voice and speech disorders ppt

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• Voice disorders

People develop a voice disorder for many reasons. A voice disorder is a change in how the voice sounds. Health care providers trained in ear, nose and throat illnesses and speech-language pathologists diagnose and treat voice issues.

Treatment depends on what's causing the voice change. Treatment can include voice therapy, drugs, shots or surgery.

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The voice box, also called the larynx, is made of a smooth covering, muscle and soft, moist areas. The voice box sits at the top of the windpipe, also known as the trachea, and the base of the tongue. The vocal cords vibrate to create sound.

Air moving through the voice box causes the vocal cords to vibrate and brings them closer together. The vocal cords also help close the voice box during swallowing to stop you from breathing in food or liquid.

If vocal cords become swollen, or inflamed, develop growths or can't move as they should, they can't work properly. Any of these might cause a voice disorder.

Some common voice disorders include:

• Voice changes related to the brain and nervous system, known as spasmodic dysphonia (spaz-MOD-ki dis-FOE-nee-uh)
• Polyps, nodules or cysts on the vocal cords — growths that aren't cancer
• Precancerous and cancerous growths
• Vocal cord paralysis or weakness
• White patches, also known as leukoplakia (loo-koh-PLAY-key-uh)

Risk factors

Many factors can lead to a voice disorder, such as:

• Alcohol use
• Conditions related to the brain and nervous system, such as Parkinson's disease or a stroke
• Gastroesophageal reflux disease (GERD)
• Illnesses, such as colds or upper respiratory infections
• Scarring from neck surgery or from trauma to the front of the neck
• Throat cancer
• Throat dehydration
• Thyroid problems
• Voice misuse or overuse

Voice disorders care at Mayo Clinic

• Bruch JM, et al. Hoarseness in adults. https://www.uptodate.com/contents/search. Accessed Aug. 30, 2022.
• Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed Aug. 28, 2022.
• Learn more about your voice. American Academy of Otolaryngology — Head and Neck Surgery. https://www.enthealth.org/be_ent_smart/learn-more-about-your-voice/. Accessed Aug. 28, 2022.
• Kost KM, et al. Voice disorders in the elderly. Clinical Geriatric Medicine. 2018; doi:10.1016/j.cger.2018.01.010.
• What causes hoarseness? American Academy of Otolaryngology — Head and Neck Surgery. https://www.enthealth.org/conditions/hoarseness/. Accessed Aug. 28, 2022.
• Ma J, et al. A 532-nm KTP laser for vocal fold polyps: Efficacy and relative factors. Ear, Nose & Throat Journal. 2021;  doi:10.1177/0145561320946153.
• Ami T. Allscripts EPSi. Mayo Clinic; Sept. 19, 2022.

News from Mayo Clinic

• Science Saturday: Bioengineering vocal cords Feb. 18, 2023, 12:00 p.m. CDT
• Minnesota man takes shot at getting his voice back Aug. 17, 2022, 04:30 p.m. CDT
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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Functional voice disorders.

Yasmin Naqvi ; Vikas Gupta .

Affiliations

Last Update: April 28, 2023 .

• Continuing Education Activity

Functional voice disorders (FVD) are caused by insufficient or improper use of the phonation apparatus without either anatomical or neurological abnormalities. The most common FVDs include vocal fatigue, muscle tension dysphonia, diplophonia, and ventricular phonation. This activity reviews functional voice disorders by discussing their etiology, epidemiology, and pathophysiology, as well as the role of the interprofessional team in the evaluation and treatment of patients with functional voice disorders.

• Explain the impact that functional voice disorders can have on patients' quality of life.
• Identify the etiology of functional voice disorders.
• Outline the evaluation of functional voice disorders.
• Review the management options available for functional voice disorders.
• Introduction

Voice is a critical medium of human communication and social interaction; therefore, partial or total loss of voice may have profound implications for quality of life and safety. Problems with the voice can also lead to severe functional and occupational impairment for professionals who rely heavily on vocalization, such as singers, teachers, lawyers, actors, media personalities, and myriad others. Most people, in fact, would be affected significantly by a major impairment in their speech. 

