Western Michigan University s7

SPPA 6400 Voice Disorders WESTERN MICHIGAN UNIVERSITY Department of Speech Pathology & Audiology

SPPA 6400: Voice Disorders CHHS 2060 Spring, 2015 Credit Hours: 2 Mon 9:00-12:40 PM (Mar 2-Apr 27, 2015)

Instructor: Stephen Tasko Phone: 387-8049 Office: Rm. 4478 e-mail: [email protected] Office hours: By appointment

Prerequisite: Department approval.

Required Materials:  Stemple, J.C., Roy, N. & Klaben, B.K. (2014). Clinical Voice Pathology: Theory and Management. 5th Edition, San Diego: Plural Publishing.  Various materials distributed in class and posted on website http://homepages.wmich.edu/~stasko/

Recommended Resources Now & in the Future  Colton, R., Casper, J.K. & Leonard, R. (2011) Understanding Voice Problems: A physiological perspective for diagnosis and treatment. 4th Edition, Baltimore, MD: Lippincott, Williams & Wilkins.  Bless, Aronson, et al. (2009). Clinical Voice Disorders (3rd Ed.). New York, NY: Thieme.  Boone DR, McFarlane SC, Von Berg SL. & Zraick (2010). The Voice and Voice Therapy (8th edition). Boston: Pearson Allyn Bacon.

Evaluation Midterm Exam (03/30/15 9-10:30 am) 35 % Final Exam (04/27/15 10:15-12:15 pm) 50 % Assignments 10 % Out-of class Experiences 5 % 100 % Grading scheme 93-100: A 88-92: BA 83-87: B 78-82: CB 70-77: C 65-69: D below 65: E

Exams The midterm exam will take place in class and will be 90 minutes in length. The final exam will take place during final exam week and will be 2 hours in length. The final exam will be comprehensive and cover all course content. Both exams will use various question types (short answer, multiple choice, case studies and essay format) with an emphasis on longer format questions that will require you to integrate concepts we have covered for the purpose of solving clinical problems. Part of the exam may require a “take-home” component that will be distributed ahead of the exam seating and will be due at the time of the exam. Students must earn a passing grade on the final exam in order to earn a passing grade in the course.

Absences from scheduled exams without prior approval of the instructor will result in a test score of zero. Students may only be excused from a scheduled exam due to illness and MUST provide medical documentation verifying the illness. Excuse from a scheduled exam for non-medical circumstances will be evaluated on a case-by-case basis.

Assignments Students must complete two (2) assignments on topics that cannot be covered directly in lecture due to time constraints. This material will be covered on classroom examinations. Details about the assignment will be provided in class. Each assignment is worth 5 % of the student’s final grade. Assignment 1: Anatomy and Physiology Review Assignment 2: Instrumental Assessment of Voice The student can receive full credit (5/5), partial credit (3/5), or no credit (0/5) for each assignment. Late assignments will receive a score of zero. SPPA 6400 Voice Disorders

Out of class experiences Three out-of class-experiences will be offered. These are outlined below. The auditory perceptual evaluation of voice quality is required of all students. Students can choose between participating in the anatomy lab visit OR getting experience performing a VLS examination. However, students are welcome and encouraged to participate in both experiences if they wish.

 Auditory Perceptual Evaluation of Voice Quality: The goal of this activity is to assist students in “calibrating” their ears to the range and severity of voice qualities they may experience in clinical practice. The activity involves listening to a wide range of normal and disordered voice samples and rating them on a set of standard auditory perceptual dimensions

 Human Anatomy Lab visit: The goal of this activity is to provide further exposure to the anatomy of the key laryngeal and velopharyngeal structures. The activity will involve a demonstration of the anatomical structures on human cadavers.

 Oral Videolaryngostroboscopic Examination: The goal of this activity is to give students hands-on experience performing an oral VLS examination on a (relatively) normal, cooperative subject (on S. Tasko – yikes).

Each experience is worth 2.5 % of the final grade up to a maximum of 5 %. Students who fully participate, which means satisfactory completion the required experience and at least one of the optional experiences, will receive the maximum points.

Grade disputes Students who take issue with an assigned grade have a window of two weeks (following receipt of the grade) to discuss the concern with me. After this two-week window, the student should consider the grade final.

An Important Note about Evaluation It is important to recognize that ASHA Academic Accreditation standards are now based upon students demonstrating competencies across a wide range of areas rather than simply completing a course sequence successfully. Therefore, it is conceivable that a student could receive a passing grade in a course, but has failed to demonstrate competency across all of the topics covered in that course. If you fail to demonstrate competencies in a particular area through organized class activities (tests & assignments), you may have to complete additional work (i.e. remediation) in that area before a passing grade can be assigned.

