the positive and negative effects of watching reality TV discussion question 1: What might be some of the positive and negative effects of watching reality

the positive and negative effects of watching reality TV discussion question 1: What might be some of the positive and negative effects of watching reality TV?question 2: Why do you think people are so fascinated with virtual reality games?this is for a beginner english class so it needs to be simple. Each question needs to be on a separate sheet Part 1 – Speech Breathing Clinical Application Scenario:
Read the following scenario – Take notes on questions you may have (See last page)
Answer the trigger questions below in your group after researching topics in trigger or
questions you have – You can divide the questions among your group if you wish A female college student, aged 20, suffered cervical spinal cord lesion (C6) secondary
to snowmobile accident resulting in quadriplegia with very limited movement of arms.
She hoped to get a service dog to assist her with daily activities. Her social worker
expressed concern about whether she could or could not control a dog because her
voice was so soft. Her neurologist made a referral to a SLP with a request to
determine her potential to increase the power of her voice.
Auditory/Perceptual examination revealed problems with reading aloud,
extemporaneous speaking and conversational speaking. Her speech was low in
loudness, characterized by short breath groups (typically 4 syllables each) and
interspersed with relatively slow inspirations. Her speech phrasing was abnormal and
voice trailed off and became inaudible towards the ends of her expirations. She could
not increase her loudness much, could not generate heavily stressed syllables, and
could not increase the lengths of her speech expirations. She tired with speaking for
more than a couple of minutes and needed to take frequent breaks while conversing to
“c_a_t_c_h_ _h_e_r_ _b_r_e_a_t_h_”._ _Her conversational style was low keyed and
gave the impression that she lacked energy.
Physical examination revealed paralysis of the abdominal wall and severe Paresis
(weakness) of the rib cage wall for both inspiration and expiration. Neck muscle
function and diaphragm function were intact. During forced inspiration, the intercostal
spaces were sucked inward and the upper rib cage wall moved inward (paradoxically).
She required trunk support to maintain an upright body position. The abdominal wall
was distended and the rib cage wall was positioned low. Forced expiration was weak,
as was her cough. Her inspiratory capacity was 0.90 L, and expiratory reserve volume
was 0.04L 35% and 3% of their predicted values. She failed a screening of alveolar
pressure for speech production (criterion 5cmH2O for 5 seconds). Impairment of
respiratory function rated as moderate to severe and impairment of expiratory function
was rated as severe to profound.
Trigger 1: How would you explain factors (anatomically and physiologically) that
affect breathing for speech and loudness control to the patient and/or family members
(assume they do not have a SLHS major or minor background)?
Trigger 2: What interventions (SLP or other) do you think will allow her to inspire
deeper and more forcefully to increase her loudness and phrase length?
Trigger 3: How would instrumentation aid in providing therapy and or measuring
progress for increased loudness and/or speech breathing capacity to this patient?
PROBLEM QUESTION: Her neurologist made a referral to a SLP with a request to
determine her potential to increase the power of her voice. What would be your
response to the patient regarding the question raised by the social worker? Do you
anticipate she is capable of increasing her loudness? Justify your answer and provide
specific interventions and/or instrumental measures that led you to your conclusion
SCENARIO REFERENCE SOURCE: Hixon, T., Weismer, G. and Hoit, J. (2014)
Preclinical Speech Science: Anatomy, Physiology, Acoustics, Perception 2nd Edition.
p. 8
Key words:
• Hoarseness
• Difficulty being heard
• Pitch breaks
• Deterioration of voice quality
• Bilateral vocal fold nodules
• Improve vocal hygiene before medical intervention
Consider:
• More detailed and more clear explanation of what is happening to her voice and voice
quality
• Will it affect her job?
• Long term implications to vocal quality
Trigger 1: How would you explain factors (anatomically and physiologically) the
relationship of vocal fold physiology on vocal registers and vocal quality?