The human voice is produced by the passage of exhaled air from the lungs over the vibrating vocal folds; this requires synchronization of diaphragmatic and laryngeal function as well as the shaping of the sound by the tongue, cheeks, and lips. In order to preserve optimal function, it is best to avoid activities that can strain the vocal folds, such as prolonged or excessively loud screaming or shouting. Organic abnormalities of the anatomy, such as nodules, scars, cartilage subluxations, and nerve injuries, are likely to cause voice anomalies. A functional voice disorder should be suspected when vocal quality is compromised without any identifiable anatomical or neurological factors.

Voice disorders can be classified as follows:

• Structural organic voice disorders result from physical changes in the laryngeal anatomy, such as edema, vocal nodules, and presbylarynx.
• Neurogenic organic voice disorders include vocal tremors, spasmodic dysphonia, paralysis of the vocal folds, etc. These problems relate to abnormalities of central or peripheral nervous system innervation to the larynx.
• Functional voice disorders (FVD) are caused by insufficient or improper use of the larynx and diaphragm without any identifiable physical structural abnormality or neurological dysfunction. These disorders often have a noticeable adverse impact on social and occupational function. Although there is a vast amount of literature relating to the topic, there is no consensus regarding foundational concepts or methodology of evaluation of voice disorders, as very few authors have rigorously investigated the most effective vocal assessment or video laryngoscopic examination techniques required to produce a consistent and definitive diagnosis of FVD. The most common FVDs are vocal fatigue, muscle tension dysphonia or aphonia, diplophonia, and ventricular phonation. [1] [2]  Vocal fatigue is caused by overuse of the voice and resultant tiring of the laryngeal musculature. Muscle tension dysphonia or aphonia is caused by hypertonicity of the laryngeal musculature, which in turn limits the vocal folds' ability to abduct and adduct with coordination and rapidity. Diplophonia is the phenomenon in which two separate fundamental frequencies are being produced during phonation, which may result from waves of different phases passing through the vocal fold mucosal surface or from different oscillatory frequencies occurring in the left and right vocal folds. Lastly, ventricular phonation occurs when the false vocal folds, also known as the ventricular folds, become the primary vibratory surfaces of the larynx due to stiffness of the true vocal folds or maladaptive voicing habits. All of these phenomena tend to present with hoarseness.

Prolonged and frequent vocal abuse is a significant risk for developing anatomical lesions of the larynx, such as nodules (also known as "singer's nodes") and hematomas and their sequelae. Functional voice disorders also result from vocal misuse or abuse as well as from behavioral health pathology. FVDs may be more easily recognized than other psychosomatic disorders because the clinician can visualize the laryngeal structure and function using a mirror or a flexible fiberoptic endoscopy, and therefore rule out organic disease. Both organic and functional voice disorders can affect multiple vocal parameters, including quality, pitch, and loudness, which can all be very problematic for patients.

Common causes of functional voice disorders include:

• Phonotrauma , which is caused by misuse, abuse, and overuse of the voice (yelling, screaming, excessive throat-clearing, and talking with increased loudness).
• Psychogenic aphonia and dysphonia , which are most commonly encountered in patients with underlying behavioral health issues, such as anxiety, depression, and conversion disorder. Associated symptoms may include blindness, paralysis, and other apparent neurological symptoms. [3]
• Epidemiology

Voice disorders have an estimated prevalence of 20 million (0.98%) in the United States. [4] [5]  Vocal abuse is the most common etiology among adults and children. Among adults, teachers represent the most at-risk population. [6] [7] [8]  A 2008 case-control study was conducted with 905 teachers in Spain in order to calculate the prevalence of voice disorders among educators and determine the associated risk factors. [7] All the teachers were given a questionnaire to fill out, followed by a complete head and neck examination and videolaryngostroboscopy. The study concluded that 57% of the teachers suffered from voice disorders, including vocal overstrain, which was the most prevalent (18%). Another study compared voice disorders between daycare center teachers and nursing staff, demonstrating a higher risk of voice disorders in teachers relative to the nursing staff. [8]  The prevalence of voice disorders among teachers was 11.6%, but it was only 7.5% in the nonteacher population. Teachers also reported current and past voice disorder symptoms in higher numbers compared to nonteachers.

