Title: SLPA 220 Test 4 (Voice & Resonance, Bleile Chapters 15 - 18)
Course: Speech Disorders & Intervention (SLPA 220-SLPA 220) > Section: Assessments

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

The ENT has recommended that Max increase his hydration.  Max weighs 84 pounds.  About how much water should he drink each day?
- 42 ounces
- 4.2 cups
- 84 ounces
- 8.4 cups
A: 42 ounces

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

Your supervising SLP asks that you teach Max to speak in a confidential voice.  What does this mean?
- Teach Max to speak only when absolutely necessary
- Teach Max to speak only in a whisper
- Teach Max to speak in a quiet, easy, breathy voice
- Teach Max to take 1-hour breaks each morning and afternoon during which he does not speak at all
A: Teach Max to speak in a quiet, easy, breathy voice

Q: Reagan is a 5 year old girl with a history of cleft lip and palate.  She underwent lip and palate repair, but continue to demonstrate nasal distortions of sounds.  Your supervising SLP has told you that Reagan's distortions of the /t, d/ and /n/ sounds are obligatory distortions, meaning that Reagan produces the sounds in the correct place in her mouth, but that her abnormal structure results in the distortions.  Based on this information you know that ______________________.
- these errors will not respond to speech therapy
- these errors will require speech therapy
- these errors will not respond to surgical intervention.
- these errors are the result of an oronasal fistula
A: these errors will not respond to speech therapy

Q: Reagan is a 5 year old girl with a history of cleft lip and palate.  She underwent lip and palate repair, but continue to demonstrate nasal distortions of sounds.  Your supervising SLP said that Reagan demonstrates some compensatory errors as a result of her difficulty completely closing the velopharyngeal port.  You know that compensatory errors are errors in which __________________________.
- Reagan produces the sound with incorrect articulatory placement
- Reagan produces the sound with incorrect voicing
- Reagan produces the sound with nasal distortion because of structural deficits
- Reagan omits the sound
A: Reagan produces the sound with incorrect articulatory placement

Q: Reagan is a 5 year old girl with a history of cleft lip and palate.  She underwent lip and palate repair, but continue to demonstrate nasal distortions of sounds.  Reagan will be having another surgery to help correct the velopharyngeal incompetence that results in these nasal distortions.  Which of the following is true regarding Reagan's speech after this surgery?
- Reagan might still have hypernasality or nasal emission if she does not use the velum and pharyngeal walls properly.
- Reagan might still have compensatory errors resulting in nasal emission.
- Reagan might still need speech therapy to correct compensatory errors.
A: (a choice with no text)

Q: Reagan is a 5 year old girl with a history of cleft lip and palate.  She underwent lip and palate repair, but continue to demonstrate nasal distortions of sounds.  Following her surgery to correct her velopharyngeal incompetence, Reagan continued to demonstrate some nasal emission which your supervising SLP said were compensatory errors.  This means that Reagan's structures were adequate, but that she had to learn how to produce sounds without nasal emission.  The SLP wrote a treatment plan that used a(n) __________________ to help Reagan hear the nasal emission that occurred in her speech.
- listening tube
- pharyngeal flap
- blood pressure cuff
- obturator
A: listening tube

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.
According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.
Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.
During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.
After the evaluation, the SLP and SLPA met with Max and his parents about the results of the evaluation, and about the desired results of therapy.

What is a vocal traumatic behavior which may cause phonotrauma that Max demonstrates?
Feedback: yelling, throat clearing

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

After the evaluation, the SLP and SLPA met with Max and his parents about the results of the evaluation, and about the desired results of therapy.  What is one substitute behavior or environmental treatment technique that could be implemented in Max's treatment program?
- Surgical removal of the nodules
- Implement vocal rest periods during the day
- Use walkie-talkies to communicate the parents when playing on a different floor of the house
- Implement the vocal function exercise program with Max
A: Use walkie-talkies to communicate the parents when playing on a different floor of the house

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

Based on the case history, what behavior does Max demonstrate that contributes to poor vocal hygiene (not a behavior that cause phonotrauma)?
- Yelling
- Drinking large amounts of caffeinated beverages
- Acid reflux
- Speaking loudly
A: Drinking large amounts of caffeinated beverages

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

When obtaining a baseline measure of Max's conversational loudness, he averaged 76 dB when speaking.  During the initial stages of therapy, the SLP asked you to work with Max to reduce his vocal loudness during conversational speech in the therapy room.  Write a behavioral objective (condition, performance, criteria) that you could use during Max's first session addressing reduced loudness.

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

After the evaluation, the SLP and SLPA met with Max and his parents about the results of the evaluation, and about the desired results of therapy.

What parent-supplied event/activity do you think would be the best choice to motivate Max to change his vocal behaviors? What do you think would be a good reinforcer (“big prize”) for Max?
- A 2-liter bottle of Mountain Dew
- A gift certificate to a local bookstore
- An extra hour of time to play video games each night
- Tickets to a college or professional sporting even nearby
A: Tickets to a college or professional sporting even nearby

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.

The SLP has decided that Max would benefit from Resonant Voice Treatment.  Which of the following techniques would you most likely implement with Max in treatment?
- Focus on production of nasal sounds and words with nasal sounds
- Produce voice with the vocal folds barely touching
- Train a "forward focus" of the voice vs. focus in the throat
A: (a choice with no text)

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.

According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.

Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.

During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes. Max was able to sustain /s/ for an average of 20.8 seconds and /z/ for an average of 12.7 seconds.  What is is s:z ratio?
- 1.6
- 0.6
- 1
A: 1.6

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.
According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.
Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.
During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.
After the evaluation, the SLP and SLPA met with Max and his parents about the results of the evaluation, and about the desired results of therapy.

What is a behavior that could be substituted for the vocally traumatic behavior which causes phonotrauma that you identified in the previous question.
Feedback: e.g., yelling - clapping, stomping foot at games; using a walkie talkie at home, going into the room to talk to parents. throat clearing - take a drink of water, swallow hard

Q: Max is a 10-year-old boy who has had a history of hoarseness for the past year. His hoarseness has gradually been getting worse. He was examined by an ENT, who noted small bilateral vocal fold nodules. The ENT referred Max to his local school speech-language pathologist for a voice evaluation and treatment.
According to the case history completed by the family, Max is on soccer, baseball, and basketball teams, so is playing some sport every month of the year. He was in school chorus, which he enjoys, until he became too hoarse to sing. Max has a six-year-old sister with whom he (loudly) fights frequently. His family lives in a three-level house and Max often plays on the lower level while his parents are on the main level, so he talks and yells up and down the stairs.
Max drinks four to five caffeinated soft drinks between the time he gets home from school and the time he goes to bed. He goes to bed around 11:00 p.m. and is up by 6:00 a.m. to ride the bus to school. He shows no signs of acid reflux.
During the voice evaluation at the school, Max was noted to talk at a volume level that was uncomfortably loud in a 1:1 situation. He cleared his throat ten times within the hour-long evaluation session. His pitch was appropriate for his age and gender. His voice quality was perceived as hoarse/breathy. His was able to discriminate between loud and more appropriate volumes.
After the evaluation, the SLP and SLPA met with Max and his parents about the results of the evaluation, and about the desired results of therapy.
How is the SLP most likely to characterize Max's disorder?
- An organic disorder caused by vocal abuse
- An organic disorder caused by environmental toxins
- A functional disorder caused by vocal behaviors which cause phonotrauma
- A functional disorder cause by a neurologic disorder
A: A functional disorder caused by vocal behaviors which cause phonotrauma