SLP CONCEPTUAL TOPICS

1. Receptive and expressive language

2. Articulation syndrome
3. Genie Willy documentary
4. Cerebral palsy
5. General Case History form
6. PMV chart
7. ICWs (Information carrying words)
8. Anticipation examples
9. Activities to improve pre-speech skills
10. Cranial nerves
11. Paralysis and paresis
12. Asperger’s syndrome
13. Autism spectrum disorder
14. Tracheostomy
15. Naming problem (memory loss: AMNESIA DISORDER)
16. SOAP (Subjective, Objective, Assessment & Plan) notes
17. MTD

❖ BRIEF EXPLANATION:

Receptive Language:

• Definition: Receptive language refers to the “input” of language—the ability

to understand and comprehend spoken or written language.
• Examples:
o Listening and following directions (e.g., “put on your coat”).
o Understanding what gestures mean.
o Answering questions.
o Identifying objects and pictures.
o Reading comprehension.
o Grasping the plot of a story.
• Development: Typically, children understand language before they can produce
it. Exposure to language, quality of the language environment, and individual
differences in language processing influence receptive language development.
Expressive Language:

• Definition: Expressive language is the “output” of language—the ability

to express wants and needs through verbal or nonverbal communication.
• Examples:
o Speaking sentences.
o Using gestures.
o Writing.
o Expressing emotions.
o Conveying thoughts and ideas.
• Development: Children gradually learn to express themselves using words
and other forms of communication

Speech Sound Disorders (Articulation disorders):

• Definition: Speech sound disorders refer to difficulties in producing speech

sounds correctly. Two common types are:
o Articulation Disorder: In this disorder, an individual has
difficulty physically producing specific speech sounds. For example, they
may struggle with pronouncing certain consonants or vowels.
o Phonological Disorder: This disorder involves patterns of sound errors. It
affects the rules governing sound patterns in a language. Children with
phonological disorders may substitute one sound for another consistently
(e.g., saying “wabbit” instead of “rabbit”).
• Development: Most children can say almost all speech sounds correctly by the
age of 4. If a child does not achieve this, they may have a speech sound disorder.

Treatment: Speech-language pathologists work with individuals to improve their

articulation and phonological skills

Genie Wiley: The Feral Child:

• Introduction: Genie Wiley’s life was marked by extreme isolation and deprivation.
Since birth, she experienced nothing but silence from her parents. At the tender
age of two, her father took a drastic step and hid her away from the world. She
grew up in isolation, confined to a room with no communication or interaction.
• Challenging Conditions: Genie spent days tied to a toilet or crib, without speaking
or being spoken to. When she was discovered at the age of 13, she had the
appearance of a 7-year-old and struggled to walk and speak properly.
• Therapeutic Efforts: Therapists worked tirelessly to help Genie recover from
years of abuse and confinement. However, despite their efforts, she was never
able to fully regain her lost abilities.
 • Legacy: Genie’s case remains a haunting reminder of the impact of extreme
social isolation on human development. Her story sheds light on the critical role
of language exposure and interaction during early childhood.
• Documentaries: Several documentaries have explored Genie’s life:
o TLC Documentary (2003): This documentary delves into Genie’s
experience, revealing the profound effects of her isolation. Scientists and
physicians studied her as part of the “Developmental Consequence of
Extreme Social Isolation” project from 1971 to 1975

Cerebral palsy (CP):

o refers to a group of movement disorders that typically appear in early

childhood.
o It is caused by damage to the developing brain, often occurring before
birth.
o Symptoms can vary widely, ranging from mild to severe.
• Symptoms:
o Poor Coordination: Individuals with CP may exhibit poor coordination, stiff
muscles, weak muscles, and tremors.
o Sensory Issues: Problems with sensation, vision, hearing, and speaking
can also occur.
• Causes:
o Brain Development Abnormalities: CP results from abnormalities or
disruptions in brain development.
o Possible causes include:
▪ Genetic Mutations: Changes in genes.
▪ Infections During Pregnancy: Such as herpes, rubella, or
chickenpox.
▪ Risk Factors:
▪ Fetal stroke or disrupted blood supply to the fetal brain.
▪ Infections or inflammation affecting the fetal brain.
▪ Head injuries during infancy.
▪ Reduced oxygen supply during labor.
▪ Premature birth.
• Complications:
o Contractures (muscle shortening).
o Epilepsy or seizures.
o Visual or hearing impairments.
o Malnutrition due to eating difficulties.
o Depression and social isolation.
o Breathing difficulties.
o Early onset of osteoarthritis.
• Diagnosis:
o Physical Examination: Doctors assess symptoms and medical history.
 o Imaging: MRI and cranial ultrasound help identify brain abnormalities.
o Electroencephalogram (EEG): Detects seizures.
o Laboratory Tests: Screen for genetic or metabolic disorders.
• Treatment Options:
o Medications: Muscle relaxants (e.g., Botox injections) to manage
spasticity.
o Orthopedic Surgery: For contractures.
o Selective Dorsal Rhizotomy: Cutting nerves causing spastic muscles.
o Therapies:
▪ Physical Therapy: Strength, balance, and mobility exercises.
▪ Occupational Therapy: Adaptive strategies for daily activities.
▪ Speech and Language Therapy: Improving communication skills.
▪ Recreational Therapy: Enhancing motor skills and emotional well-
being.
• Prevention:
o Vaccination against infectious diseases before pregnancy.
o Regular prenatal care.