• Pathophysiology

Thus far, no consensus on nomenclature for specific voice disorder pathology has been adopted in the literature. [9] That said, most voice pathologies appear to result from aberrant vocal use, particularly poor vocal technique (straining the voice, inadequate hydration, failing to rest when necessary), poor oral care and hygiene, repeated laryngeal infection, and excessive throat clearing. [10]  Patients with chronic vocal problems frequently complain of a "lump in the throat," technically known as globus hystericus, which often indicates laryngopharyngeal reflux that may present even in the absence of noticeable heartburn. [11]

• History and Physical

Taking a patient history to help diagnose voice disorders requires determining the frequency, duration, and severity of symptoms as well as any exacerbating or alleviating factors. Environmental factors are important to elicit as well, and these may include low humidity, alcohol use, cigarette smoke, and other airborne particulates like dust or chemical agents. Achieving an understanding of a patient's vocal habits and needs is likewise crucial to developing a working diagnosis and an individualized treatment plan. Including an evaluation of the patient's medical, surgical, psychological, traumatic, and pharmaceutical history can also be very informative in many cases.

The physical examination should include a standard head and neck evaluation as well as palpation of the larynx and trachea and videostroboscopic evaluation of phonation.

A systematic and thorough evaluation of the laryngeal structures and the patient's voice is vital in order to determine an effective strategy for vocal therapy exercises. Clinical evaluation for dysphonic patients is carried out in three steps:

• History Taking
• Physical Evaluation
• Examination

The history-taking involves ascertaining medical, surgical, psychological, or traumatic information that leads to diagnosing and tailoring treatment to the patient. Part of this process is the vocal evaluation, which requires understanding the anomaly and how it affects activities of daily life, such as professional commitments or personal communication. Listening to the pitch, volume, and quality of the voice will help the clinician determine the type of problem. Detailed vocal evaluation leads to a better understanding of the underlying pathology and, therefore, a more appropriate intervention. [12]

Physical examination includes a complete ear, nose, and throat examination after assessing voice quality, loudness, and range. The purpose of the assessment is to focus on nasal airway patency, pharyngeal function, and velopharyngeal competency. Some patients may need pulmonary function studies if they exhibit insufficient expiratory force or volume that leads to an alteration of the voice, compromising the normal pattern of synchronized respiration and phonation. Hearing evaluation may also be important, as hearing loss can influence a patient's perception of their own voice and therefore alter its production.

Laryngoscopy is the most important step in the diagnosis of vocal dysfunction. There are multiple methods of visualizing the larynx, including mirror laryngoscopy, flexible fiberoptic laryngoscopy, distal chip laryngoscopy, digital transoral laryngoscopy, and stroboscopy. Stroboscopy provides the greatest amount of information when evaluating the mucosal wave of the vocal cords. [13] [14]

Due to the heterogeneity of functional voice disorders, assessment should also be evaluated for psychogenic and muscle tension pathologies. Psychogenic voice disorders and muscle tension voice disorders are treated by speech-language pathologists (SLPs) who use symptomatic behavioral voice therapy along with counseling and, potentially, psychotherapy. [15]

The presentation of functional voice disorders can take many forms (dysphonia, stuttering, or prosodic abnormalities) and may mimic organic disorders, such that diagnosis can be difficult. A thorough examination, correct diagnosis, and proper treatment are critical. Functional or psychogenic disorders and behavioral movement disorders can be challenging to differentiate based solely on observable speech and voice disturbances; many behavioral and neurological conditions can mimic symptoms of organic voice conditions. [1]

• Treatment / Management

The first step in FVD management is determining the correct diagnosis, and treatment may require multiple modalities depending on the cause, type, and severity of the disorder. Most problems can be managed simply by identifying the etiology and modifying patient behavior to avoid it.

