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Voice disorder and Costa Rican preacher:

Raúl is a preacher originally from Costa Rica who relies heavily on his voice for his profession. He is the preacher of a primarily Latino church, and he himself provides Spanish-language sermons three times every week. Raúl is increasingly hoarse while delivering his sermons and asked the communication team through an interpreter if they could help him improve his voice so that he can attend to his congregation’s needs.

This case study centers around voice disorder and cultural background. What does a communication professional need to know to serve Raúl best?

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Hoarseness in Adults

The article, "Hoarseness in Adults," by House and Fisher (2017) discusses the causes, diagnosis, and treatment of hoarseness in adult patients. The authors define hoarseness as “any change in voice but more specifically refers to a coarse, rough, raspy, or strangled vocal quality” (House & Fisher, 2017). Hoarseness can be caused by a disturbance to any part of the vocal mechanism, including the vocal cords, larynx, and respiratory system. The article organizes the various pathologies into several categories: infections, benign vocal cord lesions, surgical trauma, and autoimmune diseases. The authors continue by explaining the steps in evaluating hoarseness. It is important to assess the patient’s vocal quality, speech effort, and signs of pain with speaking or swallowing. A thorough history must then be taken, focusing on the duration of symptoms, any associated symptoms, and potential risk factors, such as smoking and occupational voice strain. The article further details the treatment options for patients with hoarseness. Voice rest, vocal hygiene (avoiding irritants and alcohol, using a humidifier, controlling vocal volume, limiting large or spicy meals), voice therapy, and surgical interventions are recommended based on the etiology of the hoarseness. In conclusion, House and Fisher (2017) provide clear guidance for the evaluation, diagnostic, and management process for individuals experiencing change in their voice.

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An Evaluation of the Effects of Two Treatment Approaches for Teachers with Voice Disorders: A Prospective Randomized Clinical Trial

This article is important because it discusses teachers and voice disorders. We can correlate this to our case study because, despite Raul being a preacher and this article discussing teachers, both of these populations are considered public speakers. In this article, they discuss different issues a public speaker may experience due to prolonged use of their voice. Similarly to teachers, Raul, the preacher, may use his entire vocal mechanism for very long periods of time, which may lead to extreme strain. Even the possibility of picking up upper respiratory infections transferred in airborne environments is increased due to this extreme vocal use. This article discusses two ways treatment may be incorporated. One method is proper vocal hygiene, which includes reducing vocal behaviors causing phonotrauma, increasing hydration, and the amount/type of voice used. Another treatment option discussed involves vocal function exercises. These exercises work to strengthen and rebalance systems involved in voice production. Following these studies, the vocal function exercises reported a significant reduction in the mean voice handicap index.

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Exploring Culturally Responsive Voice Care: Introduction

The article "Exploring Culturally Responsive Voice Care: Introduction" examines the correlation between culture and voice care, emphasizing the importance of understanding cultural differences when providing voice care services. The introduction highlights the need for healthcare providers, particularly those working with vocal professionals (such as singers, teachers, or actors), to consider the diverse cultural backgrounds of their clients. The article notes that culturally responsive care should address physiological aspects of vocal health and recognize the cultural practices, values, and beliefs that shape how individuals use their voices.

The article stresses that cultural norms and traditions can impact how individuals perceive their voice and its care and the types of treatments or interventions they may prefer. Therefore, a culturally sensitive approach to voice care is crucial for ensuring that individuals receive care that is both effective and respectful of their cultural context. Overall, the introduction sets the stage for exploring how culture plays a significant role in voice care. It calls for healthcare providers to adopt a more inclusive, informed, and empathetic approach in their practices.

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ASHA Voices: Cultural Responsiveness Through Story and Self-Reflection (Podcast)

The ASHA Voices podcast episode, “Cultural Responsiveness Through Story and Self-Reflection” explores the importance of cultural responsiveness in the speech-language pathology profession. SLP and book editor, Alicia Hamilton joined the podcast to speak about the new book “Exploring Cultural Responsiveness: Guided Scenarios for Communication Sciences and Disorders Professionals.” Hamilton shares two stories from the book about cultural competence, which she describes as a “commitment of a lifetime” to develop. One story involves a little girl who was separated from her parents at the U.S./Mexico border and was put into foster care. She was considered behind in language development, but when assessed by a bilingual SLP, her language skills were found to be age appropriate. Hamilton continues by telling a story of an SLP graduate student who was penalized by her clinical supervisor for having an Spanish influenced English accent. The discussion of the book emphasizes three key points in fostering cultural responsiveness: story-telling as a tool, self-reflection, and practical strategies. In conclusion, the podcast episode encourages SLPs to take an active role in developing cultural responsiveness to provide appropriate and effective care to their patients.

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Characteristics of Communication in Population 

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Characteristics of Communication in Population 

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Latin culture communication is high-context, meaning a lot of messages are conveyed through body language and non-verbal cues. Conversations are often fast-paced and expressive. It’s important to consider these characteristics when building patient-client relationships in an SLP setting.

It is common for public speakers to report voice issues. These issues are extremely common in this population, so many will seek medical assistance. Some of the voice disorder characteristics a public speaker, such as a preacher, may experience include vocal strain, difficulty with clarity, dry mouth, and, over time, loss of voice. Additionally, they may experience issues with pitch or vocal fatigue, possibly even during continuing speech.

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Considerations for Speech, Language, or Hearing Intervention

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Considerations for Speech, Language, or Hearing Intervention

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Ensure that interventions are culturally appropriate, effective, and unique for the patient.

Incorporate culturally relevant material (Respect authority figures and understand the importance of family dynamics).

Be mindful of language variations within the Latino culture.

Values and beliefs.

Address any stigma associated with speech therapy or language difficulties within the Latino community.

Consider the patient’s lifestyle and medical history. Vocal therapy is crucial for high risk individuals such as public speakers. If the patient has previously not responded to medications, surgery may be needed.

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Considerations for Speech, Language, or Hearing Assessment

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Considerations for Speech, Language, or Hearing Assessment

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Make sure the assessment is inclusive (Accurately assess language skills in the correct language).

Be sensitive to cultural diversity/ differences.

Design the assessment to meet the patients' individual needs.

Including a translator from outside the client's family.

Accurately assess language skills in the client's primary language

Ethnographic interview the patient.

Never make assumptions about a client's cultural identity or needs. Inquire about their personal experiences.

Must take a thorough patient history, as the etiology of hoarseness may determine route for treatment and helps identify any potential risk factors.

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"Cultural responsiveness through story and self-reflection." ASHA Voices. (2021, January 21).

House, S. A., & Fisher, E. L. (2017). Hoarseness in Adults. American Family Physician, 96(11), 720–728.

Nelson, R., Gray, S. D., Simon, M., Dove, H., & al, e. (2001). An Evaluation of the Effects of Two Treatment Approaches for Teachers with Voice Disorders: A Prospective Randomized Clinical Trial. Journal of Speech, Language, and Hearing Research, 44(2), 286-96. https://www.proquest.com/scholarly-journals/evaluation-effects-two-treatment-approaches/docview/232355183/se-2

Sund, L. T., Morton-Jones, M. E., & Castro, M. E. (2024). Exploring Culturally Responsive Voice Care: Introduction. https://doi.org/23814764000300140072