Remember, early intervention and supportive care play a crucial role in improving the
quality of life for individuals with cerebral palsy.

General Case History form:

Place Manner Voice Chart, which is a valuable tool used in speech pathology to
categorize speech sounds based on their place of articulation, manner of articulation,
and voicing. Here’s a breakdown of each component:

1. Place of Articulation:
o Definition: The place of articulation refers to where in the mouth a sound
is produced.
o Examples:
▪ Labial: Involves the lips (e.g., /p/, /b/, /m/).
▪ Coronal: Made primarily with the front of the tongue (e.g., /t/, /d/,
/n/).
▪ Dorsal: Produced by the back of the tongue (e.g., /k/, /g/, /ŋ/).

2. Manner of Articulation:
o Definition: The manner of articulation describes how a sound is made.
o Examples:
 ▪ Stops/Plosives: Complete closure and release of airflow (e.g., /p/,
/b/, /t/, /d/).
▪ Fricatives: Narrowing of airflow causing friction (e.g., /f/, /v/, /s/,
/z/).
▪ Affricates: Combination of stops and fricatives (e.g., /ʧ/ as in
“church,” /ʤ/ as in “judge”).
▪ Nasals: Airflow through the nasal cavity (e.g., /m/, /n/, /ŋ/).

3. Voicing:
o Definition: Voicing refers to the vibration of the vocal folds during sound
production.
o Examples:
▪ Voiced: Vocal folds vibrate (e.g., /b/, /d/, /g/).
▪ Voiceless: No vocal fold vibration (e.g., /p/, /t/, /k/).

ICWs:

Information-Carrying Words (ICWs) and their levels. These words play a crucial role in
language development and communication. Here’s a breakdown:
1. What Are Information-Carrying Words (ICWs)?:
o Definition: ICWs are words in a sentence that carry meaning and are
essential for understanding instructions or directions.
o They allow us to assess a child’s language comprehension independently
of visual cues or context.
2. Determining ICWs:
o Context Removal: To evaluate a child’s understanding, we remove any
external clues (gestures, context) and focus solely on the words in the
instruction.
o Alternative Choices: An ICW must have an alternative word that the child
could choose. Each ICW should have a comparable alternative.
o Example Activities:
▪ 1 ICW Level: “Where’s the ball?” The intonation pattern signals that
this is a question. The ICW here is “ball”.
▪ 2 ICW Level: “Put the ball on the table.” In this sentence, the words
“put” and “on the” are redundant. The ICWs are “ball” and “table”.

Remember, understanding ICWs helps us tailor interactions and support language

development effectively

Anticipation:

Anticipation in speech-language pathology refers to the feeling a person gets when they
know something is about to happen. This skill is often developed through games and
activities that have a predictable and fun ending. Here are some examples:
 1. Peek a Boo: You can place your hands over your eyes/face and say “where am I?”
a couple of times to build excitement. Then, remove your hands suddenly and
say “boo!”1.
2. Round and Round the Garden: Trace the palm of your child’s hand with your
finger in a circle, while saying the following rhyme “Round and round the garden
like a teddy bear”. Then start to walk your fingers up the child’s arm as you say
the next lines “one step, two step… And a tickly under there!”1.
3. Horse Ride on Your Lap: There are various rhymes you can use, as you jiggle
your child up and down on your knees1.
These games help children learn vital skills such as waiting, watching, closely observing
facial expressions, and listening to voices. They also help children understand more
about the future and how to predict what might happen next1.