As a general rule, there are three primary treatment strategies:

• Medical Treatment
• Surgical Treatment
• Voice Therapy

Speech-language pathologists employ a holistic approach to treatment, striving to balance respiration, phonation, and resonance instead of directly addressing the symptoms of voice problems. Multiple rehabilitative strategies, such as auditory masking, the accent method, conversation training therapy (CTT), Lax Vox speech therapy, expiratory muscle strength training, phonation resistance training, chant speech, and confidential voice are used to manage FVDs. Multiple facilitative techniques are leveraged by SLPs to restore a normal voice, depending on the type of voice disorder, while also trying to determine the underlying causality. [16]  Correct positioning, relaxation, hydration, vocal functioning exercises, counseling, patient education, and behavioral modification may all play roles in achieving optimal outcomes. 

In some cases, vocal fold nodules are successfully treated with voice therapy alone. However, many other types of lesions (laryngeal webs, polyps, contact ulcers, and papilloma) require surgical management. Identification of the cause of the dysfunction is the key to a successful treatment. Voice therapy is the standard of care for many of the nearly 140 million people in the United States who suffer from voice disorders; unfortunately, current therapies are not always effective for a number of reasons: incorrect diagnosis, patient noncompliance, and severity of the pathology being chief among them.

• Differential Diagnosis

The following clinical entities should be considered potential diagnoses in patients with dysphonia: [17] [18]

• Somatoform disorder
• Conversion disorder
• Anxiety disorder
• Munchausen syndrome
• Malingering
• Allergic and environmental asthma
• Anaphylaxis
• Bilateral vocal fold paralysis
• Exercise-induced asthma
• Foreign body obstruction
• Laryngeal abnormalities (e.g., neoplasm, polyps, cyst)

Good prognostic indicators include acute onset of symptoms, absence of underlying organic pathology, ability to eliminate the trigger (particularly if it is a life stressor), male gender, young age, and good general health status. Poor prognostic indicators include personality disorders, poor perception of the patient's own wellbeing, associated motor symptoms, and psychogenic nonepileptic seizures.

To optimize outcomes, it is essential to arrive at the correct diagnosis through thorough evaluation and careful consideration. Unless the treatment is tailored to the underlying pathology, the results will not be satisfactory for either the patient or the clinician; voice therapy, for example, will not significantly help a patient with a glottic mass that requires surgical excision. A multidisciplinary approach, typically involving an otorhinolaryngologist or fellowship-trained laryngologist and an SLP, is likely to be most effective at alleviating symptoms and improving quality of life. [19]

• Complications

The primary complications associated with FVD relate to the barriers to communication and social isolation that ineffective phonation may produce. When speaking is difficult or results in ineffective communication, frustration, low self-esteem, anxiety, and depression may result. In psychogenic FVD, the longer the FVD exists, the worse the underlying behavioral health problem may become, which can further exacerbate the FVD. [20]

• Deterrence and Patient Education

The mainstay of treatment of functional voice disorders is vocal rehabilitation, which is tailored according to patient presentation and prognosis. The most significant drawback to this approach is the inherent difficulty in maintaining patient compliance for regular follow-up and long-term self-directed treatment. Outcomes are improved when barriers to compliance are identified and addressed, often through the use of patient-centered questionnaires. Additionally, patient motivation can be improved with a thorough understanding of the diagnosis and etiopathogenesis of the condition, which facilitates insight into the factors that contribute to the problem. [21]

• Enhancing Healthcare Team Outcomes

Delivering healthcare via multidisciplinary teams reduces the number of medical errors that occur and improves patient safety. An interprofessional team that provides a holistic and integrated approach to patient care will ultimately optimize outcomes for FVD patients. Patients with voice disorders may require a treatment team consisting of an otorhinolaryngologist or laryngologist, psychologist or psychiatrist, SLP, and other health professionals. Multidisciplinary collaboration plays a vital role in providing long-term patient-centered care that improves individual health outcomes and enhances the chances of rapid functional recovery. [22]

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Disclosure: Yasmin Naqvi declares no relevant financial relationships with ineligible companies.