Instructor Expectations The following are a few points related to my expectations of students enrolled in this course.  Commensurate with graduate education, I expect that students will take full responsibility for their own learning. That means, students need to be able to gather information and problem solve in an independent manner. If some course material is unclear, consult other resources (see below) and student colleagues. If that does not work, come see me. I am very willing to help students get through rough patches. However, I also want to see they have made an honest effort to solve their problem on their own first.  Students are expected to come to class prepared and ready to discuss the day’s topic. This is necessary for at least two reasons. First, material comes at a very brisk pace and this approach will prevent you from getting behind. Second, the quality of meetings depends on student participation. An unprepared student cannot contribute to the learning environment.  Time does not permit all material to be formally covered in lecture. However, students are responsible for material covered in readings. Students must use their own judgment (i.e. common sense) about where they should focus their studies.

Attendance and Punctuality Since we only meet once per week, class attendance is paramount. Class attendance will be taken under consideration if a student is requesting additional assistance with course material and when making decisions about borderline grading situations. Lectures begin promptly at 9:00 am. SPPA 6400 Voice Disorders Accommodation for Disabilities To assure compliance with the Americans with Disabilities Act, faculty members at Western Michigan University need to know how a disability will impact student participation and work in courses. Any student registered with Disability Services for Students who would like to discuss accommodations for this class should contact the instructor of record in a timely manner. Students with documented disabilities who are not registered with DSS should call the office at (269) 387-2116 or visit wmich.edu/disabilityservices. Students cannot request academic accommodations without scheduling an appointment and meeting with a DSS staff member. If a student does not register with DSS, their academic accommodations/modifications cannot be executed.

Academic Integrity You are responsible for making yourself aware of and understanding the policies and procedures in the Graduate Catalog (pp. 26-29) that pertain to Academic Integrity. These policies include cheating, fabrication, falsification and forgery, multiple submissions, plagiarism, complicity and computer misuse. If there is reason to believe you have been involved in academic dishonesty, you will be referred to the Office of Student Judicial Affairs. You will be given the opportunity to review the charge(s). If you believe you are not responsible, you will be given the opportunity for a hearing. You should consult with me if you are uncertain about an issue of academic honesty prior to the submission of an assignment or test. SPPA 6400 Voice Disorders Course Content

Course Description From the graduate handbook…Organic, neurologic, and functional disorders of the larynx are studied in depth.

Knowledge and Skills The specific competencies that will be evaluated in this course are listed with the goals of the course above. This course will contribute to the development of your knowledge and skills in the following areas (see also the KASA Summary Form for Speech-Language Pathology for more details). Standard III-A. Knowledge of the principles of Biological Sciences; Social and Behavioral Sciences Standard III-B. Knowledge of Basic Human Communication Processes. Biological, acoustic, psychological, developmental/lifespan, linguistic, cultural. Knowledge of swallowing processes. Biological, developmental, psychological. Standard III-C. Demonstrate knowledge of the nature of speech, language, hearing, and communication disorders. Articulation, voice and resonance, receptive and expressive language, hearing, swallowing. Standard III-D. Knowledge of the principles and methods of prevention, assessment, and intervention. Articulation, voice and resonance, receptive and expressive language, hearing, swallowing

Broad Course Objectives  Describe the basic structure and function of the normal and disordered vocal mechanism  Outline clinical and instrumental approaches to voice assessment  Be able to differentially diagnose specific classes of voice disorders based on clinical and instrumental findings  Describe behavioral treatments for specific classes of voice and laryngeal disorders  Outline medical, and surgical treatment options available for specific classes of voice disorders  Understand the importance of a multidisciplinary approach to the management of voice disorders