Activities to improve pre-speech skills:

activities that can help improve pre-speech skills:

1. Animal Jam: Say phrases like “A cow goes ‘moo’”, “A duck says ‘quake’”, "A
chicken goes ‘cluck’"1. This helps your baby recognize the names of common
animals along with their unique sounds1.
2. Sound Stories: Make reading fun by adding facial expressions, voice inflections,
sound effects, and animal sounds1. This enriches your baby’s language
development1.
3. Talk Back: When your baby communicates with you, start talking back1. If your
baby coos, coo back1. Babies learn through imitation1.
4. Use Singable Books: Strengthen verbal skills2.
5. Recite Favorite Fingerplays2.
6. Use a Telephone in the Dramatic Play Area2.
7. Create Story Baskets: Encourage preschoolers to retell stories2.
8. Play an I-Spy Game: Encourages language participation2.
Remember, every child is unique and may progress at their own pace. If you have
concerns about your child’s speech and language development, it’s always a good idea
to consult with a speech-language pathologist3.

Cranial Nerves:

1. Olfactory nerve (CN I): Responsible for the sense of smell1.

2. Optic nerve (CN II): Enables vision1.
3. Oculomotor nerve (CN III): Controls most of the eye movements and pupil
constriction1.
4. Trochlear nerve (CN IV): Controls the superior oblique muscle, which is
responsible for downward, inward, and lateral movements of the eye1.
 5. Trigeminal nerve (CN V): It is responsible for facial sensation and controlling the
muscles of mastication (chewing)1.
6. Abducens nerve (CN VI): Controls the lateral rectus muscle, which is responsible
for outward movement of the eye1.
7. Facial nerve (CN VII): Controls facial expressions and provides a sense of taste
in the anterior two-thirds of the tongue1.
8. Vestibulocochlear nerve (CN VIII): Responsible for hearing and balance2.
9. Glossopharyngeal nerve (CN IX): It is involved in taste, swallowing, and the
secretion of saliva2.
10. Vagus nerve (CN X): It is involved in the control of the heart, lungs, and digestive
tract2.
11. Accessory nerve (CN XI): Controls the sternocleidomastoid and trapezius
muscles, which are responsible for movements of the head and the shoulders2.
12. Hypoglossal nerve (CN XII): Controls the movements of the tongue

Sensory Cranial Nerves:

1. Olfactory nerve (CN I): Responsible for the sense of smell1.

2. Optic nerve (CN II): Enables vision1.
3. Vestibulocochlear nerve (CN VIII): Responsible for hearing and balance1.

Motor Cranial Nerves:

1. Oculomotor nerve (CN III): Controls most of the eye movements and pupil
constriction1.
2. Trochlear nerve (CN IV): Controls the superior oblique muscle, which is
responsible for downward, inward, and lateral movements of the eye1.
3. Abducens nerve (CN VI): Controls the lateral rectus muscle, which is responsible
for outward movement of the eye1.
4. Accessory nerve (CN XI): Controls the sternocleidomastoid and trapezius
muscles, which are responsible for movements of the head and the shoulders1.
5. Hypoglossal nerve (CN XII): Controls the movements of the tongue1.

Mixed Cranial Nerves (Both Sensory and Motor):

1. Trigeminal nerve (CN V): It is responsible for facial sensation and controlling the
muscles of mastication (chewing)1.
2. Facial nerve (CN VII): Controls facial expressions and provides a sense of taste
in the anterior two-thirds of the tongue1.
3. Glossopharyngeal nerve (CN IX): It is involved in taste, swallowing, and the
secretion of saliva1.
4. Vagus nerve (CN X): It is involved in the control of the heart, lungs, and digestive
tract1.
Each of these nerves has a specific role in the sensory and motor control of the head
and neck.

cranial nerves that are primarily involved in speech and articulation:

1. Trigeminal nerve (CN V): It provides motor control for the muscles of
mastication, which are necessary for articulation1.
2. Facial nerve (CN VII): It controls the muscles of facial expression, some of which
are used in articulation1.
3. Glossopharyngeal nerve (CN IX): It is involved in the control of the pharyngeal
muscles, which are important for speech production1.
4. Vagus nerve (CN X): It provides motor control for the heart, lungs, and digestive
tract, but also plays a key role in speech by controlling the muscles of the larynx
(voice box), pharynx, and soft palate1.
5. Accessory nerve (CN XI): It controls the sternocleidomastoid and trapezius
muscles, which can influence respiration and head position during speech1.
6. Hypoglossal nerve (CN XII): It controls the movements of the tongue, which is
crucial for articulation1.