Disclosure: Vikas Gupta declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Naqvi Y, Gupta V. Functional Voice Disorders. [Updated 2023 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Vibratory Onset of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia: A High-Speed Video Study✰. [J Voice. 2020] Vibratory Onset of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia: A High-Speed Video Study✰. Chen W, Woo P, Murry T. J Voice. 2020 Jul; 34(4):598-603. Epub 2018 Dec 28.
• [Pseudoglottis after laryngeal trauma with bilateral recurrent laryngeal nerve paralysis]. [HNO. 1993] [Pseudoglottis after laryngeal trauma with bilateral recurrent laryngeal nerve paralysis]. Ptok M. HNO. 1993 Jan; 41(1):41-6.
• Immediate effects of straw phonation in air or water on the laryngeal function and configuration of female speech-language pathology students visualised with strobovideolaryngoscopy: A randomised controlled trial. [Int J Lang Commun Disord. 2023] Immediate effects of straw phonation in air or water on the laryngeal function and configuration of female speech-language pathology students visualised with strobovideolaryngoscopy: A randomised controlled trial. Meerschman I, D'haeseleer E, Kissel I, De Vriese C, Tomassen P, Dochy F, Pieters K, Claeys S, Sataloff R, Van Lierde K. Int J Lang Commun Disord. 2023 May; 58(3):944-958. Epub 2023 Feb 1.
• Review Ventricular dysphonia: clinical aspects and therapeutic options. [Laryngoscope. 2003] Review Ventricular dysphonia: clinical aspects and therapeutic options. Maryn Y, De Bodt MS, Van Cauwenberge P. Laryngoscope. 2003 May; 113(5):859-66.
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Speech is Beautiful

Free Professional Development Teachers And Voice Disorders

Education · Tips · Vlog

I shared this PowerPoint in a video a long time ago, but I wanted to remind you guys in my new video  Video: Free Professional Development Voice Disorders  since you may be planning ahead for a staff meeting this spring. Grab my free PowerPoint presentation geared for an audience of teachers, who are professional voice users disproportionally impacted by voice disorders. And I talk a little at the end of the video about my son’s voice disorder too (I’m going to have to do a separate video about that…)

Teaching Leads to Voice Disorders

Teaching is a job with significant voice use — and overuse. Jobs like musical performance also fall into this same category because you need your voice to work. Additionally, you need to project your voice to a crowd. That’s how teachers can strain their voices, which leads to hoarseness and more seriously to voice disorders.

Yelling is Vocal Abuse

I don’t know if you knew this but yelling is vocal abuse. That’s because it puts strain on the delicate muscles inside the “voice box.” Try to stop yelling and if you feel like you cannot, considering wearing a microphone or some type of amplification device in the classroom. It will save your voice, which you want to do. You need your voice to be there for you for years to come.

Vocal Hygiene

Vocal hygiene refers to what you do with your voice to save it. If you are at risk for a voice disorder, here are some things you can do to help your voice:

• Stay hydrated. The muscles in your voice and the membranes covering them need water to move optimally.
• Reduce consumption of liquids that dry out your voice. Reduce drinking coffee and alcohol.
• Do not visit smoky places. Avoid breathing smoke, which irritates your voice box.
• Period of vocal rest. Have times of the day where you do not talk, especially after a day of heavy vocal use.
• Don’t yell. As a mentioned before, it is vocal abuse.
• Don’t whisper. Whispering puts a strain on your vocal folds or muscles of the voice box. If you do become hoarse, talk normally even if your voice quality is off. It’s actually better than whispering.
• Don’t clear your throat. When you clear your throat, you rub those vocal folds together and it’s tough on them. If you feel something stuck in there, do a quick, forceful cough.

Free Professional Development Teachers Need

Teachers need to know that their profession causes more voice disorders than virtually any other (beside singing). That’s where this free Powerpoint comes in. Share it with staff so that they learn how to protect their voices and avoid having to see a doctor.

