Classification Manual for Voice Disorders-I: Vol. 1

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Polski English Login or register account. Abstract The study's objectives were to investigate 1 the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, 2 the distribution of these variables by diagnosis, and 3 the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress Perceived Stress Scale , anxiety, and depression Hospital Anxiety and Depression Scale in a cohort of new patients presenting to a voice clinic. Data are presented on patients with muscle tension dysphonia MTD , benign vocal fold lesions, paradoxical vocal fold movement disorder PVFMD , or glottal insufficiency.

Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, Patients with PVFMD had the most frequent occurrence—and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety.

More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large.

Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals. Authors Close. Assign yourself or invite other person as author. It allow to create list of users contirbution.

Assignment does not change access privileges to resource content. Wrong email address. You're going to remove this assignment. Are you sure? Yes No. Thus, it shares the same merits and demerits as the physiological and topographic classifications as earlier discussed.

According to the Edinburgh classification [ 9 ], there are six subtypes of CP namely hemiplegia, bilateral hemiplegia, diplegia, ataxic, dyskinetic and other forms of CP including mixed forms. This classification is a combination of classifications based on topography and physiology and so has the same advantages and shortcomings as the topographic and physiologic classifications.

The SCPE [ 10 ] classifies CP into the following four subtype groups: spastic bilateral and unilateral , dyskinetic dystonic and choreoathetotic , ataxic, and non-classifiable. This grouping also combines the physiological and topographic classifications. These terms are bilateral and unilateral used to describe involvement of both sides and one side of the body, respectively.


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By this classification, spastic quadriplegia and spastic diplegia are classified as bilateral spastic CP BS-CP while spastic hemiplegia is termed unilateral spastic CP. This classification is easy to apply and is more reliable than the earlier traditional classifications. Therefore, by improving the reliability of the terms used in the topographic component of this classification, the SCPE currently seems to be the best traditional classification for description of patients with CP.

However, the SCPE classification [ 10 ] does not include functional abilities and so does not aid therapy for patients with CP. Hence, this classification currently has not had a similar level of advocacy as the functional classifications. Currently, functional classification of each case of CP is internationally advocated due to its important role in management. They are basically ordinal scales to categorize functional abilities or severity of limitation of activity and are not used as outcome measures, tests or assessments [ 14 , 30 ].

They are simple and easy to apply both by healthcare professionals and care givers and are good for clinical use and patient stratification for research purposes [ 5 , 11 , 30 ]. They have been validated by studies [ 12 , 13 , 15 ] and shown to be objective and reliable clinical classification systems for CP. They have replaced previously used imprecise and subjective functional classifications of CP into mild, moderate and severe.

Their development resulted from the paradigm shift from a focus on body structure and function impairment-based assessments and treatments to current emphasis on activity or participation function and social engagement [ 3 , 4 , 5 ]. These concepts are contained in the ICF [ 3 ]. The ICF is a new classification system for health and disease that is universal for everybody not only people with disabilities [ 3 ].

It is a new way to consider health conditions and posits an interactive relationship between health conditions and contextual factors environmental and personal factors in which all components are linked together [ 3 , 4 ]. It represents a coherent view of health from biological, individual and social perspectives a biopsychosocial approach to health, functioning and disability [ 4 ].

The ICF model has been used to guide clinical thinking and service delivery to patients with CP [ 4 ].

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This conceptual change introduced by the ICF is topical. The functional classifications are analogous and when used together complete the description of daily functional activities in CP at the activity or participation level of the ICF [ 3 , 30 ]. This is the most widely used clinical functional classification of CP [ 1 ]. Reproduced with permission. A major goal in the management of CP is to ambulate the children and enable independent living; this gave birth to the changing concepts and the GMFCS.

Pathological Voice Analysis and Classification Based on Empirical Mode Decomposition | SpringerLink

A child on GMFCS level I will walk independently and so requires no adaptive mobility equipment but appropriate stimulation. Thus, a hand-held mobility device may be provided initially for the child on level II. Therefore, the management of patients on GMFCS levels I and II would focus on appropriate stimulation, preventing complications from occurring and treatment of accompanying impairments.

