-
Primary goal?
to restore the best voice possible so voice is functional for emplyment and general communication
restoring voice to pre-morbid status may not be possible
-
Therapy should be ___ and ____ from understanding of ?
Accurate ___ is critical to tx planning?
- rooted in
- derived
- laryngeal anatomy and physiology
Diagnostic
-
Prognosis contributing factors?
- patient compliance
- willingness
- depression
- voice problem is amenable to resolution w/voice tx
- appropriateness of pts expectations
- Pt's general health status as well as current laryngeal status
- Pt must recognize there is a problem
-
Voice Tx:
Pt education on?
- normal respiration
- normal phonation
- normal resonance
- abnormal phonation- how physiology have been altered
- vocal hygiene and reflux
- use pictures, graphics, etc and level of education and age
-
Hygienic Voice Therapy
Concentrates on discovering the ___ causes of the voice disorder and _____ of the causes to improve ____ and __?
- behavioral
- modification/elimination
- vocal condition and voice quality
-
Program of vocal hygiene:
identify ___
maintain ___
limit___
limit___
___ precautions
ID ___?
eliminate __
avoid__
- hyperfunctional behaviors
- data on freq of misuse/abuse
- voice usage
- speaking in noise
- hydration, reflux
- exercise- weights, martial arts, vocalizations
- throat clearing and coughing
- irritants like smoke, dust, gases, cigarettes, etc.
-
Symptomatic Voice Therapy
Modification of deviant vocal symptoms such as __?
organized and promoted by ?
breathiness, inappropriate pitch, loudness, hard glottal attacks, and so on.
Daniel Boone
-
Psychogenic Voice Therapy
Focus is on ___ and ___ status of the pt that led to and maintained the voice disorder?
Organized by ?
emotional and psychosocial
Arnold Aronson
-
Physiologic Voice Therapy
Based on expanded knowledge of ___ as evaluated through objective voice assessment?
Strives to improve ?
Promotes ?
vocal function
balance among voice respiratory support, laryngeal muscle strength, control and stamina, and suprglottic modification of laryngeal tone.
a healthy vocal fold cover
-
Physiologic Tx organized by ?
concentrates on the modification of the underlying physiology of the voice producing mechanisms:?
weakness?
- Colton and Casper
- Stempl, Glaze, and Gerdeman
respiration, phonation, resonance
does not account for behavior
-
Electic Voice Therapy
Combination of ___?
any and all of the previous orientations to affect positive vocal change.
-
Strategies for Physiologic Voice Tx?
- Vocal function exercises (stemple)
- resonant voice therapy (Verdolini)
- Accent Method (smith)
- lee Silverman Voice therapy (Ramig)
-
Vocal Function Exercises?
a series of ___ similare in theory to ___ for the vocal folds, designed to ___ and to improve ___ ?
- systematic voice manipulations
- physical tx
- strengthen and balance the laryngeal musculature
- the efficiency of the relationship among airlfow, vocal fold vibration, and supraglottic tx of phonation
-
Physiologic Voice Tx
Rehab for injuries to the Larynx?
- sometimes voice rest
- vocal hygiene counseling
- modify symptoms
- continuation of previous voicing activities
-
Physiologic Voice tx missing element?
direct systematic exercises for restrengthening and balancing the laryngeal musculature and rebalancing the three laryngeal subsystems
-
Physiologic Voice Tx:
Vocal function exercises
warm up?
Goal?
sustain the vowel /i/ for as long as possible on the musical note (f) above middle (c) for females below middle (c) for males.
Goal = ___ sec
-
Physiologic Voice Tx:Vocal function exercises
stretching technique?
Goal?
- glide from your lowest note to your highest note on the word "knoll", "whoop" or tongue trill or lip trill
- Goal= no voice breaks
-
Physiologic Voice Tx: Vocal function exercises
Contracting?
Goal?
glide from your highest note to your lowest note on the word "knoll", " boom" or on a tongue or lip trill
Goal= no voice breaks
-
Physiologic Voice Tx:Vocal function exercises
power technique?