Detailed Learning Objectives  Describe the basic structure of the larynx including skeletal, muscular, neurological and laryngoscopic anatomy.  Describe phonatory behavior from biomechanical, aerodynamic and acoustic perspectives.  Describe the relationship of the various subsystems in the production of voice.  Describe what Stemple refers to as the etiologic correlates of voice disorders.  Outline the categories that comprise the Classification Manual for Voice Disorders.  Know the prevalence of voice disorders and who is at greatest risk for developing a voice disorder.  Differentiate between a voice disorder, a resonance disorder and speech disorder.  List the professionals that may be involved in the management of voice disorders.  Contrast the different types of information collected by an otolaryngologist vs. an SLP  Describe in detail the range of symptoms associated with voice disorders.  Outline, describe and provide a rationale for the key components of a case history.  Outline, describe and provide a rationale for the key components of the clinical examination process including the oral-peripheral exam, the auditory perceptual evaluation of voice, and self-report indices of vocal dysfunction.  Employ the CAPE-V method of auditory perceptual evaluation of voice.  Briefly describe the key components of various laryngeal imaging systems.  Identify key anatomical structures in a laryngoscopic image.  Have some familiarity with the range of dimensions evaluated in a stroboscopic examination.  Describe selected acoustic methods and measures relevant to voice evaluation.  Describe key aerodynamic methods and measures used to evaluate voice disorders.  Briefly describe the principles of electroglottography (EGG).  Briefly describe the principles of laryngeal electromyography (EMG).  Outline the range of vocal misuse, phonotrauma and laryngeal irritants and their presumed effect on the vocal folds.  Differentiate common lesions of the vocal folds based on appearance and presumed etiology.  Differentiate between hygienic, symptomatic, psychogenic, physiologic and eclectic categories of voice therapy.  Briefly describe, and provide well-reasoned arguments for the range of treatment approaches for voice disorders secondary to common vocal fold lesions.  Outline in detail the key clinical features of laryngopharyngeal reflux. SPPA 6400 Voice Disorders  Discuss the challenges of identifying laryngopharyngeal reflux.  Provide a description of treatment options for voice disorders secondary to laryngopharyngeal reflux.  Outline in detail the key clinical features of muscle tension dysphonia.  Describe the evaluation procedures for identifying muscle tension dysphonia.  Describe the range of treatment options for muscle tension dysphonia.  Explain the diagnostic and therapeutic value of circumlaryngeal techniques in the management of elevated musculoskeletal tension.  Outline the role of personality/psychological factors with muscle tension dysphonia and other voice disorders.  Outline the key signs and symptoms of the various forms of spasmodic dysphonia.  Describe the processes involved in the differentially diagnosis of the subtypes of spasmodic dysphonia from each other and from muscle tension dysphonia.  Provide a thorough description of treatment options and considerations for spasmodic dysphonia.  Describe the basic neurology of the larynx.  Outline signs and symptoms associated with different peripheral nerve damage.  Provide a thorough description of treatment options and considerations for vocal fold paresis and paralysis.  Provide brief, but accurate descriptions of the general surgical approaches to improve glottic closure.  Describe vocal signs and symptoms associated with Parkinson’s Disease (PD).  Provide an overview of contemporary treatment for voice disorders associated with PD.  Outline the key signs and symptoms that differentiate paradoxical vocal fold motion from asthma.  Demonstrate knowledge of treatment options and considerations for paradoxical vocal fold motion.  Outline some of the basic assessment and treatment considerations with transgendered voice.  Describe some common congenital laryngeal disorders.  Differentiate the anatomical characteristics of the infant and adult larynx.  Describe typical voice problems in the pediatric population.  Discuss key issues related to treating youngsters with voice disorders.  Describe the special considerations related to managing the professional voice user.  Describe the current state of the field with regard to treatment outcomes in voice disorders.  Provide a rationale and outline for broad spectrum voice treatments such as vocal function exercises and resonant voice therapy.  Develop rational treatment plans across the spectrum of voice disorders discussed in the course.  Most important, you should be able to integrate the material covered in the course for the purposes of clinical problem solving. SPPA 6400 Voice Disorders Course Outline Topic Date (approx.) Reading I. Preliminaries (not directly covered in Feb 24 Stemple et al. 2 lecture)  Laryngeal Anatomy  Laryngeal Physiology I. Introduction to Voice Disorders Mar 2  Introduction to voice disorders Stemple et al. 3, 4 (73-78)  Prevalence of voice disorders Williams (2003) Occupational Medicine 53, 456-460. II. Assessment  Clinical Assessment Mar 2 Stemple et al. 5  Instrumental Assessment Mar 16 Stemple et al. 6 III. The Spectrum of Voice Disorders A. Misuse/Phonotrauma Mar 16  Vocal misuse/phonotrauma Stemple et al. 3  Pharmacologic agents & irritants  Common vocal fold lesions Stemple et al. 4 (72-85, 111-112)  Treatment Approaches Stemple et al. 5 (204-267) B. Laryngopharyngeal reflux (LPR) Mar 23 Stemple et al. 4 (88-89) 7 (269-71)  Clinical Features Ford (2005) JAMA  Treatment C. Functional/Muscle Tension Dysphonia Mar 23,30 Stemple et al. 4 (99-100), 7 (243-252)  Clinical Features Roy (2003) Current Opinion in Otolaryngology  Treatment  Psychological Factors and Voice D. Neurogenic voice disorders Stemple et al. 4 (100-111), 7 (271-283) i. Spasmodic dysphonia Mar 30, Apr 6 Pearson & Sapienza (2003) Neurorehabilitation, 18, 325-338  Clinical Features Ludlow et al. (2008) Otolaryngology-Head & Neck Surgery 139, 495-505  Treatment ii. Paresis/paralysis Apr 6 Rubin & Sataloff (2007) Otolaryngology Clinics of North America 40 1109–1131  Clinical Features  Treatment iii. Selected CNS disease: Parkinson’s Apr 6 Stemple et al. 7 (267-268) Disease  Treatment E. Paradoxical vocal cord dysfunction Apr 13 Stemple et al. 4 (113-114), 7 (252-253)  Clinical Features Mathers-Schmidt, BA (2001) AJSLP 10, 11-125.  Treatment Sandage & Zelazny (2004) LSHSS F. Selected Populations  Special Considerations for Apr 13 Ruddy & Sapienza (2004) LSHSS children Lee et al. (2004) LSHSS  Gender Reassignment Apr 20 Stemple et al. 7 (238-239) Pausewang Gelfer (1999) AJSLP 8, 201-208.  Professional voice Apr 20 Stemple et al. 8 Schneider & Sataloff (2007) Otolaryngology Clinics of North America