The management is multidisciplinary depending on the nature and number of accompanying impairments. Nevertheless, GMFCS level III is usually classified as ambulatory because the child is independently mobile in some settings irrespective of the need for assistive mobility device. This need or use of adaptive mobility equipment is acceptable current thinking [ 5 ]. In addition to multidisciplinary care, the child on GMFCS level IV requires initially a body support walker that supports the pelvis and trunk for floor and chair sitting and later powered mobility and a manual wheelchair for transportation outdoors, at school, and in the community.

The management of a child on GMFCS level V involves pervasive supports and a manual wheelchair for transportation in all settings physical assistance at all times [ 11 ]. The children on level III require some assistance and sometimes adaptive equipment for independent handling of objects. Children on level IV require continuous assistance and adaptive equipment while those on level V need total assistance. It classifies everyday communication performance of an individual with CP into five levels ranging from effective communication in all settings level I to ineffective communication even with familiar partners level II.

The categorization of the effectiveness of current communication is based on the performance of sender and receiver roles, the pace of communication, and the type of conversational partner. In ascertaining the current level of communication, the CFCS aptly considers and includes use of all methods of communication. This implies that it describes both use of normal verbal and non-verbal communication speech, gestures, behaviors, eye gaze, and facial expressions and use of augmentative and alternative communication systems AACs manual sign, pictures, communication books, communication boards and talking devices such as speech generating devices and voice output communication aids [ 16 ].

The five-level scale classifies the safety and efficiency of eating and drinking while the three-level scale classifies level of assistance required to bring food and drink to the mouth.

Speech Therapy for Children with Voice Disorders

The five-level scale is based on the range of food textures eaten, the presence of cough and gag when eating or drinking, and the control of movement of food and fluid in the mouth. The three-level scale is categorized into independent, requires assistance, and dependent for eating and drinking.

Thus, the EDACS ranges from independent ability to safely and efficiently eat and drink like peers on a wide range of textures level I to total dependence for eating and drinking and reliance on tube feeding level V [ 17 ]. Reproduced with permission [17]. The final goal of a managing doctor and the final hope of a patient and his family is an ambulatory self-dependent individual.

Using the functional classifications to guide management helps the pediatrician, the occupational therapist, the physiotherapist, the speech and language therapist and all involved in the care of children with CP to achieve this goal. For instance, the GMFCS is used to ascertain the requirements for ambulation appropriate for the age of the child and gross motor functional abilities while the MACS helps ascertain appropriate upper limb interventions for independent performance of activities of daily living.

It helps identify those that will require augmentative and alternative communication systems to improve their communication.

Classification Manual for Voice Disorders-I

Therefore, in simplistic terms, these current classifications tell us what to do to the child with CP. A summary of all groups of classifications is shown in Tables 1 , 2 , 3. The development of a standardized or holistic classification of CP is topical and in tandem with advances in understanding of CP, imaging techniques and quantitative motor assessments [ 1 ]. Currently, there are obvious limitations with categorization of neuroimaging findings and identifying specific causes of CP.

Therefore, as we await comprehensive and acceptable neuroanatomic and etiologic classifications, the minimum acceptable multiaxial classification of CP for both developed and developing countries should include: Classification of motor abnormalities according to SCPE. The classification by SCPE provides enough clinical descriptive information about children with CP while the supplemental and functional classifications are useful for management and service delivery. The use of the functional scales in clinical context to aid management and in research is in accordance with current thinking and the reconceptualization of the management of CP.

Each classification system used in CP has its merits and shortcomings. Therefore, the clinical classification of CP needs to use many axes to be comprehensive. Currently, it must include the functional scales so as to guide management. The neuropathologic classification is being awaited, and due to its contribution to the assessment of etiological factors and timing of insults in CP, it is critical to the development of a holistic or standardized classification of CP. I am grateful to Professor Sylvester O.

Thanks too to my beautiful wife Mrs. Linda Chigozie Ogoke for all her support during the period of writing up of this book chapter. Licensee IntechOpen.

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