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Pathology Toolbox
San Diego, November
2014
Date:
For the surveys below, there are no right or wrong answers. When answering, please consider both how severe the
problem is when you get it and how frequently it happens.
1. VHI-10 Instructions: These are statements that many people have used to describe their voices and the effects of their
voices on their lives. Circle the response that indicates how frequently you had the same experience in the last 4 weeks.
My voice makes it difficult for people to hear me.
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always
Reference:; Rosen, C.A., Lee, A.S., Osborne, J., Zullo, T., & Murry, T., Development and validation of the Voice
Handicap Index-10, The Laryngoscope. 114, pp 1549-1556. (The validity and reliability of the VHI-10 has been
determined. The normal mean is 3.38; standard deviation is 5.65. Add up the points. A score of 10 or higher indicates
referral to SLP.
2. RSI Instructions: These are statements that many people have used to describe their voices and the effects of their
voices on their lives. Circle the response that indicates how frequently you had the same experience in the last 4 weeks.
0 = No problem
5 = Severe problem
Reference: Belafsky, P. C., Postma, G. N., & Koufman, J. A. (2002). Validity and reliability of the reflux
symptom index (RSI). J Voice, 16(2), 274-277, A score of 10 or high indicates a high suspicion of reflux disease and
medical referral.
3. CSI Instructions: These are statements that many people have used to describe their cough and the effects of coughing
on their lives. Please circle the response that indicates how frequently you had the same experience in the last 4 weeks. If
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always
Gartner-Schmidt J, Shembel A, Rosen CA, Zullo TG. Development and Validation of the Cough Severity Index (CSI): A
Severity Index for Chronic Cough Related to the Upper-Airway. Accepted for publication in Laryngoscope.
4. EAT-10: To what extent are the following scenarios problematic for you? Please circle the appropriate response.
0 = No problem
4 = Severe problem
Swallowing is painful.
Swallowing is stressful.
Date:________
Instructions: These are statements that many people have used to describe their
voices and the effects of their voices on their lives. Check the response that
indicates how frequently you have had the same experience within the past
month.
Statement
F1
My voice makes it
difficult for people to
hear me.
P2 I run out of air when I
talk.
F3
People have difficulty
understanding me in a
noisy room.
P4 The sound of my voice
varies throughout the
day.
F5
My family has difficulty
hearing me when I call
them throughout the
house.
F6
I use the phone less
often than I would like.
E7 Im tense when talking
with others because of
my voice.
F8
I tend to avoid groups
of people because of
my voice.
E9 People seem irritated
with my voice.
P10 People ask, Whats
wrong with your
voice?
F11 I speak with friends,
neighbors, or relatives
less often because of
my voice.
Statement cont.
F12 People ask me to
repeat myself when
speaking face-to-face.
P13 My voice sounds
creaky and dry.
P14 I feel as though I have
to strain to produce
voice.
E15 I find other people
dont understand my
voice problem
F16 My voice difficulties
restrict my personal
and social life.
P17 The clarity of my voice
is unpredictable.
P18 I try to change my
voice to sound
different.
F19 I feel left out in
conversations
because of my voice.
P20 I use a great deal of
effort to speak.
P21 My voice is worse in
the evening.
F22 My voice problem
causes me to lose
income.
E23 My voice problem
upsets me.
E24 I am less outgoing
because of my voice
problem.
E25 My voice makes me
feel handicapped.
P26 My voice gives out
on me in the middle of
speaking.
E27 I feel annoyed when
people ask me to
repeat.
Statement cont.
E28 I feel embarrassed
when people ask me
to repeat.
E29 My voice makes me
feel incompetent.
E30 Im ashamed of my
voice.
Compute a Z-score for the pts Total Score so you can interpret the impact
of the patients voice disorder on QOL.
Pt Total Score 8.75
14.97
Interpret the Patients z-score as follows: (negative values are WNL,
negative values mean no perception of handicap. Positive values indicate that
voice impairment has a negative impact on aspects of daily life).
Patient Z-score
0 to +1.00
+1.01 to +1.99
+2.00 to +2.99
Interpretation
No significant impact on aspects of daily life
Mild significant impact on aspects of daily life
Moderate significant impact on aspects of daily
life
+3.00 or greater
Severe significant impact on aspects of daily
life
If patient has a significant score, then also describe the physical, emotional, and
function contributions (from greatest impact to least). See report for Trish for an
example.
6
7
Very effective
ALS SPEAKERS
LISTENERS
*Rank Situation
*Rank
Situation
5.5
5.5
Speaking while
Speaking at a distance
Speaking at a distance
8.6
In a noisy environment
In a noisy environment
8.6
8.6
10
If you checked more than one item, your friend or family member probably has
problems with speech and communicating. Many of the problems revealed by
this survey can be improved with speech therapy. Talk to your doctor or health
care provided about referral to a speech language pathologist who specializes in
treatment with persons who have Parkinson Disease.
On the following page, place an X next to the lowest and highest note your patient achieves. Count the
number of semitones for his or her range (S column). Once you have the semitone range, use the
instructions to compute a z-score and then use normative table to interpret performance.
