorders. CMVD-I is a must-have resource for professionals who specialize in voice disorders, especially speech-language pathologists and otolaryngologists. The handy organization of this reference makes it a convenient and accessible resource for voice coaches and teachers of singing. It will also be invaluable as a textbook in master’s-level communication sciences programs throughout the world. Proceeds received by Division 3 will be used to support the mission of Special Interest Division 3, which provides continuing education and networking opportunities to promote leadership and advocacy for voice issues from professional, clinical, educational, and scientific perspectives.
Treatment of Voice Disorders, Second Edition presents the entire range of behavioral, medical, and surgical voice treatment options from the perspective of a variety of specialist practitioners with exceptional breadth and clarity. As suggested in the opening chapter, contemporary treatment of voice disorders draws on interdisciplinary expertise, and the book is true to that perspective. The team approach to voice treatment is realized through the contributions of laryngologists, speech-language pathologists, singing voice specialists, nurses, physiotherapists, acting voice trainers, and others. The reader will find discussion of various treatment procedures, including surgical, pharmacological, and behavioral. This text presents essential information that allows for the effective interaction of various specialties. For example, behavioral specialists can draw on the information that is given on surgery, trauma and injury, and medications. This book is at once a template for team-based treatment and a deep informational resource for treatment alternatives. Its scope and depth make it a book that the voice specialist will want to keep close at hand. New to this edition: New content on topics such as technology in the studio and pedagogy for children.Many topics have been expanded to highlight current practices, to include information published since the previous edition, and to present current management approaches.Chapters have been rewritten extensively to include the most current techniques and to reflect the latest beliefs and practices, as well as the most recent information from the evolving literature in this field.Chapter 16 on nutrition has been completely rewritten and includes important changes in criteria and strategy, reflecting developments in nutritional science over the past decade.New material on topics such as choral pedagogy for geriatric singers, laryngeal manipulation, and cosmetic procedures and their implications for voice professionals. Treatment of Voice Disorders, Second Edition is ideal for speech-language pathology students and clinicians and is suitable for classroom use as well as for reference. It is an essential volume for anyone concerned with voice disorders.
Voice Work: Art and Science in Changing Voices is a key work that addresses the theoretical and experiential aspects common to the practical vocal work of the three major voice practitioner professions - voice training, singing teaching, and speech and language pathology. The first half of the book describes the nature of voice work along the normal-abnormal voice continuum, reviews ways in which the mechanism and function of the voice can be explored, and introduces the reader to an original model of voice assessment, suitable for all voice practitioners. The second half describes the theory behind core aspects of voice and provides an extensive range of related practical voice work ideas. Throughout the book, there are a number of case studies drawn from the author's own experiences and a companion website, providing audio clips to illustrate aspects of the text, can be found at
Presents the entire range of behavioral, medical, and surgical voice treatment options from the perspective of a variety of specialist practitioners.
Overviews various models of counselling and psychotherapy, with particular emphasis on the principles of systems theory and family therapy practice before going on to provide practical guidance, supplemented with case examples, on how to identify and implement them in the management of psychosocial voice disorders in clinical scenarios.
How do a few Third World political movements become global causes clbres, while most remain isolated? This book rejects dominant views that needy groups readily gain help from selfless nongovernmental organizations (NGOs). Instead, they face a Darwinian struggle for scarce resources where support goes to the savviest, not the neediest. Examining Mexico's Zapatista rebels and Nigeria's Ogoni ethnic group, the book draws critical conclusions about social movements, NGOs, and 'global civil society'.
Voice Therapy: Clinical Case Studies, Fifth Edition provides both the student and the working clinician with a broad sampling of management strategies as presented through clinical case studies by master voice clinicians, laryngologists, and other voice care professionals. Through concise patient histories, pre- and post-treatment evaluations, and tailored therapeutic approaches, this classic text addresses assessment, management, as well as treatment and therapy approaches for a range of voice disorders; muscle tension dysphonia, glottal incompetence and neurogenic disorders, and professional voice care. New to the Fifth EditionAn expanded discussion of the principles of successful voice therapy including issues of self-efficacy and patient responsibilities for their own care. (Chapter 1)An introduction to the concept of 'Meta-Therapy;' those clinical and personal characteristics that go beyond the therapy technique to make patients more flexible and competent users of their own vocal instruments. (Chapter 1)Cases describing new evidence-based therapies such as 'Conversation Training Therapy' and 'Lax Vox' therapy. (Chapters 3 and 4)New cases describing treatments for chronic cough, superior nerve paralysis, and vocal tremor in a singer. (Chapters 5 and 6)A NEW chapter on a non-traditional therapy delivery model, telepractice and therapeutic challenges not previously discussed, treatments for enhancing the transgender voice, pervasive vocal fry, and muscle tension dysphagia. (Chapter 8) The fifth edition of this text has been extensively revised and updated and includes 54 case studies and 7 case vignettes sampling a wide variety of voice disorders with various pathologies, etiologies, and therapy techniques. Through a systematic case study format, 64 voice experts and master clinicians have provided detailed descriptions of voice assessment and management approaches and techniques. It is the ideal text for both students learning the basics of evaluation and treatment of voice disorders and practicing clinicians providing voice care.
Full-color textbook introducing concepts in communication sciences and disorders. Written in accessible, engaging and caring language, it is rooted in the American Speech-Language-Hearing Association's "Big Nine" knowledge and skill areas. Units provide cohesive "big picture" introductions and conclusions, while individual chapters focus on key information in smaller, more detailed packages. Going beyond expectations for an introductory text, it explores the emotional and social effects of disorders to help readers truly understand the profession.
Text on the current trends in prevention, assessment, diagnosis, and treatment of voice disorders, for students and clinicians in speech-language pathology or otolaryngology.
Written by some of the top researchers and clinicians in the field, Communication Disorders in Multicultural Populations, 4th Edition offers an in-depth look at the major cultural groups in the U.S. and the issues concerning their communication development, common disorders, and treatment options. This fourth edition features a wealth of updates and new features — including the latest research and added coverage of communication issues in countries such as Australia, China, Canada, and Brazil — to give speech-language pathology students and speech-language pathologists a balanced and global perspective on the most topical multicultural communication issues of today. Comprehensive coverage focuses on a wide variety of cultural and age populations. Cutting-edge research and data offer up-to-date discussions based on the latest studies in multiculturalism as it relates to the SLP and AuD professions. Diverse panel of expert authors include some of the top researchers and clinicians in the field. Additional resources provide a focused listing of print and electronic sources at the end of each chapter to support more in-depth study of a particular subject. Chapter on international perspectives tackles issues in countries such as Australia, Canada, China, and Brazil to give you a more global understanding of communication disorders. The latest statistics from the 2010 U.S. Census report offers the most current data available. Increased content on older adults covers the multicultural issues, voice disorders, and neurogenic disorders particular to this important demographic. Case studies give you practice solving realistic clinical problems. Chapter overview and conclusion outline the key information in each chapter and serve as a checklist for content mastery.

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