15 - Voice Therapy

Question 1

How is voice therapy a very individual process?

7

Answer 1

Different etiologic factors

Background history

Certain voice demands

Medical complexities

Occupational and social issues

Motivation

Patient SKILL!

Question 2

What is the goal of voice therapy?

2

Answer 2

Restoring best voice possible (focus on functional outcomes)

Re-educating patient most effective and efficient use of voice (eliminate voice disorder/pathology)

Question 3

What are five things to remember when doing voice therapy?

Answer 3

Clinician needs sufficient information to plan and institute treatment program

Each program should be specifically designed for patient

Patient should understand therapeutic process

Patient shares responsibility for progress

Use a multidisciplinary approach

Question 4

What are three examples of typical long term goals?

3

Answer 4

Patient will demonstrate functional voice quality for age and gender in spontaneous speech.

Client will decrease vocal fatigue from 90% presence to 10% presence in structured speech tasks

The client will identify no more than 2 instances of vocal fatigue in a 2 week period of typical voice use tasks.

Question 5

What are five things we may need to teach and explain to the client?

(5)

Answer 5

Laryngeal status

Normal anatomy of VT (vocal tract)

Causative factors

Management plan (To not be here next year, this is what I’m going to have to do)

Explanations should be based on emotional status, educational/intellectual level of patient

Question 6

What is an indirect therapy method?

Answer 6

Vocal Hygiene

Question 7

What is a direct therapy method?

Answer 7

Therapy methods improving laryngeal function

Question 8

What are the 7 typical voice therapy protocols?

Answer 8

Vocal wellness

Respiratory training

Relaxation training

Phonatory retraining

Medical coordination

Singing training

Referrals as appropriate

Question 9

What are three vocal wellness protocols?

3

Answer 9

Vocal hygiene

Phonotrauma – ID and Eliminate

Vocal Inventory (Take an inventory of how patient uses their voice and how much)

Question 10

What are three respiratory training protocols?

3

Answer 10

LAB (lower abdominal breathing)

Use of breath in phrases/sentences

Expiratory Muscle Training (Two types)

Question 11

What are four relaxation training protocols?

4

Answer 11

Whole Body Relaxation

Stress Reduction etc.

LAB (Very relaxing to the larynx; 1,2, and 3 of program)

Laryngeal Massage

Question 12

What are six phonatory retraining protocols?

6

Answer 12

Easy Voice

Challenge principles (adduction exercises, increase tension)

Rate, intonation

Vocal Function Exercises

Valsalva Maneuver

Resonant Voice Therapy (Mask Focus)

Question 13

What are two singing training protocols?

2

Answer 13

Referral to or coordination with Singing Teacher

Give advice about singing

Question 14

What are three conditions that might require medical coordination?

(3)

Answer 14

Reflux

Allergies

Asthma

Question 15

Who might we make referrals to?

2

Answer 15

Psychology

Neurology

Etc

Question 16

What is the ultimate goal of voice therapy?

2

Answer 16

Design a series of tasks/exercises to increase phonation efficiency (easier and more effective phonation)

Move from sound -> syllables -> words -> sentences -> conversations on a day-to-day basis

Question 17

What four things happen when voice therapy session begin?

Answer 17

Describe

Measure motivation for therapy

Discuss a timeline

Home practice materials.

Question 18

What makes up the describe phase of voice therapy?

4

Answer 18

Normal anatomy and physiology

Etiologic factors

Correlate etiology and vocal symptoms

Impact on vocal fold function

Question 19

What are reasons to end therapy?

4

Answer 19

Resolution of the vocal pathology

Patient satisfaction with voice outcome

Clinician satisfaction with voice outcome

Other issues – reimbursement, travel, health

Question 20

What are the therapy approaches?

7

Answer 20

Voice Rest (and Modified Voice Rest)

Vocal Wellness (Hygiene)

Symptomatic Voice Therapy

Psychogenic Voice Therapy

Physiologic Voice Therapy

Eclectic Therapy

Combined Modality

Question 21

What makes up the psychogenic therapy approach?

2

Answer 21

Idenifying vocal habits due to emotional, occupational, or social stresses (Serious cases, should be referred for a psychiatric evaluation)

Helping patient remediate the emotional disturbances associated with the onset or maintenance of the condition

Question 22

What makes up the physiologic voice therapy?

Answer 22

Direct exercises used to activate the laryngeal muscle and other subsystems (respiratory and supraglottal)

Question 23

What are examples of physiologic voice therapy?

4

Answer 23

Vocal Function Exercises

Lessac-Madsen Resonant Voice Therapy

Lee Silverman Voice Treatment

Inspiratory and expiratory muscle strength training (Changes the physiology)

Question 24

What is Voice Rest?

Answer 24

Not using voice

Question 25

What is Modified Voice Rest?

2

Answer 25

Limited phonation

Strict rules on the length of time and manner one is allowed to phonate

Question 26

What is Vocal Wellness/Hygiene?

2

Answer 26

Patient education on healthy voice habits

Education on reducing phonotrauma

Question 27

What is Symptomatic Voice Therapy?

Answer 27

Modifying unhealthy voice patterns (inappropriate pitch, vocal fry, etc.)

(Does not deal with classic phonotrauma)

Question 28

What is Eclectic Therapy?

Answer 28

Uses multiple techniques to treat disorder

Question 29

What is Combined Modality?

Answer 29

Uses multiple disciplines to treat disorder

voice therapy, surgery, counseling, etc.