Goal?
sustain the musical notes (C-D-E-F-G) for as long as possible on the word "old" without the /d/
Goal= ___ sec
- middle (c) females
- octave below middle (c) males
-
Vocal function exercies
are done ? __ per day
all exercises are done ?
quality of tone is monitored for?
extreme care is taken to ?
attnetion is paid to the?
appropriate ? is assured
- 2 x each, 2x per day
- as softly as possible
- for breaks, wavering, and breathiness
- to teach the production in a forward tone focus without tension
- glottal onset of the tone to assure an easy onset without breathiness
- breathing technique
-
Vocal function exercises:
notes as matched to ?
daily ___ is charted by the pt?
estimated time of completion ?
some pts experience ___?
- a pitch pipe, tape recorder, key board, piano
- record
- 8-10 weeks
- minor laryngeal aching the first few days of exercise
-
Vocal function exercises:
explanation to the pt
admit?
Compare?
Stress?
Explain?
- that it seems silly
- it to workout program, phy tx, weight lifting, etc
- the necessity of systematic exercises without breaks
- that the times do not increase due to increased lung capacity
-
Vocal function exercises: Advantages for the pt
easily?
systematic, permits?
pt must?
involves?
- understood, resonable model
- plotting of progress
- attend to th evoice at least two times per day
- doing something positive as opposed to the "don't do's"
-
Direct modification of Tone focus:
pt ?
1) ___ phrase production
chant ___? on a ?
- education
- nasalized
- oh no, oh my, oh me, etc
- comfortable pitch and loudness
-
Direct modification of Tone focus:
nasalized phrase production cont.
2) introduce __ and ___ using the same phrases
(5)
- intensity
- rate variations
- 1) very slow and very soft
- faster louder
- fast loud
- slower-softer
- very slow and very soft
-
Direct modification of Tone focus:
nasalized phrase productio cont:
3) introduce ___ and ___
(4)
- inflected phrase and normal speech
- 1) soft and slow
- louder-faster
- exaggerated inflection
- normal speech
-
Direct modification of Tone focus:nasalized phrase productio cont:
4) expand to ?
phrases, paragraph reading, conversation
-
Resonant Voice Techniques
(person)
for ___ or ___ to increase ___?
- Verdolini-Martson, et. al
- hyperfunctional /hypofunctional
- loudness
-
Resonant Voice Techniques
Goal:
dec
dec
incr
- hyperfunction
- medial compression of VFs
- loudness/ ability to project
-
Resonant Voice Techniques
Consists of ____ uses ? then ?
- frontal tone placement
- syllables, words, sentences etc. with /m,n,j,r,z/ then generalize techniques to conversation
-
Principles of Resonant Voice Techniques
voice production involving ?
in the context of ?
where resonant voice is a ?
oral vibratory sensations, usually on the anterior alveolar ridge or higher in the face
easy phonation
continuum of oral sensations and easy phonation build from basic speech gestures through conversational speech
-
Principles of Resonance therapy cont:
Training methodologies are experiential focusing on the processing of ___ info?
training model assumes similar approaches for voice restoration and enhancing the ?
sensory
normal voice (excellence training)
-
Fundamental Characteristics of RT (resonance tx)
Fundamental perceptual target is focused, ____ in the context of ?
the singular training focus (resonance) is expected to affect?
Large numbers of __ are used in varying speech contexts?
Training is ? involving a dogged insistence upon the greatest possible ___ in the achievement of the perceptual tasks?
- oral vibratory sensations
- multiple levels of physiology (breathing and laryngeal)
- repetitions
- strongly goal (results)
- precision
-
Resonance Therapy targeted populations
Any populations in which ?
intra-vocal fold impact stress should be increased or decreased
-
Resonance Therapy targeted populations
Decreased ?
