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Evaluation of Vocal Tremor

presented by Julie Barkmeier-Kraemer PhD

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Vocal tremor affects approximately 1/3 of individuals with Essential Tremor, Parkinson Disease, and Spasmodic Dysphonia. To date, the focus of treating these individuals has utilized localized injection of botulinum toxin (Botox®) into laryngeal musculature with mixed benefit. Recent work addressing vocal tremor speech science principles determined patterns that enable improved accuracy in identifying and characterizing vocal tremor patterns. Furthermore, speaking strategies were developed to reduce the opportunity of perceiving vocal tremor during speaking for those with mild to moderately severe vocal tremor. However, critical to the success of speech treatment for vocal tremor is a thorough evaluation including auditory-perceptual, acoustic, and laryngeal-pharyngeal imaging methods. The focus of this course is to summarize the background and principles behind clinical evaluation of vocal tremor for effective treatment planning.

Meet Your Instructor

  • Julie Barkmeier-Kraemer PhD, CCC-SLP

    Julie Barkmeier-Kraemer, PhD, CCC-SLP is a speech-language pathologist and professor in the Division of Otolaryngology, Clinic Director for the Voice Disorders Center, and Adjunct Faculty to the Communication Sciences and Disorders program at the University of Utah. Dr. Barkmeier-Kraemer received her M.A. and Ph.D. degrees from the Department of Speech Pathology and Audiology at the University of Iowa and completed postdoctoral work in the area of neurolaryngology with Dr. Christy Ludlow at the National Institutes of Health. Prior to joining the faculty at the University of Utah, Dr. Barkmeier-Kraemer served in the Department of Speech, Language, and Hearing Sciences faculty at the University of Arizona (1997-2011), after which she joined the Neuroscience Graduate Group as well as the Voice-Speech-Swallowing Center team in the Department of Otolaryngology at UC, Davis (2011-2014). She has served on several ASHA committees, including as a past coordinator for ASHA’s SIG 3: Voice and Voice Disorders, during which time she contributed to the development of the Consensus Assessment Protocol for Evaluation of Voice (CAPE-V) and the Classification Manual for Voice Disorders. She co-chaired the ASHA Annual Research Symposium on Neural Regeneration in 2009, served as ASHA’s representative to the AAOHNS Guidelines on Improving Voice Outcomes after Thyroid Surgery and the American Academy of Neurology’s working group for the development of the Essential Tremor Quality Measurement Set, and served on ASHA’s working group for the development of the Core Instrumental Voice Assessment Protocol completed in 2015. She has published numerous book chapters, one workbook, and several publications in scientific and educational journals related to her clinical and research interests in the neural controls of the larynx for respiration, voicing, and swallowing functions. In 2011, she was awarded Fellow of the American Speech-Language-Hearing Association in recognition of her contributions to the profession.

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Chapters & Learning Objectives

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  1. What is Vocal Tremor?

    1. What is Vocal Tremor?

    Understanding the characteristics of tremor, in general, and how the physiology of tremor manifests in vocal tremor is critical to clinical evaluation and treatment. This chapter will also define tremor, vocal tremor, and their classifications.

  2. Principles Behind the Evaluation of Vocal Tremor:  Overview and Auditory-Perceptual Evaluation

    2. Principles Behind the Evaluation of Vocal Tremor: Overview and Auditory-Perceptual Evaluation

    This chapter summarizes the research and scientific/clinical principles behind recommended procedures for evaluating vocal tremor using auditory-perceptual methods.

  3. Principles Behind an Acoustic Evaluation of Vocal Tremor

    3. Principles Behind an Acoustic Evaluation of Vocal Tremor

    This chapter summarizes the research and scientific/clinical principles behind recommended procedures for evaluating vocal tremor using acoustic methods. Clinical evaluations of fundamental frequency, sound pressure level, and formants one and two will be presented along with measuring articulation rate during connected speech samples.

  4. Principles Behind the Evaluation of Vocal Tremor:  Laryngeal-Pharyngeal Imaging

    4. Principles Behind the Evaluation of Vocal Tremor: Laryngeal-Pharyngeal Imaging

    This chapter summarizes the research and scientific/clinical principles behind recommended procedures for evaluating vocal tremor using laryngeal-pharyngeal imaging. Analysis of speech tasks during observation of the upper airway and its limitations will be presented.