Speech is created through a complicated process in the respiratory, phonational
and articulatory systems. In short, when we start to begin a word or a sentence, air
travels through our larynx. Our larynx houses the vocal folds, therefore when air goes
through the larynx the folds are forced open and shut rapidly enough to create
vibrations within your throat. These vibrations create the sound waves that are turned
into speech through the many articulators within the vocal tract such as our tongue,
palates, lips, teeth, etc.
The shape, size, tension and speed in which the vocal folds vibrate affect the
pitch at which we speak. This is why males characteristically have lower voices, due to
thicker and larger vocal folds, while females have a higher speaking voice because their
folds generally have less mass. Furthermore, by shifting in shape and size, the vocal
folds allow us to speak in three different vocal registers. The first register, and the one
that we most commonly use, is the modal register. The second is our pulse register,
which is very low tones that result in a crackly voice quality. This can sometimes cause
damage if it’s used too often. The third and final is our falsetto register, characterized by
very high notes.
Any compromise or change to the vocal folds and/or their vibration can cause
hoarseness, breathiness, roughness or other dysfunctions related to vocal quality. Not
being able to completely adduct the vocal folds results in an audible escape of air,
creating breathy speech. If the folds are closing too tightly or too harsh, the voice comes
out tense and pressed. Obstacles created in the vocal tract can create a low, raspy
vocal quality, or roughness. Vocal fold stiffness from swelling or a combination of
roughness and breathiness is commonly referred to as a hoarse vocal quality. The vocal
registers can also be affected by the balance between the activity of the muscles within
the larynx, the balance between the opening and closing of the vocal folds, the amount
of vibration, and the shape of the vocal tract.
Finally, there are six factors that create what we perceive as a “normal” voice.
The first is your maximum frequency range. This is how high and low your pitch can
reach, and a lack of flexibility in this measure can result in speech that sounds
monotone. Second is your speaking frequency. As mentioned before, this is the
average rate at which your vocal folds vibrate and different people speak at higher and
lower pitches. Having a pitch that doesn’t correspond with your age, gender or size can
be considered abnormal. Third is your maximum phonation time. This is simply defined
as the length of time you can hold a sound (usually a vowel). This is usually about 15-25
seconds for an adult and 10 seconds for a child. Anyt hing significantly lower than this
can suggest a respiratory problem or blockages/obstacle in the airway. The fourth factor
is your minimum and maximum intensity. There should be a minimum variance of 20-30
decibels and anything less would suggest a problem or could also result in speech
sounding monotone. Periodicity of vibrations is the sixth factor. Each opening and
closing of the vocal folds is considered one cycle. These cycles generally take about the
same amount of time, making them mostly periodic. This factor measures jitter, which is
the measurement of variation in cycle duration. Jitter measures that are too high result
in a rough or hoarse sounding voice. The sixth and last factor is obstacles and
interference. As mentioned before, this can also cause voice qualities characterized as
breathy, hoarse or rough.
Trigger 2: How would instrumentation be used to collect baseline data on vocal
parameters?What are normal values? Describe what acoustic measures you need
to collect.
For this client, the first piece of instrumentation we would use would be a Visi
Pitch. For this client, it would be important to use the Visi Pitch to measure her
fundamental frequency, intensity, jitter, shimmer, and voice quality. For an adult female,
the average fundamental frequency is 180 to 250 Hz (textbook, 179). The average
intensity for conversation speech is between 65 and 80 dB SPL (textbook 183).
To examine the vocal folds, laryngoscopy should be considered. This process
involves using a fiberoptic scope to view the vocal folds while they are working through
the nasal passages. This will let the clinician know if the appearance of the vocal folds
are normal and if they are functioning properly.
https://voicefoundation.org/health-science/voice-disorders/overview-of-diagnosistreatment-prevention/laryngoscopystroboscopy/
http://web.nmsu.edu/~lleeper/pages/Voice/simpson/instrumentation.html
https://www.asha.org/public/speech/disorders/Vocal-Cord-Nodules-and-Polyps/
Interview Questions:
Recommendation: Is vocal hygiene an appropriate recommendation based on her
case history and instrumental examinations/data? Include a list of appropriate
Case History questions.

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