SLP - Speech-Language Pathology Voice, Resonance, and Motor Speech Questions and Answers — Questions and Answers
Question 1: A 45-year-old female teacher presents with a chief complaint of a 'choppy' and 'effortful' voice that worsens with stress. During assessment, the SLP notes a strained-strangled vocal quality with intermittent voice breaks, particularly on voiced sounds. The patient reports her voice sounds normal when she whispers or laughs. This clinical presentation is most characteristic of which voice disorder?
- Muscle Tension Dysphonia (MTD)
- Adductor Spasmodic Dysphonia (ADSD) (Correct answer)
- Vocal Fold Paralysis
- Abductor Spasmodic Dysphonia (ABSD)
Correct answer: Adductor Spasmodic Dysphonia (ADSD)
Adductor Spasmodic Dysphonia (ADSD) is a neurological voice disorder characterized by involuntary spasms of the adductor laryngeal muscles, causing the vocal folds to slam together and stiffen. This results in the classic strained-strangled, effortful vocal quality with voice breaks described in the scenario. [4, 8] Symptoms are typically absent during non-speech acts like whispering or laughing. [4, 11] Abductor spasmodic dysphonia presents with a weak, breathy voice, while MTD is a functional disorder, and paralysis would likely present with consistent breathiness or diplophonia.
Question 2: An SLP is evaluating a child with a history of a repaired cleft palate. The most prominent and consistent perceptual speech characteristic associated with velopharyngeal insufficiency (VPI) is:
- Hyponasality on nasal consonants
- Cul-de-sac resonance
- Hypernasality on vowels and voiced oral consonants (Correct answer)
- Weak vocal intensity
Correct answer: Hypernasality on vowels and voiced oral consonants
Hypernasality is the most common and defining perceptual feature of velopharyngeal insufficiency (VPI). [5, 23] It is caused by the inability of the soft palate to properly close against the back of the throat, allowing excessive nasal resonance during the production of sounds that should be oral, such as vowels and voiced consonants. [5] Hyponasality is the opposite (too little nasal resonance), and cul-de-sac resonance results from a blockage, not insufficient closure.
Question 3: A 68-year-old male is referred for a motor speech evaluation following a cerebellar stroke. His speech is characterized by irregular articulatory breakdowns, distorted vowels, excess and equal stress on all syllables (scanning speech), and dysdiadochokinesia. His speech sounds similar to someone who is intoxicated. Which type of dysarthria is the most likely diagnosis?
- Spastic Dysarthria
- Flaccid Dysarthria
- Hyperkinetic Dysarthria
- Ataxic Dysarthria (Correct answer)
Correct answer: Ataxic Dysarthria
Ataxic dysarthria is directly associated with damage to the cerebellum. [16, 20] The hallmark features are motor incoordination affecting speech, resulting in irregular articulatory breakdowns, prosodic excess (excess and equal stress), and a 'drunken' quality of speech. [13] These characteristics distinguish it from the strained quality of spastic dysarthria, the breathy weakness of flaccid dysarthria, or the involuntary movements of hyperkinetic dysarthria.
Question 4: The Lee Silverman Voice Treatment (LSVT LOUD) is a widely used, evidence-based intervention, particularly for individuals with Parkinson's disease. What is the single, core therapeutic target of this program?
- Improving articulatory precision
- Eliminating vocal tremor
- Increasing vocal loudness (Correct answer)
- Enhancing respiratory support
Correct answer: Increasing vocal loudness
The fundamental principle of LSVT LOUD is to focus on a single target: increasing vocal loudness ('Think Loud!'). [2, 7] This intensive program uses this single goal to trigger a cascade of improvements in other areas of speech production, including better breath support, articulation, and intonation, by recalibrating the patient's perception of their own vocal effort. [3, 6, 7]
Question 5: During respiration for life-sustaining purposes, the vocal folds must open to allow air to pass through the glottis. Which intrinsic laryngeal muscle is solely responsible for vocal fold abduction?
- Lateral Cricoarytenoid
- Thyroarytenoid
- Posterior Cricoarytenoid (Correct answer)
- Interarytenoid
Correct answer: Posterior Cricoarytenoid
The posterior cricoarytenoid (PCA) is the only intrinsic laryngeal muscle that abducts (opens) the vocal folds. [1, 10, 18] Its contraction pulls the muscular processes of the arytenoids medially, which in turn moves the vocal processes laterally, opening the glottis. All other intrinsic laryngeal muscles are primarily involved in adduction (closing) or adjusting the tension of the vocal folds. [1, 17]
Question 6: An SLP in a school setting wants to perform a quick, low-tech screening for nasal air emission, a common correlate of hypernasality. Which of the following is the most appropriate method?
- Using a nasometer to calculate a nasalance score
- Placing a small mirror under the nares during production of pressure consonants (Correct answer)
- Conducting a videofluoroscopic swallowing study
- Requesting a nasopharyngoscopy by an otolaryngologist
Correct answer: Placing a small mirror under the nares during production of pressure consonants
Placing a small mirror under the nares (nostrils) while the client produces oral pressure-sensitive consonants (like /p/, /t/, /k/, /s/) is a classic, low-tech method to detect nasal air emission. [19, 25] Fogging on the mirror indicates that air is escaping through the nose, suggesting potential velopharyngeal dysfunction. Nasometry, videofluoroscopy, and nasopharyngoscopy are all instrumental assessments that are more complex than a simple screening.
SLP - Speech-Language Pathology Voice, Resonance, and Motor Speech Questions and Answers
A 45-year-old female teacher presents with a chief complaint of a 'choppy' and 'effortful' voice that worsens with stress.
During assessment, the SLP notes a strained-strangled vocal quality with intermittent voice breaks, particularly on voiced sounds.
The patient reports her voice sounds normal when she whispers or laughs.
This clinical presentation is most characteristic of which voice disorder?