1. NEUROGEnic voice disorders 2

2. TOpics Flaccid Dysarthria（无力型） Hypokinetic Dysarthria（运动功能减退型）
Vocal Fold Paralysis
Cricothyroid Muscle Paralysis
Bilateral Vocal Fold Paralysis
Unilateral Vocal Fold Paralysis
Hypokinetic Dysarthria（运动功能减退型）
Parkinson’s Disease

3. Flaccid Dysarthria

4. Flaccid Dysarthria Cause/etiology
Bilateral or unilateral damage to specific cranial nerves
At their nuclei in the brain stem
Somewhere along their extracranial route to the speech sub system muscles that they innervate

5. Flaccid Dysarthria Symptoms (damage to peripheral nervous system)
Flaccid paralysis
Reduced force of muscle contraction（肌肉收缩力量减小）
Reduced range of motion（运动范围减小）

6. Vocal fold paralysis

7. Vocla fold paralysis A kind of Flaccid Dysarthria patient
Cause/etiology
Damage to the cranial nerve Ⅹ
The type and extent of dysphonia depends on
The lesion site
Bilateral or unilateral
Partial or complete

8. 1、cricothyroid Muscle Paralysis
Cause/etiology
Mostly viral infection of SLN
Bilateral or unilateral
Function of cricothyroid
Tensing of the VF
Elevation of picth
VF adduction

9. 1、cricothyroid Muscle Paralysis
Sign
A slight rotation of the invovled VF
A slight bowing of the invovled VF
Typical voice symptoms
Inability to elevate or lower pitch
Some breathiness – bowing

10. 1、cricothyroid Muscle Paralysis
Treatment
Medicine
Corticosteriods and antivirtal agents
Surgery
Selective reinnervation of the cricothyroid muscle
Thyroplasty

11. 2、bilateral VF Paralysis
Cause/etiology
Lesions in the trunk of the vagus nerve
Lesions at the nuclei of origin in the medulla
Neonatal stridor 新生儿喉喘鸣（common reason in children）

12. 2、bilateral VF Paralysis
Types and symptoms
Adductory - neither VF can move to midline
Making phonation impossible
At risk for aspiration（误吸）
Abductory - the VFs remain at the midline
Serious respiratory problems
tracheostomy

13. 2、bilateral VF Paralysis
Treatment – for continued bilateral VF paralysis
Tracheostomy – greater airway competence
Surgical reinnervation of VFs
Unilateral removal of one arytenoid - more anterior glottal closure
Electrical stimulation to the posterior cricoarytenoid muscle
Laser surgery - decrease open glottal space for bilateral adductor fold paralysis

14. 3、uilateral VF Paralysis (uvfp)
Cause/etiology
Damage to one side of RLN
Disease
Trauma - surgical trauma (most common reason)
Location
Left UVFP is more common
The routes of the left and the right RLN are different

17. 3、uilateral VF Paralysis (uvfp)
Mechanism
Damage to one side of RLN
Poor Larygeal adductor muscles (麻痹不能调节自身的张力等因素)
Paralyzed fold in paramedian position
Neither fully abducted nor adducted (声门不能完全闭合或开放)

18. 3、uilateral VF Paralysis (uvfp)
Neither fully abducted nor adducted
Breathy
Short phonation time
Poor Larygeal adductor muscles
Pitch breaks
Diplophonia
Hoarsness
Excessive supraglottal constriction
Symptoms

19. 3、uilateral VF Paralysis (uvfp)
Treatments
Traumatic UVFP can have spontaneous recovery with the first 9-12 months postonset
Behavioral voice therapy
Permanent corrective procedures

20. 3、uilateral VF Paralysis (uvfp)
Behavioral voice therapy
Half-swallow boom
Head positioning
Tuck-chin
Digital manipulation
Focus
Tongue protursion /i/
Yawn-sigh
Pitch shift up
Inhalation phonation

21. 3、uilateral VF Paralysis (uvfp)
Permanent corrective procedures
Paralyzed VF injection
Teflon
Fat - reabsorbed
Facial tissue
Thyroplasty
Rectangular window
Micrometric screw （微动螺丝）
Reinnervating the paralyzed VF
Phrenic nerve (膈神经)
Section of SLN and hypoglossus nerve

22. uVFP before & after Surgery (Teflon Injection)

23. Hypokinetic Dysarthria

24. Hypokinetic Dysarthria
Cause/etiology
Problem with the effect of neurotransmitter dopamine on the activities of the basal ganglia
Depletion（损耗过多）
Functional reduction（功能减退）
Symptoms
Rigidity, slow movement - bradykinesia
Limited range of motion
Resting tremor

25. Parkinson’s Disease

26. Parkinson’s Disease (PD)
98% hypokinetic dysarthrias are of the Parkinson’s type
Symptoms
Reduced loudness
Breathy voice
Monotony of picth
Intermittent rapid rushes of speech
Soft production of consonants

27. Parkinson’s Disease (PD)
Treatments
Task
Quick conversational pattern
Mechanism
Rapid and accelerated movement of the articulators
Results
Speech is unintelligible

28. Parkinson’s Disease (PD)
Treatments
Speak with intent
Louder
slower
Better voice quality
Better articulation

29. Parkinson’s Disease (PD)
Treatments
LSVT (Lee Silverman Voice Treatment)
Increase VF adduction
Respiratory effort
PLVT (Pitch limiting Voice Treatment)
Increase respiratory support
Phonation at a low pitch
DAF (delayed auditory feedback)
Instrumental procedure

30. Its all for today!