These nerves work together to coordinate the complex movements necessary for
speech production

definitions and differences between paralysis and paresis:

Paralysis: is a condition that refers to a complete loss of muscle function in one or
more muscles of the body due to damage to the central nervous system1. The damage
can be caused by a variety of factors, including stroke, trauma, infection, or
degenerative diseases1. Paralysis can affect only one limb (monoplegia), one side of the
body (hemiplegia), the legs and lower trunk (paraplegia), or both arms and both legs, as
well as the torso (quadriplegia)1.

paresis : condition that involves a partial loss of muscle strength or

control1.Unlike paralysis, paresis does not involve a complete loss of movement in the
affected muscles1. Paresis is often caused by damage to the motor cortex of the brain
or the nerves that control muscle movement1. Paresis can affect one side of the body
(hemiparesis), the legs (paraparesis), or all four limbs (quadriparesis)1.
The main difference between paralysis and paresis is the extent and severity of muscle
weakness. Paralysis involves a complete loss of movement in the affected muscles,
whereas paresis involves a partial loss of muscle strength or control12. Another
difference between the two conditions is the location of the damage1
Asperger’s syndrome:
Asperger’s Syndrome, now diagnosed under the umbrella of Autism Spectrum Disorder
(ASD), is a neurodevelopmental condition that affects a person’s ability to interact and
communicate effectively123.
Symptoms of Asperger’s Syndrome include123:

• Difficulty in assessing others’ feelings and “reading” other people

• Exaggerated facial expressions and gesture usage
• Aggressive behavior
• Poor muscle coordination
• Depressive mood
• Problems understanding humor
• Inability to perceive gestures
• Lack of social awareness
• Sensitivity to noise, touch, odor, or tastes
• Repetitive motor patterns

Treatment for Asperger’s Syndrome is usually multidisciplinary and can include145:

• Behavioral and educational interventions

• Medications like Haloperidol, Risperidone for anger outbursts, oppositional
behavior, aggressiveness, repetitive movements, tics
• Social skills training
• Speech and language therapy
• Cognitive behavior therapy

Role in Speech and Language: People with Asperger’s Syndrome often show no delays
in their overall language development (e.g., grammar skills and vocabulary), but can
have trouble using language in a social context6. They may have trouble with literal vs
figurative speech, handling sarcasm, and figures of speech can be confusing7. Their
speech patterns are also often different, making them confusing for their peers7. They
may have different modulations in tone and voice than someone without ASD7. They
may also find it challenging to start new conversations or enter into a conversation
that’s already happening7. These issues are largely related to difficulty perceiving social
cues7.
Speech therapy can help teach people on the spectrum strategies and tools that can
help with that emotional regulation7. It can increase the individual’s awareness of the
world around them and also their social understanding7.
Remember, every individual is unique and may not exhibit all these symptoms or
respond to treatments in the same way
Autism Spectrum Disorder (ASD):
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects a
person’s ability to interact and communicate effectively123.
Symptoms of ASD include123:

• Difficulty in social interaction and communication

• Restricted or repetitive behaviors or interests
• Challenges with understanding and using gestures
• Difficulty in maintaining conversations
• Sensitivity to changes in routine or environment

Treatment for ASD is usually multidisciplinary and can include4567:

• Behavioral and communication therapies

• Educational therapies
• Social skills training
• Speech and language therapy
• Cognitive behavior therapy
• Medications for related symptoms like depression, seizures, insomnia, and
trouble focusing

Role in Speech and Language: People with ASD often show no delays in their overall
language development (e.g., grammar skills and vocabulary), but can have trouble using
language in a social context1. They may have trouble with literal vs figurative speech,
handling sarcasm, and figures of speech can be confusing1. Their speech patterns are
also often different, making them confusing for their peers1. They may have different
modulations in tone and voice than someone without ASD1. They may also find it
challenging to start new conversations or enter into a conversation that’s already
happening1. These issues are largely related to difficulty perceiving social cues1.
Speech therapy can help teach people on the spectrum strategies and tools that can
help with that emotional regulation1. It can increase the individual’s awareness of the
world around them and also their social understanding1.
Remember, every individual is unique and may not exhibit all these symptoms or
respond to treatments in the same way

