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- Welcome, my friends, to the "Bob and Brad Podcast."
My name is Mike Kienitz, I'm a PT assistant,
and today I'm accompanied by...
- Bob Schrupp.
- This guy over here.
Today we're interviewing Sierra Corbin,
who is a speech language pathologist from Oregon.
Is that how she said it?
- Oregon, right.
- We were saying it wrong. She corrected us.
She also has a YouTube channel called Sierra Speech,
where she offers free speech video programs.
So if you wanna work on your speech at all,
you can go check it out there.
So without further ado, here's Sierra.
Okay, we're gonna start talking
about improving your voice after a stroke.
- Okay.
- So can you talk
about the three common diagnoses after a stroke?
- Sure. Yeah.
Well, first of all, improving your voice
after a stroke when there's been some sort
of assault to your brain,
that can affect your voice just like it affects
the rest of your body and muscle.
- Oh, yeah.
- 'Cause there's a lot of different parts
of our brain that have to do with voicing and speech.
And one thing I wanted to share was a video stroboscopy,
because no matter what's happened
with a change in your voice,
you want to get an imaging study
in order to figure out what to work on.
- I see.
- So while I'm pulling that up,
I can say that the most common voicing deficits
are a change in pitch,
so your range,
usually the higher pitches, and vocal quality.
So it can be breathy, strained.
Can you see my screen?
- Yep. I can see it.
- Yep, there we go.
- This is a typical voice,
so not after a stroke.
We're looking at the vocal chords,
and this is a video stroboscopy.
So we're seeing them move in slow motion.
- [Instructor] Tiny resonating muscles called vocal chords.
They're about the size of a dime
in a woman and about the size of a nickel in a man.
Your vocal chords vibrate very quickly,
120 to 240 times per second in conversation.
The human eye can't track that.
- Okay. So when they popped open, they were breathing,
and when they were vibrating slowly,
that was them phonating.
And you can see
that they're symmetrical,
they've got a nice wave.
The structures around the vocal chords aren't coming in
and taking over.
Everything looks really good.
So you would use an imaging study to figure out
what the deficits are for voice.
- I see.
- So you could work on relaxation potentially.
We have semi occluded vocal tract exercises
with things like straws,
where you're creating, literally by occluding the air,
it has nowhere to go.
So you create a back pressure in your throat
and that kind of releases the muscles,
working on respiration to get better support.
Things like that, depending on the need for the voice.
- So you yourself look at that test,
or get the results?
- So people's first stop,
and this is if they're even diagnosed.
So if you go in for an inpatient stay with a stroke,
hopefully your doctor realizes there's a change
in your voice and refers an SLP to you.
And hopefully they recognize that you have a voice change.
If you don't have an inpatient stay,
hopefully your outpatient or home health person
will recognize that you have a voice change.
But as you can imagine,
this isn't diagnosed enough, especially post-intubation.
People might say, "Oh you'll just have a horse voice
for a little while."
So first off is usually an ENT, ear, nose and throat doctor,
and they will take the same type of little camera
and look at your vocal chords.
The thing to think about, though,
and this is in the blog posts that I wrote about,
is that most ENTs are generalists,
and they don't do extra training for voice disorders.
So if possible, trying to find a laryngologist,
someone who's a voice expert, and has the strobe light.
Most ENTs don't have a strobe light.
So they're just seeing your vocal cords with the naked eye.
Are they coming together?
Do they have cancer?
- Sure.
- Things like that.
So anywho, hopefully you get yourself
to someone who has stroboscopy,
and that could be an SLP.
I do not do it myself.
I contract someone to do it for me.
And then if you're going to get therapy,
same thing with speech pathologists.
We graduate as generalists,
and so ask them if they have experience
with voice disorders.
- Perfect.
- Yeah.
And as to your question about different diagnoses
post-stroke, so there's voice which we just talked about.
Aphasia is a language disorder,
where depending on where the lesion was or lesions,
you can have a change in receptive language,
which is understanding
what people are saying or writing, or signing,
expressing language, so using words.
And there's a lot of different types of aphasia.
They're basically fluent or non-fluent.
Do you have a lot of speech coming out
or a little bit of speech coming out?
And that can affect, again, reading, writing, sign language,
not just your oral communication.
And then dysarthria, speech disorder
where the muscles themselves aren't able to execute
what you need them to do.
So you can have slurred speech, inaccurate placements,
things like that, weakness,
and apraxia, which is a motor programming disorder, where-
- Like coordination?
- Like coordination, exactly.
Yeah. The information gets jumbled.
So physically, all your muscles are working just fine.
- They're strong.
- But you don't know what to do with your mouth.
- Sure.
- Which diagnosis can someone typically see
the most progress in?
- Hmm.
- Or does it vary?
- It totally varies.
I mean, you can be severe or mild in all of these areas.
And you can have all of them
or two of them. - Wow.
- Or only one of them.
So that's why a speech pathology assessment is really key,
'cause we are the ones who pinpoint what the problem is,
and that informs our therapy on what to do for it.
- Do you want to mention your YouTube channel for us?
- Yeah. Yeah, yeah.
So I created an online voice program for folks
who just want to change the way that they sound,
and it works on all of those things we talked about today,
but in greater detail,
and it has specific exercises,
and it is backed up by the research and the evidence,
and the science that...
- Supports it.
- Supports, Motor change, sorry.
Sorry, that supports,
again, I have an 18 month old.
I don't sleep very well.
- Yeah, understood.
- So it uses dosage and specificity and all of those things,
but it's really simple to understand and to do.
And it's super fun.
I even brought on a friend who is a professional singer
to do some of the modeling, and yeah.
It's on my YouTube channel.
- How long is it?
- I want to say the videos themselves
are about two hours,
but they're in little videos,
so you can pick and choose which ones you want to do.
- I see.
- Yeah, and it's totally free
to anybody who wants to improve their voice.
There's a PayPal link if you want to support it.
- And your channel is called Sierra Speech on YouTube?
- Yep.
- We'll link that for everyone watching this episode
and listening. - Sure.
- Thank you.
- All right.
Well, is there anything else we can do for you?
- Yep, I was so happy to get to do this.
Thank you so much. I love your channel.
- Well, we love you.
- (laughs) Thank you.
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