Voice Assessment Case History PDF

Voice Assessment Teresa L. Kiernan, MA, CCC-SLP SPE 682 | Fall 2023 1 Voice Evaluation Laryngeal Exam Case Perceptual & Refer...

Voice Assessment Teresa L. Kiernan, MA, CCC-SLP SPE 682 | Fall 2023 1 Voice Evaluation Laryngeal Exam Case Perceptual & Referral from History: Assessment ENT Interview Recommendations & Objective Prognosis Stimulability Measures Treatment Plan / GOALS Referral: ✓ ENT (Laryngology Specialist) ✓ Diagnosis Vocal fold lesions / tissue Vocal fold motion Vocal fold closure patterns (determined with strobe only) ✓ Recommendations / Plan Behavioral therapy (speech therapy? Singing lessons?) Medications given? Surgery planned?  CASE HISTORY First Impressions… Your patient is more nervous than you are even when: ○ Aloof, snobby, combative Chat about the weather! Know the patient’s background ○ Talk to MD – What’s the diagnosis? Did you prescribe any medication? Voice rest? Does the patient need surgery? Have a framework for what topics to cover so you don’t get sidetracked AND get the information you need to know your next steps First Impressions… Learn to listen more than talk ○ The aim of listening is to understand Listen without judging or predicting or stereotyping ○ Listen without an agenda! Listen with understanding that patient is the expert ○ Sometimes patient will feel disconnected Be curious about the person; their needs, goals, fears Be supportive of their journey ○ Commend self-awareness, attempts to self-treat, attempts to seek help  Ask good questions Open-ended: ○ What is worrying you about your voice? ○ What exactly happens when you have problems? ○ Tell me more about that… ○ What sort of things have you tried on your own? Avoid serial questions! ○ Focus on behavior and feelings Go through a “typical day” Check if patient wants to add anything Elicit more information Facilitative Responses: ○ Mmm-hmmm ○ I see ○ Tell me more about that Reflect back what you’re hearing Summarize and ask patient to add anything you may have missed. Case History: What’s the story? Past Onset & Progression Medical History Vocal Lifestyle & Schedule & Motivation Personality 9  ONSET & PROGRESSION ✱ “When did you first notice your voice problem?” ✱ “Did it come on suddenly or gradually?” ✱ “Is your problem getting better, worse, or staying the same?” ✱ “What are your current symptoms?” ✱ “Have you had voice problems in the past?” ✱ “What treatment have you had?” ✱ “Are there patterns to your voice problems?” Patient Report: Voice Symptoms COMMON SYMPTOMS ✱ THE SOUND OF THE VOICE ✱ TOO HARSH / HOARSE / RASPY ✱ VOICE LOSS ✱ TOO HIGH / LOW ✱ TOO LOUD / SOFT ✱ REDUCED VOCAL RANGE ✱ THE FEEL OF THE VOICE ✱ TOO EFFORTFUL ✱ PAINFUL / IRRITATED / SORE ✱ DRY THROAT ✱ INCREASED MUCOUS 11 Case Hx: Past Medical History Irritation: Phonotrauma or Internal vs blunt trauma External Surgery Neurological Disorders Illness: Congenital Bacterial Dysphonia Conditions or Viral  Case Hx: Vocal Schedule & Social Hx Home- Social related Activities activities Work- related Personal activities Habits Dysphonia Case Hx: Lifestyle Diet & Exercise Sleep & Stress & Fatigue Emotional levels Health Dysphonia Case Hx: Patient Motivation Ruler Method Ruler method On a scale of 1-10, how important is it for you to address your problem? ○ Why ___ and not 1? = Elicit change-talk: WHY it’s important On a scale of 1-10, how confident are you in your ability to change? ○ Why ___ and not 1? Elicits talk about self-efficacy ○ What would help you get a higher score? PERCEPTUAL ASSESSMENT Perceptual Assessment Patient’s Clinician’s Estimation: Perception: CAPE - V Quality of Life Survey Patient (VHI) motivation Level of Stimulability effort - Trial therapy Discrepancy? Quality of Life Assessment ✱ Insight into patient perspective ✱ Components: ✱ Physical ✱ Psychological ✱ Social ✱ Economical ✱ Track progression of condition and effectiveness of treatment  Voice Handicap Index -10 (VHI-10) Jacobson et al, 1997; Rosen et al, 2004 Validated and Standardized Questionnaire = Self-analysis of Quality of Life Issues as it relates to: 1. Functional Impact on Daily Activities 2. Physical Perception of Laryngeal Discomfort 3. Patient’s Emotional Response to the Disorder Voice Handicap Index-10 OBJECTIVE EVALUATION 22 Stimulability Testing 23 Stimulability Testing: Kinesthetic Builds Awareness self-efficacy Assess readiness  Impressions 1. Summary of the patient diagnosis and symptoms 2. Summary of subjective & objective findings 3. What might have caused and/or perpetuated the problem? 4. What is the patient’s prognosis with treatment? Level of Handicap Self-Reliance is Level of os Motivation o gn Pr Kinesthetic Self-Efficacy awareness GOAL setting  Goal Writing Just simply having goals clearly defined makes it more likely that we will achieve them Long-term Goals (LTG) = the big picture. ○ What pt. wants to achieve Short-term Goals (STG) = steps/tools to achieve goal. Specific, measurable, attainable, relevant, time-bound Goal Writing What will the patient do? How well? Under what circumstances? How will you measure progress? ○ Who? Using what? From where? How often?  CONCLUDING DISCUSSION: Collaborative Interaction & Decision Making ID what might be causing or contributing to problem ○ Sum up what you found in an easy to understand manner Educate and Counsel: ○ Explain Diagnosis & Prognosis ○ If needed, cover Vocal Hygiene that is MOST needed by your student (less is more). Ensure planned behavioral intervention is consistent with your patient’s goals With permission from your patient, relay the information to anyone who serves as a support (e.g., caregiver, MD, parent, etc). Thank you for participating!