Tracheostomy:
A Tracheostomy (also known as a tracheotomy) is a medical procedure that involves
creating an opening in the neck in order to place a tube into a person’s trachea, or
windpipe123. The tube may be temporary or permanent2. It’s inserted through a cut in the
neck below the vocal cords that allows air to enter the lungs1. Breathing is then done
through the tube, bypassing the mouth, nose, and throat2. The hole in the neck that the
tube passes through is commonly known as a stoma2.
A tracheostomy is performed when an adult or child has a condition that makes normal
breathing difficult or impossible4. It may be performed during an emergency when your
airway is blocked2. It could also be performed when a health condition or other issue
makes regular breathing impossible2. Conditions or situations that may require a
tracheostomy include: the need for prolonged respiratory or ventilator support,
congenital abnormalities of the airway, airway burns from the inhalation of corrosive
material, obstruction of the airway by a foreign object, obstructive sleep apnea, injury to
the larynx, also known as the voice box, severe neck or mouth injuries, bilateral vocal
cord paralysis, facial burns or surgery, chronic lung disease, anaphylaxis, coma, cancers
that affect the head and neck, infection2.
After creating the tracheostomy opening in the neck, surgeons insert a tube through it
to provide an airway and to remove secretions from the lungs
Naming problem:

Amnesia is a condition characterized by the inability of a person to recall facts or

previous experiences.
Symptoms of Amnesia include:

• Inability to remember past events or activities

• Inability to learn new information
• Confabulation (the brain subconsciously invents false memories to fill in memory
gaps)
• Disorientation

Treatment options for Amnesia include:

• Most amnesia patients usually recover without treatment, but the disease must
be managed if there are any underlying conditions1.
• No medication is available for amnesia management1.
• Occupational therapy: Intervenes and helps patient learn how to recover
memories1.

Role in Speech and Language: Amnesia, by definition, results from impairment of

memory functions, not impairment of other functions (e.g., attention, motivation,
reasoning, language), which may cause similar symptoms6. However, it’s important to
note that while amnesia primarily affects memory, it can indirectly impact speech and
language. For example, a person with amnesia might struggle to find the right words
during conversation because they can’t recall them (a phenomenon known as anomia).
They might also repeat themselves or have trouble following along in conversation
because they can’t remember what has been said. In severe cases, a person with
amnesia might even forget language skills that they once knew.

SOAP NOTES:
The Subjective, Objective, Assessment and Plan (SOAP) note is an acronym representing a
widely used method of documentation for healthcare providers. The SOAP note is a way for
healthcare workers to document in a structured and organized way.
This widely adopted structural SOAP note was theorized by Larry Weed almost 50 years ago. It
reminds clinicians of specific tasks while providing a framework for evaluating information. It
also provides a cognitive framework for clinical reasoning. The SOAP note helps guide
healthcare workers use their clinical reasoning to assess, diagnose, and treat a patient based on
the information provided by them. SOAP notes are an essential piece of information about the
health status of the patient as well as a communication document between health professionals.
The structure of documentation is a checklist that serves as a cognitive aid and a potential index
to retrieve information for learning from the record.

