The prerequisite, essential components for the Certificate E: FEEV transition session, to be held at the Delta Burnaby Hotel Thursday on October 24, 2019, are listed below. This is followed by a resource list for registrants. There is an assumption that participants have the knowledge and skills level in voice equivalent to an SLP graduate program course(s) in vocal anatomy/physiology and clinical assessment and management.
1. Anatomy & Physiology
- Differences between speech breathing and vegetative breathing.
- Primary systems involved in speech breathing. Passive versus Active speech breathing mechanisms.
- Speech breathing measurement and evaluation: e.g. respiratory kinematics and dynamics.
- Anatomical factors in respiratory systems that influence sub-glottal pressures, phonation duration, phonatory dynamics (e.g. intensity, fundamental frequency).
- Use (e.g. Posture) factors that influence sub-glottal pressures, phonation duration, phonatory dynamics.
- Effects of development and aging on speech breathing anatomy and function.
- Gender-based differences in speech breathing anatomy and function.
Laryngeal & Paralaryngeal Anatomy:
- Laryngeal suspension system: role of extrinsic laryngeal suspension system during voice production.
- Primary cartilages of the larynx: functional significance for voice production and breathing of structure, shape and location.
- Intrinsic muscles of the larynx: primary roles of each for voice production, abduction, adduction, medial compression, registration, dynamics of intensity, fundamental frequency (f0).
- Structures involved in vocal resonance.
- Vocal Registration mechanisms (e.g. Modal, Falsetto, Glottal Fry).
- Primary differences in laryngeal structure between infants, children and adults. Effects of development and aging on vocal structure and function.
- Primary gender-based differences in laryngeal structure and function.
- Factors that determine sub-glottal pressures and resistance. Phonation threshold pressures.
- Vocal fold layer-structure of the vocal folds: influence of the layer-structure on vibratory patterns.
- Vibratory patterns: longitudinal phase difference; vertical phase difference; mucosal wave.
- Biomechanical-aerodynamic principle of phonation: flow-separation, etc. Primary asymmetrical force factors determining sustained self-oscillation of the vocal folds.
- Vocal Registration: Unique postural, vocal fold vibratory, biomechanical, aerodynamic, speech-breathing patterns for different vocal registers.
- Primary mechanisms responsible for pitch change in modal register, falsetto register.
- Secondary vocal tract adjustments in the vocal tract that may contribute to pitch changes.
- Mechanical, aerodynamic and acoustic correlates to intensity changes in modal register, falsetto register.
- Physiological factors contributing to variable vocal quality, e.g. Breathiness, pressed voice/glottal fry.
- Supra-glottal influences on vocal quality.
- Resonance mechanisms/factors in larynx and extra-laryngeal structures.
- Acoustic and aerodynamic principles of phonation, e.g. Source-Filter/Acoustic Theory
2. Causes & Classifications
- Examples: tumours; infections; mucosal changes from use/misuse; laryngeal trauma (internal/external); contact ulcer and granuloma; cysts, sulci, and mucosal bridges; congenital and acquired webs; Cricoarytenoid Joint Problems; Neurological Factors: Motor Speech Disorders; occupational diseases; environmental toxins/sensitivities; irritable larynx/laryngeal breathing dysfunction (e.g. chronic cough, laryngospasm-PVFM, Globus).
- Examples: Vocal dose; environmental; acoustic; ergonomic; occupational; habitual misuses.
Emotional & Psychological Factors:
- Examples; autonomic and voluntary nervous system responses to emotional stressors; levels of emotional awareness; attachment factors; Conflict Over Speaking Out (COSO); psychiatric disease.
- Lifestyle, anatomical factors contributing to LPR; responses of laryngeal valve; chronic laryngeal irritability
- Examples; alignment/posture; specific regional muscle misuses, e.g. jaw clenching; laryngeal misuses, e.g. valving; inappropriate speech breathing; misuses related to register/pitch use, intensity use.
3. Assessment of Voice Disorders
- Speech-breathing measures (e.g. kinematics; dynamics; vital capacity; phonatory flow volumes).
- Multi-factorial, client-centred history taking for voice/laryngeal dysfunction including standardized self-report protocols.
- Auditory perceptual protocols. (E.g. CAPE-V; Vocal Profile Analysis; GRBAS.
- Other perceptual protocols. (E.g. manual evaluation; visual analysis of posture)
- Acoustic measures: for intensity; rate; duration measures of typical values and ranges.
- Spectral-acoustic measures of vocal perturbations, Cepstral measures.
- Aerodynamic measures of voice production: phonatory flow rates, volumes; estimated sub-glottal pressure and glottal/laryngeal airway resistance measures; phonation threshold pressures.
- Laryngeal endoscopy: intra-oral; trans-nasal rationale, protocols including stroboscopic assessment of vocal fold vibratory movements.
- Other instrumental measures: E.g. electro-glottography; slow-motion photography-kymography; laryngeal electromyography
Diagnostic Voice Therapy:
- Selection process for therapy probes: How do we choose diagnostic therapy approaches based on information obtained from knowledge of normal and abnormal anatomy/physiology, client history and assessment results?
4. Voice Therapy Approaches
- Focused/symptomatic therapy approaches and applications.
- Comprehensive therapy approaches and applications.
- Augmentative/holistic therapy approaches and applications.
Prerequisite Resource Examples for Voice Endoscopy Education
Aronson, A.E. and Bless, D.M. (2009) Clinical voice disorders 4th Edition, New York: Thieme.
Baker J and Lane RD (2009) Emotion Processing Deficits in Functional Voice Disorders. Chapter 7 in
Emotions in the Human Voice, Vol III, K. Izdebski (Ed). San Diego: Plural Publishing: 105-135.
Ferrand, CT (2012) Voice Disorders: Scope of Theory and Practice, Allyn & Bacon
Harris, T. (1998). Laryngeal mechanisms in normal function ad dysfunction. In T. Harris, S. Harris, J. S.
Rubin & D. M. Howard (Eds.), The Voice Clinic Handbook, 64-90. London: Whurr Publishers Ltd.
Hixon, T and Hoit, J. (2005) Evaluation and Management of Speech Breathing Disorders, Reddington Brown LLC
LeBorgne, W (2018) Rating Laryngeal Videostroboscopy and Acoustic Recordings. Plural Publishing.
Morrison, M. D., & Rammage, L. A. (1993). Muscle misuse voice disorders: description and classification. Acta Otolaryngologica, 113, 428-434.
Morrison, M. D., Rammage, L. A. & Emami, A. J. (1999). The irritable larynx syndrome. Journal of Voice, 13(3), 447-455
Morrison M, Rammage L. (2010) The irritable larynx syndrome as a Central Sensitivity Syndrome. Canadian Journal of Speech-Language Pathology and Audiology 2010;4(4):282-289.
Rammage L., Shoja S. and Morrison M. (in press) Muscle Misuse Disorders of the Larynx. Chapter 93: Ballenger`s Otorhinolaryngology, Head and Neck Surgery, 18th Edition. J.B Snow and P.A. Wackym, (eds.) BC Decker.
Sapienza C, Hoffman Ruddy, B (2018) Voice Disorders. Plural Publishing.
Sapienza C, Hoffman Ruddy, B Visual Examination of Voice Disorders- DVD Plural Publishing
Titze, IR. Principles of Voice Production
Van den Berg (1960) The Vibrating Larynx.
For further information, please contact Mardi Lowe, Director, Quality Assurance & Professional Practice at Mardi.Lowe@cshbc.ca.