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Speech and Language Disorders

Mar 25, 2019

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Speech and Language Disorders. By: Arla Garcia. Federal & State Definitions. A speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance.

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Presentation Transcript

Speech and Language Disorders By: Arla Garcia

Federal & State Definitions • A speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance.

SPEECH & LANGUAGE Speech Disorders: Language Disorders: Language-Based Learning Disabilities Preschool Language Disorders • Childhood Apraxia of Speech • Dysarthria • OrofacialMyofuntional Disorder • Speech Sound Disorders: Articulation and Phonological Processes • Stuttering • Voice

Identification Process • All students will get a screening. • A child might be identified to need further testing, diagnosis or treatment. • Student will meet with an SLP for further evaluation. • Visual examination of oral cavity and throat to examine physical structures • Articulation of speech sounds • Expressive language and spontaneous speech tests • Fluency and Voice Evaluations • Hearing test (this could be a problem) • Case History • Speech therapy • Qualification for Special Education Services

Characteristics • Noticeably behind other students in speech and/or language skills development • May have difficulties with reading or written language • Uses words and their meanings incorrectly • Unable to express ideas • Incorrect use of grammar when talking or writing • Trouble understanding word meaning • Will not initiate conversation • During verbal interaction is slow to respond • Cannot identify the use of different language

4 Major Areas Where Impairments Occur: • Articulation • Fluency • Voice • Language

Accommodations: • IEP!!! • Seat arrangements

Instructional Strategies • Focus on interactive communication. • Use active listening. • Incorporate the student’s interest into speech. • Reinforce communication attempts. • Ask open-ended appropriate questions. • Encourage reading and writing daily. • Be a good speech model • Model acceptance and understanding in the classroom. • Be patient when student is speaking, since rushing may result in frustration. • Encourage student to participate in classroom activities and discussions. • Speak clearly to the student. • Allow the nonverbal students to use augmentative communication systems.

Tips for Parents: • Be informed. • Patience is key. • Get to know your SLP • Stay positive.

Organizations to Consult With: • ASHA| American Speech-Language-Hearing Association: www.asha.org • NICD: National Institute on Deafness and Other Communication Disorders: http:www.nidcd.nih.gov/ • National Stuttering Foundation: http://stuttersfa.org/

Recommended Books • Gerald McBoing Boing by Dr. Seuss • Basghetti Spaghetti by Susanne Vettiger • Ruby Mae Has Something to Say by David Small

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A lawmaker with a brain disease used voice assist to back her bill on the House floor

Rachel Treisman

Virginia Rep. Jennifer Wexton used text-to-speech technology to advocate for her bill on the House floor Monday, following her diagnosis with the rare brain condition known as progressive supranuclear palsy. C-SPAN/Screenshot by NPR hide caption

Virginia Rep. Jennifer Wexton used text-to-speech technology to advocate for her bill on the House floor Monday, following her diagnosis with the rare brain condition known as progressive supranuclear palsy.

Rep. Jennifer Wexton is being hailed as an inspiration after advocating for her bill on the House floor this week, even as she battles a rare brain disorder that has limited her ability to speak.

The Virginia Democrat took the podium on Monday to make the case for her bill, which would rename a post office in her county after regular customer — and late Secretary of State — Madeleine Albright.

Wexton delivered her nearly two-minute remarks using a text-to-speech application, technology she's increasingly relied on since she was diagnosed last year with a degenerative brain condition known as progressive supranuclear palsy (PSP).

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"PSP makes it very difficult for me to speak, and I use an assistive app so that you and our colleagues can understand me," Wexton told the House speaker by way of opening remarks.

Today, with the assistance of voice to text tech due to my PSP, I spoke on the House floor in favor of my bill to rename the Purcellville post office in honor of Madeleine Albright. Sec. Albright was a trailblazer & inspiration to countless women in public service, including me. pic.twitter.com/S5v203jBsu — Rep. Jennifer Wexton (@RepWexton) May 7, 2024

PSP is a rare brain disease that affects walking, balance, eye movements and swallowing, for which there is no cure, according to the Mayo Clinic .

