《嗓音障礙》特殊兒童教育課件Voice8

1、NEUROGEnic voice disorders 2TOpicsFlaccid Dysarthria（無力型）Vocal Fold ParalysisCricothyroid Muscle ParalysisBilateral Vocal Fold ParalysisUnilateral Vocal Fold ParalysisHypokinetic Dysarthria（運(yùn)動(dòng)功能減退型）Parkinsons DiseaseFlaccid DysarthriaFlaccid DysarthriaCause/etiology Bilateral or unilateral damage to

2、 specific cranial nerves At their nuclei in the brain stemSomewhere along their extracranial route to the speech sub system muscles that they innervateFlaccid DysarthriaSymptoms (damage to peripheral nervous system)Flaccid paralysisReduced force of muscle contraction（肌肉收縮力量減?。㏑educed range of motion

3、（運(yùn)動(dòng)范圍減?。￢ocal fold paralysisVocla fold paralysisA kind of Flaccid Dysarthria patientCause/etiology Damage to the cranial nerve The type and extent of dysphonia depends onThe lesion siteBilateral or unilateralPartial or complete1、cricothyroid Muscle ParalysisCause/etiology Mostly viral infection of S

4、LNBilateral or unilateralFunction of cricothyroid Tensing of the VFElevation of picth VF adduction1、cricothyroid Muscle ParalysisSignA slight rotation of the invovled VFA slight bowing of the invovled VFTypical voice symptomsInability to elevate or lower pitchSome breathiness bowing1、cricothyroid Mu

5、scle ParalysisTreatmentMedicine Corticosteriods and antivirtal agentsSurgerySelective reinnervation of the cricothyroid muscleThyroplasty2、bilateral VF ParalysisCause/etiology Lesions in the trunk of the vagus nerve Lesions at the nuclei of origin in the medullaNeonatal stridor 新生兒喉喘鳴（common reason

6、in children）2、bilateral VF ParalysisTypes and symptomsAdductory - neither VF can move to midlineMaking phonation impossibleAt risk for aspiration（誤吸）Abductory - the VFs remain at the midlineSerious respiratory problems tracheostomy2、bilateral VF ParalysisTreatment for continued bilateral VF paralysi

7、sTracheostomy greater airway competenceSurgical reinnervation of VFsUnilateral removal of one arytenoid - more anterior glottal closure Electrical stimulation to the posterior cricoarytenoid muscle Laser surgery - decrease open glottal space for bilateral adductor fold paralysis3、uilateral VF Paraly

8、sis (uvfp)Cause/etiology Damage to one side of RLNDiseaseTrauma - surgical trauma (most common reason)LocationLeft UVFP is more commonThe routes of the left and the right RLN are different3、uilateral VF Paralysis (uvfp)MechanismDamage to one side of RLNPoor Larygeal adductor muscles (麻痹不能調(diào)節(jié)自身的張力等因素)

9、Paralyzed fold in paramedian positionNeither fully abducted nor adducted (聲門不能完全閉合或開放)3、uilateral VF Paralysis (uvfp)SymptomsUVFPNeither fully abducted nor adducted Breathy Short phonation timePoor Larygeal adductor muscles Pitch breaksDiplophoniaHoarsnessExcessive supraglottal constriction3、uilater

10、al VF Paralysis (uvfp)TreatmentsTraumatic UVFP can have spontaneous recovery with the first 9-12 months postonsetBehavioral voice therapy Permanent corrective procedures3、uilateral VF Paralysis (uvfp)Behavioral voice therapy Half-swallow boomHead positioningTuck-chinDigital manipulationFocus Tongue

11、protursion /i/Yawn-sighPitch shift upInhalation phonation3、uilateral VF Paralysis (uvfp)Permanent corrective proceduresParalyzed VF injection TeflonFat - reabsorbedFacial tissueThyroplastyRectangular windowMicrometric screw （微動(dòng)螺絲）Reinnervating the paralyzed VFPhrenic nerve (膈神經(jīng))Section of SLN and hy

12、poglossus nerveuVFP before & after Surgery (Teflon Injection)Hypokinetic DysarthriaHypokinetic DysarthriaCause/etiology Problem with the effect of neurotransmitter dopamine on the activities of the basal gangliaDepletion（損耗過多）Functional reduction（功能減退）SymptomsRigidity, slow movement - bradykinesiaLi

13、mited range of motionResting tremor Parkinsons DiseaseParkinsons Disease (PD)98% hypokinetic dysarthrias are of the Parkinsons typeSymptomsReduced loudnessBreathy voiceMonotony of picthIntermittent rapid rushes of speechSoft production of consonantsParkinsons Disease (PD)TreatmentsTaskQuick conversational patternMechanismRapid and accelerated movement of the articulatorsResultsSpeech is unintelligibleParkinsons Disease (PD)TreatmentsSpeak with intentLouderslowerBetter voice qualityBetter articulationParkinsons Disease (PD)TreatmentsLSVT (Lee Silverm