Voice TherapyVoice Therapy

CDIS 700CDIS 700

General Points Regarding Voice General Points Regarding Voice TherapyTherapy

There is no single approach that will There is no single approach that will work with all clients/disorders.work with all clients/disorders.

Successful therapy will use a holistic Successful therapy will use a holistic approach that combines:approach that combines:– Behavioral therapy Behavioral therapy – Cognitive training Cognitive training – CounselingCounseling

A “Typical” Therapy SessionA “Typical” Therapy Session

Engage the client in general Engage the client in general conversation. conversation. – Note how the client’s voice sounds when they Note how the client’s voice sounds when they

are relaxed and therapy doesn’t seem like it are relaxed and therapy doesn’t seem like it has officially begun.has officially begun.

Segue into how the client’s voice was Segue into how the client’s voice was and how practice of techniques from the and how practice of techniques from the previous session.previous session.

Pick one or two techniques to work on Pick one or two techniques to work on during the session.during the session.

End a bit early to assign “homework” for End a bit early to assign “homework” for the next session. Be sure to leave time the next session. Be sure to leave time to address questions.to address questions.

Facilitating ApproachesFacilitating Approaches

Your authors provide a discussion of 25 Your authors provide a discussion of 25 therapeutic techniques that may be used to therapeutic techniques that may be used to treat voice disorders.treat voice disorders.

Review the DVD that accompanies your bookReview the DVD that accompanies your book Here we will cover some of the fundamentals:Here we will cover some of the fundamentals:

– RelaxationRelaxation– Respiration trainingRespiration training– Elimination of abusesElimination of abuses– Yawn-sigh techniqueYawn-sigh technique– Vocal Function ExercisesVocal Function Exercises

RelaxationRelaxation

Voice symptoms: diplophonia, dry Voice symptoms: diplophonia, dry throat and mouth, harsh voice throat and mouth, harsh voice quality, elevated pitch, functional quality, elevated pitch, functional dysphonia, shortness of breath.dysphonia, shortness of breath.

Progressive relaxation is a common Progressive relaxation is a common type of relaxation training: type of relaxation training: http://www.youtube.com/watch?v=KmxfjjamcuY&feature=related

Accompanying techniques: yawn-Accompanying techniques: yawn-sigh, open-mouth approachsigh, open-mouth approach

Respiration TrainingRespiration Training

Voice symptoms: Shortness of breath, Voice symptoms: Shortness of breath, “squeezing” out words, hyperfunctional voice. “squeezing” out words, hyperfunctional voice.

Clinician must be able to demonstrate good Clinician must be able to demonstrate good diaphragmatic breathing and explain how diaphragmatic breathing and explain how respiration works in client-appropriate terms.respiration works in client-appropriate terms.

Start small and gradually increase length of Start small and gradually increase length of utterance; do not let the client phonate longer utterance; do not let the client phonate longer than they can sustain a good quality voice.than they can sustain a good quality voice.

Compare and contrast voicing with good Compare and contrast voicing with good respiration and poor respiration. The client respiration and poor respiration. The client should be able to switch between the two and should be able to switch between the two and note the difference on voice production.note the difference on voice production.

http://www.youtube.com/watch?v=YMp-Zqbud_0

Elimination of AbusesElimination of Abuses Review with all clients those behaviors that Review with all clients those behaviors that

constitute vocal abuse, including hard glottal constitute vocal abuse, including hard glottal attacks, using inappropriate pitch, etc. attacks, using inappropriate pitch, etc.

Counsel clients on these abuses/misuses. Ask Counsel clients on these abuses/misuses. Ask them to identify which of these behaviors they them to identify which of these behaviors they use and how they might avoid them. Work to use and how they might avoid them. Work to provide alternatives to abusive behaviors.provide alternatives to abusive behaviors.

Therapy ideas for children and tips for adultsTherapy ideas for children and tips for adults

Yawn Sigh TechniqueYawn Sigh Technique

Relaxes the vocal mechanismRelaxes the vocal mechanism Voice symptoms: functional dysphonia, spasmodic Voice symptoms: functional dysphonia, spasmodic

dysphonia, nodules, polyps, vocal fold thickeningdysphonia, nodules, polyps, vocal fold thickening Accompanied by digital manipulation/laryngeal Accompanied by digital manipulation/laryngeal

massage if necessary.massage if necessary. Demonstrate the technique, beginning with a Demonstrate the technique, beginning with a

yawn and sighing with an open mouth. Add a yawn and sighing with an open mouth. Add a vowel on the sigh, then proceed to words that vowel on the sigh, then proceed to words that start with /h/ = start with /h/ = hahhah..

Once the client has mastered this technique, they Once the client has mastered this technique, they should remember the feeling that accompanies should remember the feeling that accompanies the yawn-sigh, and should be able to obtain the the yawn-sigh, and should be able to obtain the same effects without actually engaging in the same effects without actually engaging in the technique.technique.

Sample of student cliniciansSample of student clinicians

Stemple’s Vocal Function Exercises

1. Warm-up. Sustain /i/ as long as possible on a comfortable note.

2. Stretching. Glide from the lowest to the highest note in the frequency range, using /o/.

3. Contraction. Glide from the highest to the lowest note in the frequency range, again using /o/.

4. Adductory Power Exercises. Sustain the notes C, D, E, F, and G (still using /o/) as long as possible. Middle C for females, one octave below for males.

Do twice in a row (first very quietly) about twice daily.

Many variations on these exercises: see YouTube example

How Can We Document How Can We Document Progress?Progress?

According to Andrews (2006), we can:According to Andrews (2006), we can:– Gather tape recordings of the pre- and Gather tape recordings of the pre- and

post-therapy voice.post-therapy voice.– Obtain videorecordings of the vocal folds Obtain videorecordings of the vocal folds

pre- and post-therapy.pre- and post-therapy.– Obtain instrumental measures (e.g., the Obtain instrumental measures (e.g., the

Visi-Pitch or electroglottograph) when Visi-Pitch or electroglottograph) when available.available.

– Make graphs, or use rating scales, quizzes, Make graphs, or use rating scales, quizzes, etc. to chart progress.etc. to chart progress.

Sample Dismissal Criteria Sample Dismissal Criteria (Andrews, 2006)(Andrews, 2006)

Voice doesn’t sound tenseVoice doesn’t sound tense People don’t ask if I have a coldPeople don’t ask if I have a cold Voice doesn’t tire quicklyVoice doesn’t tire quickly Voice carries well/people don’t ask me to Voice carries well/people don’t ask me to

speak up/people can hear mespeak up/people can hear me My voice sounds livelyMy voice sounds lively I understand how to protect my voiceI understand how to protect my voice Voice is clearVoice is clear Voice is expressiveVoice is expressive I sound confidentI sound confident

Dismissal Criteria (cont.)Dismissal Criteria (cont.)

Reduction of hard attacks by 80%Reduction of hard attacks by 80% Elimination of throat clearingElimination of throat clearing Normal looking vocal foldsNormal looking vocal folds Resolution of vocal nodules or Resolution of vocal nodules or

pathologypathology Clearance from otolaryngologistClearance from otolaryngologist Replenishing breaths used 90% of Replenishing breaths used 90% of

the timethe time

Summary

No “cookbook” approach to voice therapy.

Impossible to cover all techniques in class; be prepared to learn on your own

Be flexible and be ready to substitute one technique for another depending on client’s needs.