Function
Structure
The 4 headings of a SOAP note are Subjective, Objective, Assessment and Plan. Each heading is
described below.
Subjective
This is the first heading of the SOAP note. Documentation under this heading comes from the
“subjective” experiences, personal views or feelings of a patient or someone close to them. In the
inpatient setting, interim information is included here. This section provides context for the
Assessment and Plan.
Chief Complaint (CC)
The CC or presenting problem is reported by the patient. This can be a symptom, condition,
previous diagnosis or another short statement that describes why the patient is presenting today.
The CC is similar to the title of a paper, allowing the reader to get a sense of what the rest of the
document will entail.
• Examples: chest pain, decreased appetite, shortness of breath.
However, a patient may have multiple CC’s, and their first complaint may not be the most
significant one. Thus, physicians should encourage patients to state all of their problems, while
paying attention to detail to discover the most compelling problem. Identifying the main problem
must occur to perform effective and efficient diagnosis.
History of Present Illness (HPI)
The HPI begins with a simple one line opening statement including the patient's age, sex and
reason for the visit.
• Example: 47-year old female presenting with abdominal pain.
This is the section where the patient can elaborate on their chief complaint. An acronym often
used to organize the HPI is termed “OLDCARTS”:
• Onset: When did the CC begin?
• Location: Where is the CC located?
• Duration: How long has the CC been going on for?
• Characterization: How does the patient describe the CC?
• Alleviating and Aggravating factors: What makes the CC better? Worse?
 • Radiation: Does the CC move or stay in one location?
• Temporal factor: Is the CC worse (or better) at a certain time of the day?
• Severity: Using a scale of 1 to 10, 1 being the least, 10 being the worst, how does the
patient rate the CC?
It is important for clinicians to focus on the quality and clarity of their patient's notes, rather than
include excessive detail.
History
• Medical history: Pertinent current or past medical conditions
• Surgical history: Try to include the year of the surgery and surgeon if possible.
• Family history: Include pertinent family history. Avoid documenting the medical history
of every person in the patient's family.
• Social History: An acronym that may be used here is HEADSS which stands for Home
and Environment; Education, Employment, Eating; Activities; Drugs; Sexuality; and
Suicide/Depression.
Review of Systems (ROS)
This is a system based list of questions that help uncover symptoms not otherwise mentioned by
the patient.
• General: Weight loss, decreased appetite
• Gastrointestinal: Abdominal pain, hematochezia
• Musculoskeletal: Toe pain, decreased right shoulder range of motion
Current Medications, Allergies
Current medications and allergies may be listed under the Subjective or Objective sections.
However, it is important that with any medication documented, to include the medication name,
dose, route, and how often.
• Example: Motrin 600 mg orally every 4 to 6 hours for 5 days
Objective
This section documents the objective data from the patient encounter. This includes:
• Vital signs
• Physical exam findings
• Laboratory data
• Imaging results
• Other diagnostic data
 • Recognition and review of the documentation of other clinicians.
A common mistake is distinguishing between symptoms and signs. Symptoms are the patient's
subjective description and should be documented under the subjective heading, while a sign is an
objective finding related to the associated symptom reported by the patient. An example of this is
a patient stating he has “stomach pain,” which is a symptom, documented under the subjective
heading. Versus “abdominal tenderness to palpation,” an objective sign documented under the
objective heading.
Assessment
This section documents the synthesis of “subjective” and “objective” evidence to arrive at a
diagnosis. This is the assessment of the patient’s status through analysis of the problem, possible
interaction of the problems, and changes in the status of the problems. Elements include the
following.
Problem
List the problem list in order of importance. A problem is often known as a diagnosis.
Differential Diagnosis
This is a list of the different possible diagnosis, from most to least likely, and the thought process
behind this list. This is where the decision-making process is explained in depth. Included should
be the possibility of other diagnoses that may harm the patient, but are less likely.
• Example: Problem 1, Differential Diagnoses, Discussion, Plan for problem 1 (described
in the plan below). Repeat for additional problems
Plan
This section details the need for additional testing and consultation with other clinicians to
address the patient's illnesses. It also addresses any additional steps being taken to treat the
patient. This section helps future physicians understand what needs to be done next. For each
problem:
• State which testing is needed and the rationale for choosing each test to resolve
diagnostic ambiguities; ideally what the next step would be if positive or negative
• Therapy needed (medications)
• Specialist referral(s) or consults
• Patient education, counseling
A comprehensive SOAP note has to take into account all subjective and objective information,
and accurately assess it to create the patient-specific assessment and plan.
MTD (Muscle Tension Dysphonia):

Muscle Tension Dysphonia (MTD) is a voice disorder that is characterized by excessive

muscle tension in and around the voice box, which can prevent the voice from working
efficiently1.
Symptoms of MTD include:

• Voice that sounds rough, hoarse, gravelly, or raspy

• Voice that sounds weak, breathy, airy, or is only a whisper
• Voice that sounds strained, pressed, squeezed, tight, or tense
• Voice that suddenly cuts out, breaks off, changes pitch, or fades away
• Voice that “gives out” or becomes weaker the longer the voice is used
• Pitch that is too high or too low
• Pain or tension in the throat when speaking or singing
• Feeling like the throat is tired when speaking or singing

Treatment for MTD primarily includes1:

• Voice therapy with a speech-language pathologist to reduce throat tension and

maximize vocal efficiency
• Treatments that aid in tension release, such as massage, acupuncture,
psychotherapy, or physical therapy, at the same time you are receiving voice
therapy

Role in Speech and Language Pathology: MTD can cause disrupted phonation due to
overactive laryngeal musculature3. It is diagnosed by a thorough clinical history and
laryngoscopic visualization of the vocal cords and supra-glottic region3. Vocal hygiene
and voice therapy are the foundations of MTD treatment with concomitant medical
therapy when indicated3. Speech-language pathologists play a crucial role in diagnosing
and treating MTD. They help patients learn to use their voice more comfortably in order
to speak or sing without strain.

ABDUL SABOOR