User:LaurieSlater/sandbox

Article Evaluation
Article on first language: only one definition of bilingualism is given, although the article states many exist. It could be good to add at least one other definition to contrast the one detailed in the article. Link to source #8 doesn't work.

Spasmodic Dysphonia
Under Diagnosis :

Diagnosis of spasmodic dysphonia requires a multidisciplinary team and consideration of both perceptual and physiological factors. There is currently no universally accepted diagnostic test for spasmodic dysphonia, which presents a challenge for diagnosis. Additionally, diagnostic criteria have not been agreed upon as the distinguishing features of this disorder have not been well-characterized.

A team of professionals including a speech-language pathologist, an otolaryngologist, and a neurologist, are typically involved in spasmodic dysphonia assessment and diagnosis. The speech-language pathologist conducts a speech assessment including case history questions to gather information about voice use and symptoms. This is followed by clinical observation and perceptual rating of voice characteristics such as voice breaks or strain, which are selectively present in normal speech over other voice activities such as whispering or laughing. Symptoms also vary across types of spasmodic dysphonia. For example, voiced sounds are more affected in adductor spasmodic dysphonia, while unvoiced sounds are more affected in abductor spasmodic dysphonia. Following speech assessment, the otolaryngologist conducts a flexible transnasal laryngoscopy to view the vocal folds and activity of the muscles controlling them in order to eliminate other possible causes of the voice disorder. In spasmodic dysphonia, producing long vowels or speaking sentences results in muscle spasms which are not observed during other vocal activities such as coughing, breathing, or whispering. To evaluate the individual for any other neurological problems, this examination is followed up with an assessment by the neurologist.


 * It might be interesting to add more about differential diagnosis; what allows to see the difference between SD and muscle tension dysphonia
 * Possibly also add more detail about the different types of SD (adductor and abductor; i.e. abductor and adductor muscles of the VF)
 * Add detail to whispering kind od SD

Differential Diagnosis
Because spasmodic dysphonia shares many characteristics with other voice disorders, misdiagnosis frequently occurs. A common misdiagnosis is muscle tension dysphonia, a functional voice disorder which results from use of the voice, rather than a structural abnormality. Some parameters can help guide the clinician towards a decision. In muscle tension dysphonia, the vocal folds are typically hyperadducted in constant way, not in a spasmodic way. Additionally, the voice difficulties found in spasmodic dysphonia can be task specific, as opposed to those found in muscle tension dysphonia. Being able to differenciate between muscle tension dysphonia and spasmodic dysphonia is important because muscle tension dysphonia typically responds well to behavioural voice treatment but spasmodic dysphonia does not. This is crucial to avoid providing inappropriate treatment, but in some cases a trial of behavioural voice treatment can also be helpful to establish a differential diagnosis.

Spasmodic dysphonia can also be misdiagnosed as voice tremor. The movements that are found in this disorder are typically rhythmic in nature, as opposed to the muscle spasms of spasmodic dysphonia. It is important to note that voice tremor and spasmodic dysphonia can co-occur in some patients.

Differential diagnosis is particularly important for determining appropriate interventions, as the type and cause of the disorder determine the most effective treatment. Differences in treatment effectiveness are present even between the types of spasmodic dysphonia. Diagnosis of spasmodic dysphonia is often delayed due to these challenges, which in turn presents difficulties in choosing the proper interventions.

Botulinum Toxin :

Botulinum toxin (Botox) is often used to improve some symptoms of spasmodic dysphonia. Whilst the level of evidence for its use is limited, it remains a popular choice for many patients due to the predictability and low chance of long term side effects. It results in periods of some improvement. The duration of benefit averages 10–12 weeks before the patient returns to baseline. Repeat injection is required to sustain good vocal production.

Side effects: Some side effects observed in adductor spasmodic dysphonia include reduced speaking volume, difficulty swallowing, and a breathy and hoarse voice quality.

Changes added to the introduction :

Spasmodic dysphonia, also known as laryngeal dystonia, is a type of focal dystonia affecting the intrinsic muscles of the larynx. More precisely, it is a disorder in which the muscles that generate a person's voice go into periods of spasm. This results in breaks or interruptions in the voice, often every few sentences, which can make a person difficult to understand. The person's voice may also sound strained or they may be nearly unable to speak. Onset is often gradual and the condition is lifelong.