Wexton, 55, announced her diagnosis in September, several months after being misdiagnosed with Parkinson's Disease. Acknowledging that "there is no 'getting better' with PSP," she said she would not seek reelection in 2024 — but pledged to keep serving the people of northern Virginia's 10th Congressional District until then.

"While my time in Congress will soon come to a close, I'm just as confident and committed as ever to keep up the work that got me into this fight in the first place for my remaining time in office – to help build the future we want for our children," said Wexton.

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Wexton is in her third term after first flipping her seat blue in 2018. A dozen Democrats and four Republicans are vying to replace her , with primary voting set to close in mid-June.

Wexton has remained involved as promised. In the days leading up to her speech, she traveled to Baltimore to discuss restoration of the Francis Scott Key Bridge with other Appropriations Committee leaders and used voice assistive technology to question Transportation Secretary Pete Buttigieg , as well as Acting Secretary of the U.S. Department of Housing and Urban Development Adrianne Todman at separate hearings, disclosing her PSP diagnosis in both.

"I describe it as Parkinson's on steroids and I don't recommend it," she said.

On Monday, Wexton spoke in favor of a bill she first introduced last spring, seeking to rename the post office in Purcellville — about 50 miles west of Washington, D.C. — after her former constituent.

Albright, who died in 2022 at age 84, "chose not to have her mail delivered to her rural western Loudoun County farm but instead became a fixture at the post office that will bear her name," Wexton said.

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"Secretary Albright was a fearless trailblazer for women and a devoted public servant who touched the lives of so many whom she taught, mentored and worked with, including me," she added. "It is my honor to lead this legislation to celebrate her historic life and legacy here in Virginia's 10th Congressional district, where her farm is located and where she spent as much time as she was able."

Wexton noted that this would be the latest in a long list of accolades for the former secretary — including a 2012 Presidential Medal of Freedom — and called it an honor to help preserve her legacy in Virginia.

"Secretary Albright once said the greatest honor of her life was representing the United States of America, a sentiment I am sure we all share as members of the House of Representatives," Wexton said.

The House passed the bill the next day, by a vote of 371 to 28. The Albright family called it a "wonderful tribute to her memory" in a statement shared by Wexton's office.

Wexton has successfully introduced several bills to rename post offices in her district during her time in the House, after WWII veteran Norman Duncan and country music icon (and Winchester native) Patsy Cline .

She is not the first lawmaker to use assistive technology in Congress — Sen. John Fetterman, D-Penn., uses captioning technology due to auditory processing issues following his 2022 stroke. But it remains a rare sight, and has garnered attention and considerable praise in recent days.

As video of Wexton's remarks racked up thousands of views and hundreds of likes on X, formerly Twitter, other politicians and onlookers shared statements of support for the congresswoman.

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"Congresswoman Jennifer Wexton gets more inspiring each day," wrote Virginia State Delegate Rip Sullivan . "With remarkable courage and grace, she continues to dedicate herself to the 10th district. Her constituents are lucky to have her fighting for them."

Virginia State Delegate Kathy Tran wrote that "for individuals who use augmentative and alternative communication ( AAC ) Jennifer Wexton is showing them that they too can lead and serve at the highest levels."

Even Vice President Kamala Harris weighed in , calling Wexton "an inspiration to me and to millions of Americans across our nation."

"You are showing the world what true courage and determination look like," she wrote late Tuesday. "Keep fighting."

Wexton replied with a message of thanks, adding: "And I still have things to do!" — muscle emoji included.

• brain disease
• House of Represantatives
• speech assistive technology
• Jennifer Wexton

Congresswoman battling brain disorder delivers House speech using a text-to-voice app

Rep. Jennifer Wexton (D-Va.), whose ability to speak, hear and move has been affected by a degenerative brain condition, uses assistive technology to help her navigate life on the Hill.

Rep. Jennifer Wexton (D-Va.) stepped to the microphone on the House floor Monday to speak about one of her latest pieces of legislation, as she has done many times before during her five years in Congress.