2
Note
C2
C2# / D2b
D2
D2# / E2b
E2
F2
F2# / G2b
G2
G2# / A2b
A2
A2# / B2b
B2
Semitones (S)
24
25
26
27
28
29
30
31
32
33
34
35
Frequencies (F)
65
69
73
77
82
87
92
98
103
110
116
123
C3
C3# / D3b
D3
D3#/ E3b
E3
F3
F3# / G3b
G3
G3# / A3b
A3
A3# / B3b
B3
36
37
38
39
40
41
42
43
44
45
46
47
130
138
146
155
164
174
185
196
207
220
233
246
C4
C4# / D4b
D4
D4# / E4b
E4
48
49
50
51
52
261
277
293
311
329
3
F4
F4# / G4b
G4
G4# / A4b
A4
A4# / B4b
B4
53
54
55
56
57
58
59
349
370
392
415
440
466
493
C5
C5# / D5b
D5
D5# / E5b
E5
F5
F5# / G5b
G5
G5# / A5b
A5
A5# / B5b
B5
C6
60
61
62
63
64
65
66
67
68
69
70
71
72
523
554
587
622
659
698
739
783
830
880
932
987
1046
highest note was ______ What is Fo? __________ What is semitone? ________
lowest note was ______ What is Fo? __________ What is semitone? __________
What is semitone range?
Compute pt z-score: [ Pt semitone range norm Mean (ST)]
[Norm SD (ST)]
Authors
Ramig & Ringel, 1983
Linville, 1987
No. of
Subjects
8
8
8
24
20
23
Gender
Age
Mean (ST)
SD (ST)
M
M
M
F
F
F
26-35
46-56
62-75
25-35
45-55
70-80
32.2
28.3
31.4
33.1
34.0
29.0
8.77
8.74
4.38
3.43
3.22
4.13
Values falling:
Between -1 sd and +1 sd
Between -1.1 and -1.99
Interpretation
Total Phonatory Range is within normal limits
(WNL)for sex and age
Total Phonatory Range is mildly restricted
-3.0 or beyond
+3.0 or beyond
Interpretation:
Sample write-up in a report: Maximum total phonational range was assessed by stimulating Ms. Patient to
produce phonation using her lowest and highest voice. Fundamental frequency (Fo) was measured using a Korg
Frequency Analyzer. Her lowest Fo was measured at 207 Hz and her highest Fo was measured at 415 Hz. This
indicates a total phonatory range of 12 semitones (z-score = > -3.0), which indicates a total phonatory range
that is severely restricted . Fo values were restricted for both high and low voice productions.
Males
Using the Figure below, plot the patients z-score for TPR
Functional Sentences
2. I'm fine.
7. I'm in a hurry.
48. Nevermind.
WORDS
Mine
Me
Moon
Men
Mom
Mail
May
Mall
One
Nine
Many
Mow
Newer
Meaner
Nanny
Normal
Marine
Mommy
Yummy
Yellow
PHRASES
Many men
Nine-one-one
Mow the lawn
My home
My mom
My room
My name
My son
One-one-one
My phone
No one
Never mind
Meet me
Lend me
No news
On the moon
Yummy yams
No nerve
Nelly knits
Roomy rambler
SENTENCES
Mary made me mad.
Maybe I can meet you at the mall at noon.
My mom made lemonade
No one found the money
No news is good news
Mom is a morning woman
Make many trips to town
Meet me at the mall
Meet me at the zoo
Meet me at the movies
Heeeeeeeeeeeeee
Haaaaaaaaaaaaay
Hooooooooooooo
Who is she?
Huuuuuuuuuuuuu
Hey there
Haaaaaaaaaaaaaa
Hey Joe
Hmmmmmmmmm
N
The opposite of yes is ___________________
The coin worth 5 cents is a _______________
The opposite of far is ___________________
Y
The opposite of no is ___________________
Another word for delicious is _____________
People knit with needles and _____________
The color of the sun is ___________________
The opposite of old is ___________________
The yellow part of the egg is the ___________
L
The opposite of short is __________________
When life gives you lemons, make ___________
When you wash your clothes, you do the ______
Communicating with
Parkinsons Disease
Tips for Individuals with Parkinsons
Disease and their Communication
Partners
Jessica Tellis B.A.& Kate Holden B.S.
Table of Contents
I.
II.
III.
IV.
V.
VI.
Speech Tutorial
VII.
Effective Response
Ineffective Response
Im not sure if I
caught all of that.
Did you say?
Caregiver gives a
thumbs up louder
cue
Caregiver gives PWP
ample time to finish
thought
Caregiver yells at
PWP or speaks very
loudly
Caregiver interrupts
PWP before he is
finished his thought
Caregiver interrupts
PWP or attempts to
finish their thought
PWP looks
uninterested or bored
due to reduced facial
expression
PWP is speaking
too quietly
Resources:
http://www.parkinsons.org.nz/books/parkinsonsandspeech.pdf
Ask the Doctor:
http://www.parkinson.org/Page.aspx?pid=255
Ask the Nutritionist:
http://www.parkinson.org/Page.aspx?pid=257
Ask the Speech-Language Pathologist:
http://www.parkinson.org/Page.aspx?pid=256