Increased?
edema, nodules, polps, cysts, granulomas,
paresis, paralysis, atrophy, bowing, sulcus
-
Resonance Therapy targeted populations
___ and ___ to process auditory and kinesthetic info related to voice and speech
-
Basic RVT training maneuvers
Stretches and breathing warm-ups
seconds per stretch
Shoulders
(2) techniques
3-10 seconds
- touch elbows in back
- stretch arms in front
-
Basic RVT training maneuvers
neck
(5) techniques
- drop head down slowly in fractions
- rotate head up until right on top of the neck, feel neck muscles "turn off" when the crown and ball of head are balanced
- lift head away from the neck
- cross fiber stretch toward shoulders with fingers
- tilt ear to shoulder and stretch out opposite arm
-
Basic RVT training maneuvers
jaws
(2)
- massage the masseters, pull down and forward
- push thumbs into masseters with slightly open mouth
-
Basic RVT training maneuvers
Floor of Mouth (FOM)
(2)
- press thumb into floor of mouth
- first make no sound, thne produce a vowel with no tongue stiffness
-
Basic RVT training maneuvers
stretching
lips
- -lip trill
- no voice
- continuous voice
- alternating off/on
-
Basic RVT training maneuvers
Stretching
Tongue
2
- 1)-tongue trill
- no voice
- continuous voice
- alternating off/on
- 2) protrude tongue out and down, hands behind back
- voiceless breathing
- voiced
-
Basic RVT training maneuvers
stretching
Pharynx
(2)
- yawn
- yawn-sigh with voice
- -stretch the pharynx with these maneuvers
-
Basic RVT training maneuvers
Stretching
Breathing
(2)
- 1) breathe out all air on /f/; do not breathe in until you must; when you must, simply release the abdomen, it will breathe for you
- 2) breathe-release-breathe-release, etc with and without voice
-
Basic training gesture for RT maneuvers
Step 1 for all stages of RT
____ as a sigh?
Extreme ?
Make ?
Pt should feel?
- Hmmm-molm-molm-molm-
- forward focus is required with appropriate breath support
- the connection from the abdominal muscles of the lips
- very relaxed at the end of this gesture
-
RT Hierarchy stage 1 "all voiced"
molm-molm-molm ___
vary?
discover?
eventually focus on?
increase?
Increase ?
- sustained pitch
- the rate only
- the vibrations; experiment with broad and narrow vibrations
- the narrow vibration "like a narrow beam of light"
- the ease of production by reducing the effort by 1/2 and 1/2 again
- "lift" (as if pitch were increasing)
-
RT Hierarchy stage 1 "all voiced"
2)
- molm-molm-molm
- slow-fast-slow
- soft-loud-soft on __ note
-
RT Hierarchy stage 1 "all voiced"
3)?
- molm-molm-molm as speech
- use non linguistic phrases
- vary the rate, pitch, and loudness
- make the connection from the abdonminal muscles to the lips
-
RT Hierarchy stage 1 "all voiced"
4)?
- Chant the following voiced phrases on the musical note ___
- mary made me sad
- my mother made marmalade
-
RT Hierarchy stage 1 "all voiced"
5)
Over-inflect these phrases as speech
-
RT Hierarchy stage 2 "Voice-Voiceless Contrasts"
Basic Training Gesture
1)?
mamapapa vary the rate on ___ note
-
RT Hierarchy stage 2 "Voice-Voiceless Contrasts"Basic Training Gesture
2)
- mamapapa
- slow-fast-slow
- soft-loud-soft on ___ note
-
RT Hierarchy stage 2 "Voice-Voiceless Contrasts"Basic Training Gesture
3)?
- mamapapa as speech
- use non-linguistic phrases
- vary the rate, pitch, and loudness;
- make the connection from the abdominal muscles to the lips
-
RT Hierarchy stage 2 "Voice-Voiceless Contrasts"Basic Training Gesture
4)?
- chant the following voiced/voiceless phrases on the musical note __
- Mom may put Paul on the moon
- Mom Told Tom to copy my manner
-
RT Hierarchy stage 2 "Voice-Voiceless Contrasts"Basic Training Gesture
5)?
Over-inflect these phrases as speech
-
RT Hierarchy stage 3 "Any Phrase"
Basic Training Gesture
Produce the following phrases in sequence as follows?
- First chant the phrase on the note__
- then over inflect it with extreme forward focus
- then finally repeat it as natural speech with a forward focus
Each individual phrase should be produced following this 3-step sequence before moving on to the next phrase.
-
RT Hierarchy stage4 "Paragraph Reading"
?
- read paragraph with phrase markers
- separate each phrase only by the natural inhalation of air
- exaggerate focus and then repeat with a more normal speech/voice production
- repeat the above without phrase markers
-
RT Hierarchy stage 5 "controlled Conversation"
?
