Mr. Juan Lopez, a 70-year-old retired pilot for the U.S. Air Force, was recently diagnosed with amyotrophic lateral sclerosis during a visit to his medical institution, due to concerns about noticeable facial weakness and difficulty swallowing. The speech-language pathologist at the medical institution reported that the patient demonstrated dysarthria characterized by hoarseness, weak voice, and hypernasality. Mr. Lopez was referred to your office as an outpatient for services concerning preservation of verbal communication as well as options for augmentative communication devices in the future.
During the intake interview, you noted Mr. Lopez’s hoarse vocal quality, hypernasality, and imprecise articulatory movements. Also evident was vocal weakness characterized by low volume. The client’s wife asserted that her husband demonstrates evident vocal tiredness during conversation, and his hoarse vocal quality appears to be worsening. During the interview, Mr. Lopez needed to pause at non-junctural points in an utterance in order to replenish his breath supply.
Using acoustic instrumentation, you obtained Mr. Lopez’s speaking fundamental frequency. Average SFF during conversation was 168 Hz, well above the average for a healthy male of Mr. Lopez’s age. Jitter, shimmer, and HNR values during sustained vowel /a/ were 2.5 percent, 2.3 dB, and 1.4 dB, respectively. Maximum phonational frequency range was 0.76 octaves. Average intensity during connected speech was 46.8 dB.
1. In addition to the acoustic measures mentioned above, what other instrumental measures might be helpful in evaluating the client’s vocal function? Provide a rationale for each additional measure.
2.What are possible causes for the increased noise evident in Mr. Lopez’s vocal output?
3.Would it be beneficial to construct a voice range profile for Mr. Lopez? Why or why not?
4.Given your knowledge of the relationship between frequency and amplitude capabilities of the human phonatory system, how would a voice range profile differ for Mr. Lopez compared to a healthy speaker of his age and sex?
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