But the voice that gave the speech wasn’t hers — it was from a text-to-voice application, an assistive device she uses to help her navigate a degenerative brain condition with which she was diagnosed last year.

Wexton’s disorder — progressive supranuclear palsy (PSP) — has largely affected her ability to speak, hear and move. With the help of the assistive app, the congresswoman on Monday spoke about legislation she introduced to rename a post office in Purcellville, Va., after former secretary of state Madeleine Albright, who lived in nearby Hillsboro, Va.

“PSP makes it very difficult for me to speak, and I use an assistive app so that you and our colleagues can understand me,” Wexton said in her remarks. “I am proud to be here today speaking in support of my bill to rename the Purcellville, Virginia, post office in honor of my former constituent.”

. @RepWexton - who has Progressive Supranuclear Palsy (PSP) - uses an assistive device to speak on the House floor. pic.twitter.com/ZoA5PAohKR — Howard Mortman (@HowardMortman) May 6, 2024

Wexton, 55, explained that Albright was a fixture at the Purcellville post office, which she visited often while living on her farm in rural western Loudoun County. The lawmaker said she wanted to ensure that Albright’s legacy “continues to live on in Virginia for generations to come.”

The Virginia Democrat, who first won election to the House in 2018, received the PSP diagnosis last summer after an initial misdiagnosis of Parkinson’s disease. PSP, a rare neurological condition, typically progresses rapidly and has no cure.

Wexton announced in September that she would not run for reelection for her seat in Virginia’s 10th District. Next month, a crowded field will battle for each party’s nomination for the general election, hoping to succeed Wexton in the seat she turned blue in 2018 with a win over Republican Barbara Comstock. Early voting is underway.

Wexton isn’t the first lawmaker to recently employ assistive technology in Congress. Sen. John Fetterman (D-Pa.) relies on real-time talk-to-text technology to help him with auditory processing issues after suffering a near-fatal stroke in 2022.

In her remarks Monday, Wexton only briefly touched on the topic of her condition, focusing her remarks instead on her effort to name the Purcellville post office after a woman who she said helped shape the political careers of many more.

Albright, Wexton said, “was a fearless trailblazer for women and a devoted public servant who touched the lives of so many whom she taught, mentored and worked with — including me.”

Congresswoman with brain disorder uses text-to-voice app to deliver House speech

R ep. Jennifer Wexton (D-VA) is utilizing a text-to-voice application in order to speak on the House floor as she navigates a degenerative brain condition she was recently diagnosed with.

Wexton was diagnosed with progressive supranuclear palsy which affects her ability to speak, hear, and move. When she testified before Congress on Monday, she used the assistive application to speak about legislation she introduced to rename a post office in her constituency.

“PSP makes it very difficult for me to speak, and I use an assistive app so that you and our colleagues can understand me,” Wexton said via the app. “I am proud to be here today speaking in support of my bill to rename the Purcellville, Virginia, post office in honor of my former constituent.”

During her remarks, she only briefly touched on her condition before centering the speech around the post office renaming. She is proposing the post office be renamed after fellow Virginian and former Secretary of State Madeleine Albright. 

“[Albright] was a fearless trailblazer for women and a devoted public servant who touched the lives of so many whom she taught, mentored, and worked with — including me,” Wexton said.

Wexton was diagnosed with PSP last year after initially being misdiagnosed with Parkinson’s disease. She announced she would not seek reelection this year after representing Virginia's 10th Congressional District since 2019.

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“I’m heartbroken to have to give up something I have loved after so many years of serving my community,” Wexton said in a statement . “But taking into consideration the prognosis for my health over the coming years, I have made the decision not to seek reelection once my term is complete and instead spend my valued time with Andrew, our boys, and my friends and loved ones.”

She is the first member of Congress to use this type of assistive technology. Sen. John Fetterman (D-PA) uses talk-to-text technology to help him with auditory processing problems, which make it difficult to understand different sounds, brought on by a stroke he suffered in 2022.

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