- practice forward speech placement in conversation
- do not permit glottal attacks, glottal fry, etc.
-
RT Hierarchy stage 6 "Environmental Manipulations"
?
- simulate actual speaking environments
- use tapes of background noise
- go to noisy cafeteria
-
RT Hierarchy stage7 "emotional manipulations"
?
use materials and topics that increasingly engage and challenge the patient
-
RT Home Exercises
The critical portion of each exercise for each week is ___ as a home exercise example. The home program involves ___ sessions, ___ per day with ___ as needed
1.
2.
3.
- tape recorded
- 15-20 minute
- two times"minis"
- 1. stretches
- 2. basic RV gesture
- 3. selected level of hierarchy
-
Accent Method (person)
?
focus on ?
- Kotby
- hyperfunction
- diaphragmatic breathing
- aspirated attack
- rythmic intonation in speech
- appropriate pitch and loudness
-
Accent Method
Goal?
- dec hydration
- coordinate respiration and phonation
-
Accent Method
Consists of productions of ?
- diff rhythmic patterns of the syllable "ha' produced while physically moving the body
- i.e. stepping forward, etc.
-
Symptomatic Voice Therapy Techniques
Techniques to dec
Techniques to dec
Techniques to incre
- laryngeal muscle tension
- hard glottal attacks
- glottic closure
-
Voice Tx: Use of Pre-phonation Glottal Airflow to eliminate hard glottal attacks
___-idea of constant airflow, connected flowing speech; link vowels & consonants "she ate the apple and orange'
__?
___?
__? (has constant air flow)
__? (use of instrumental devices)
- easy onset/linking
- yawn-sigh
- chewing talk technique for hard glottal attacks/hyperfunction
- Biofeedback monitoring of productions
-
Voice Tx: Dec Laryngeal Muscle Tension
____: dec muscle tension, can lower larynx, dec thyrohyoid tension
How to dec 'supraglottic' muscle tension (3)?
Circumlaryngeal massage & digital manipulation
- 1. tongue stretches
- 2. yawns
- 3. 'deep sniff'
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
___ used post-surgically or post injury (nodules, polyps, swelling, etc) eliminate hard glottal attacks?
Confidential Voice
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
Goal:?
easy onset of phonation, dec impact stress & dec medial compression
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
Consists of ?
Is a ____ voicing technique, not a ___ technique?
just audible breathy phonation but NOT a whisper
temporary
permanent
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
Purpose?
Improve glottic closure, VF strength
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
Useful for:?
- VF paresis
- VF paralysis
- bowing
- lower motor neuron damage
-
Therapy techniques for Hyperfunctional Disorders (misuse/abuse)
Techniques?
Possibly -?
- pushing/pulling with phonation
- hard glottal attack, high loud phonation on 'ee'
- vocal function Exs
- Resonant Voice (incr loudness, dec strain)
P: laryngeal muscle relaxation exs
-
Lee Silverman Voice Therapy (person)?
Designed specifically for __ pts but can be used for many ___ pts. Where ___ is present?
- (Ramig)
- Parkinson's pt
- hypofunctional voice pts
- dysarthria
-
Lee Silverman Voice Therapy
Focus is on?
Tasks:?
loud phonation and recalibration of level of effort
- Loud sustained /a/
- pitch glides up and down
- loud phonation on 10 functional phrases then generalized
-
Voice TX: additional technique
(4)
- Teaching auditory discrimination
- Relaxation tx- progressive relaxation
- Relaxation exs for jaw, tongue, neck, shoulders
- Shaping vegetative vocal productions like laugh, cough, throat clear, hum, yawn-sigh, phonation on inhalation
-
Voice Tx: Improving Breath Support
Breathing exs to train?
Breathing exs to increase?
Breathing exs to train ___ of breathing and phonation?
- diaphragmatic breathing
- control of expiration
- coordination
-
Voice Tx: breath support
exercises?
- lower back breathing or abd'l breathing
- Pavone Exs
- Vocal Function Sustain Exescises
- Teach expiration w/ voice occuring simultaneously (no breath holding)
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