|
Perceptual-auditory
|
Manifestations
|
Specific goals (Targets)
|
Strategies (Ingredients)
(25-27)
|
|
Vocal Quality (GRBASI)
|
Hoarse, rough, breathy, asthenic, tense, unstable voice in mild, moderate, or intense degrees. |
Adapting vocal quality to meet social and/or professional demands |
General objective of therapeutic planning |
|
Average Maximum Phonation Times (MPT)
|
Reduced or increased MPT. |
Adjusting maximum phonation times |
Techniques: vowel emission, fricative sound, lip or tongue vibration, nasal sounds – with maximum comfortable support. |
|
Dynamic Field
|
1. Reduced dynamic range for frequency variation. |
Adjusting dynamic range for frequency variation |
Techniques: frequency modulation with variation towards the bass, frequency modulation with variation towards the treble, and musical scales (ascending and descending) with facilitating sounds. |
| 2. Reduced dynamic range for intensity variation. |
Setting the dynamic range for intensity variation |
Intensity modulation technique with facilitating sounds |
|
Resonance
|
1. Low vocal resonance. |
Balancing resonance |
1. Techniques: nasal sounds, yawning-sighing, chewing associated with nasal sounds, monitoring by multiple routes - proprioceptive route. |
| 2. High vocal resonance. |
Balancing resonance |
Techniques: over-articulation, prolonged “b”, basal sound nasal sounds. |
|
Vocal attacks
|
1. Sudden vocal attacks. |
Matching vocal attacks |
1. Techniques: control of sudden vocal attacks (emission of vowels initiated by aspirated vocal attacks), fricative sounds (alternating from unvoiced to voiced). |
| 2. Aspirated vocal attacks. |
Matching vocal attacks |
Techniques: control of aspirated vocal attacks (emission of vowels with a glottal blow), plosive sounds (pa ta ka), trigger sounds, sounded incomplete swallowing. |
|
Pitch
|
1. Low pitch for gender and age. |
Matching pitch to age and gender |
1. Techniques: digital manipulation of the larynx, frequency modulation (towards the high end), hyperacute sound, musical scales (ascending), monitoring by multiple routes (auditory and visual). |
| 2. High pitch for gender and age. |
Matching pitch to age and gender |
Techniques: digital manipulation of the larynx, prolonged “b”, frequency modulation (towards the bass), musical scales (descending), basal sound. |
|
Loudness
|
1. High loudness for the communicative context. |
Adjusting loudness to the communicative context |
Techniques: auditory repetition – Loop, sound amplification, intensity modulation, multi-way monitoring (auditory and visual). |
| 2. Reduced loudness for the communicative context. |
Adjusting loudness to the communicative context |
Techniques: auditory repetition – Loop, sound amplification, intensity modulation, multi-path monitoring (auditory and visual). |
|
Speech sound articulation
|
1. Undifferentiated |
Adjusting the articulation of speech sounds |
Techniques: over-articulation, vowel-only reading, mouth opening, chewed speech, multi-path monitoring (visual and proprioceptive). |
| 2. Locked |
Matching articulatory accuracy |
| 3. Exaggerated |
Matching articulatory accuracy |
Multi-way monitoring technique – visual and proprioceptive. |
|
Speech rate
|
1. Reduced speech rate. |
Matching speech rate to the communicative context |
Techniques: auditory repetition – Loop, vocal pacing, multi-pathway monitoring (auditory, visual, and proprioceptive). |
| 2. Increased speech rate. |
Matching speech rate to the communicative context |
Techniques: delayed auditory monitoring, auditory repetition – Loop, vocal pacing, multi-path monitoring (auditory, visual, and proprioceptive). |
|
Speech intelligibility
|
Inadequate speech intelligibility. |
Promoting speech intelligibility |
Techniques: reading vowels only, over-articulation, delayed auditory monitoring, chewed speech, multiple pathway monitoring (visual and proprioceptive), tongue twisters. |
|
Speech rhythm
|
Inappropriate speech rhythm. |
Matching speech rhythm to the communicative context |
Techniques: auditory repetition, vocal pacing, delayed auditory monitoring, multi-pathway monitoring (auditory and proprioceptive). |
|
Respiratory support during speech
|
1. Upper respiratory type (clavicular). |
Adjusting the type of respiratory support |
Multi-way monitoring technique (visual and proprioceptive), breathing exercises: sustained inhalation, fractionated inhalation, fractionated inhalation + upper limbs. Breathing training for flow and force with respiratory stimulators/exercisers. Fricative sounds technique at maximum phonation time. |
| 2. Medium respiratory type (thoracic). |
Adjusting the type of respiratory support |
|
Breathing mode while speaking or singing
|
1. Nasal breathing mode. |
Setting up oro-nasal breathing |
Breathing exercises with air injections through the oral cavity associated with nostril occlusion. |
| 2. Oral breathing mode. |
Setting up oro-nasal breathing |
Multi-way monitoring technique – Proprioceptive. Nasal aeration exercise with one nostril occluded (alternating nostrils). |
|
Respiratory coordination and articulation of speech sounds
|
Respiratory and articulatory incoordination of speech sounds |
Promoting respiratory and articulatory coordination of speech sounds |
Techniques: proprioceptive monitoring, vibration of the lips or tongue in TMF, fricative sounds in TMF, nasal sounds in TMF, multi-way monitoring (proprioceptive and visual), modulated voice. |
|
Parameter
|
Diagnosis
|
Therapeutic planning
|
|
Laryngeal palpation Brito et al.(21) |
Manifestations
|
Specific goals (Targets)
|
Strategies (Ingredients)
(17)
|
|
Strength
|
|
Adjusting muscle resistance. |
1. Technique of cervical movements, stretching of the cervical muscles, massage of the cervical region (manual – electric massager), application of heat, technique of digital manipulation of the larynx. |
|
Laryngeal position
|
|
Adjusting laryngeal position. |
Techniques: digital manipulation of the larynx, cervical movements, stretching of the cervical muscles, massage of the cervical region (manual – electric massager), application of heat. |
|
|
|
Parameter
|
Diagnosis
|
Therapeutic planning
|
|
ENT diagnosis
|
Etiological diagnosis
|
Specific goals (Targets)
|
Strategies (Ingredients)
(17)
|
|
1. Nodules 2. Polyp 3. Reinke’s edema 4. Cyst 5. Furrow
|
|
1 to 6. Stimulating the mucus movement. |
1 to 6. Techniques: vibrating sounds, basal sound, massager associated with glottal sonorization, fricative sounds (in sonority passage), phonation in tubes submerged in water. |
| 1, 2, and 5. Absorbing the injury. |
1, 2, and 5. Techniques: lip and tongue vibration, voiced fricative sounds. Techniques: lip constriction, phonation in tubes. |
| 1 and 6. Adjusting glottal absorption. |
1 and 6. Techniques: tongue or lip vibration, fricative sounds (in sonority passage). Techniques: inspiratory phonation, prolonged “b”, phonation in tubes. |
|
Supraglottic activity
|
|
Removing the involvement of supra-glottic structures in phonation. |
Techniques: inspiratory “i”, yawn-sigh, sniff, breath, high-pitched sound. Lip constriction sequence. |
|
Parameter
|
Diagnosis
|
Therapeutic planning
|
|
Vocal self-assessment Protocols
|
Diagnosis
|
Specific goals (Targets)
|
Strategies (Ingredients)
(25,28)
|
|
Vocal Symptoms Scale (VSS)
(22)
|
Above 16 points – self-perception of negative impact on voice functionality. |
Removing and/or reducing vocal symptoms. |
Pedagogy and Counseling. Vocal guidance – customized indirect vocal therapy based on approaches to deal with the patient’s symptoms. |
|
Vocal Disadvantage Index (VDI)
(23)
|
Above 19 points – self-perception of vocal disadvantage. |
Improving the voice-related patient’s quality of life. |
Pedagogy and Counseling. Voice guidance – customized indirect voice therapy. |
|
Dysphonia Coping Strategies Protocol (PEED)
(24)
|
Average score for individuals with voice complaints: 51.86. Average score for the population without vocal complaints: 23.18. |
Promoting coping strategies for the solution of dysphonia. |
Pedagogy and Counseling. Voice guidance – customized indirect voice therapy. |