Chapter 7: Voice Management (Physiologic Voice Therapy)

Question 1

What is physiologic voice therapy? (3 ideas)

Answer 1

• based on vocal function
• aims to improve the relationship/balance between 1. respiratory support, 2. laryngeal muscle strength + control + stamina, and 3. supraglottic modification of the laryngeal tone/resonance
• treats the voice holistically, not one single focus

Question 2

Physiologic voice therapy is modification of the ______________ _____________ of the voice producing mechanisms: (3)

Answer 2

underlying physiology

1) respiration
2) phonation
3) resonance

Question 3

What are the 2 types of voice disorders?

Answer 3

1) pathology leads to loss of balance between the voice systems
2) loss of balance between the voice systems leads to pathology

Question 4

What are 2 examples of when a pathology leads to loss of balance between the voice systems?

Answer 4

1) granuloma

2) presbylarynx

Question 5

What are 2 examples of when the loss of balance between the voice systems leads to pathology?

Answer 5

1) nodules

2) muscle tension dysphonia

Question 6

What is an example of how the same pathology/problem may lead to different responses with nodules?

Answer 6

1) the system is overworked: increased glottic and subglottic effort
2) the system is underused: decrease respiratory and/or glottic effort

Question 7

What is an example of how the same pathology/problem can lead to different responses with unilateral VF paralysis?

Answer 7

1) overwork the system (increase supraglottic effort)

2) underuse the system (decreased effort and permit falsetto for better approximation)

Question 8

Many voice disorders share this same problem = _____ of __________ ______________ _______
and will respond to the same approach = ____________ of _______________ __________

Answer 8

Loss of normal physiological balance

Restoration of physiologic balance

Question 9

What is physiological voice therapy treatment focused on?

Answer 9

returning the system to (more) normal patterns of production

Question 10

Physiological therapy approaches may consider multiple different cases have same basic concerns such as: (3)

Answer 10

1) lack of glottic closure
2) leading to inefficient use of glottal/phonatory systems
3) and possible compensatory patterns

Question 11

Physiologic approaches to therapy can do what? (4)

Answer 11

1) simplify therapy planning
2) address underlying physiology rather than specific symptoms
3) may use 1 or a combo of approaches
4) used with the understanding that other areas may need to be addressed

Question 12

What does the semi-occluded vocal tract do? (3)

Answer 12

1) improve vocal function in normal and disordered voices
2) heightens source (VF vibration), by raising supra- and intra-glottal pressures
3) impedance matching by VF adduction and epilarynx tube narrowing makes voice more efficiency (reduces VF tissue collisions)

Question 13

What is are 3 types of semi-occluded vocal tract?

Answer 13

1) non-speech SOVT
2) artificial lengthening of the vocal tract
3) speech-based SOVT

Question 14

What are 3 non-speech SOVT exercises?

Answer 14

1) humming
2) tongue/lip trills
3) /ol/-buzz

Question 15

What are 3 artificial vocal tract lengthening exercises?

Answer 15

1) kazoo
2) straw
3) tube

Question 16

What are 3 speech-based SOVT exercises?

Answer 16

1) resonant voice therapy
2) accent method of voice therapy
3) flow phonation

Question 17

What are vocal function excersizes?

Answer 17

a series of isometric/isotonic vocal exercises designed to balance the laryngeal musculature, improve stamina, and maximize glottal efficiency

Question 18

What do vocal exercises accomplish?

Answer 18

improvement of the 3 subsystems of voice production (resonance, respiration, phonation)

Question 19

Vocal function exercises work because there is a direct relationship between the condition of the ___________ __________ and the _______ of _______.

Answer 19

laryngeal musculature

quality of voice

Question 20

Direct laryngeal exercises should be effective in improving the voice of individuals with vocal ______________

Answer 20

hyperfunction

Question 21

For vocal function exercises to be fully effective, voice therapy must restore the normal __________ ________________ of the intrinsic laryngeal muscles. And the patient must learn to ____________ that through the precise _____________ of these _________.

Answer 21

dynamic equilibrium
maintain
adjustment of these muscles

Question 22

Vocal function exercises are a set of ___________ voice ______________ that are similar in theory to ___________ __________.
They are designed to ________________ and ________________ the ____________ musculature.
And to improve efficiency of the relationship among what 3 things?

Answer 22

systematic voice manipulations
physical therapy

strengthen and coordinate the laryngeal musculature

1) airflow
2) vocal fold vibration
3) supraglottic treatment of phonation

Question 23

The larynx is made of multiple ____________, ___________, and __________ ________.
It is a _________ system.
And it can become __________, ____________, or ________________ in its function.

Answer 23

cartilages, muscles, and connective tissue

jointed

injured, weakened, or imbalanced

Question 24

How are disorders/injuries of the larynx typically treated? (5 “steps”)
What is missing?

Answer 24

1) voice rest/modified use
2) hygiene counseling
3) supports (amplification)
4) treatment of symptoms (meds, behavioral therapy)
5) return to original activity

systematic vocal exercise to rehabilitate the laryngeal complex

Question 25

What are the 4 steps of VFEs?

Answer 25

1) warm up
2) stretching exercise
3) contracting exercise
4) adductory strengthening exercise

Question 26

In VFEs, what are 5 manner of production components?

Answer 26

1) posture
2) breathing
3) placement
4) onset
5) muscle engagement

Question 27

What is the first VFE exercise goal warm-up done on?

Answer 27

sustain the vowel /i/ for as long as possible on the musical note F
(F above middle C for females, middle for males)

Question 28

VFE exercise 1 goal is based on the patients personal ___________ and _____________, what is the range of efficient voice production flow rates?

Answer 28

anatomy and physiology

80-200 liters/second

Question 29

What does an air flow rate below 80 liters/second indicate? Above 200?

Answer 29

• limiting the air flow through the system

- allowing excessive air through the system

Question 30

What are the 2 methods for calculating VFE goal 1?

Answer 30

1) determine pts expiratory volume, divide by 80 (most efficient system), and obtain # of seconds pt should sustain tone
2) sustain lightest /s/ possible for as long as possible

Question 31

During VFE exercise 1, you should monitor for what 3 things and expect what 3 things?

Answer 31

1) tone focus
2) breathing, onset of tone
3) posture

1) poor control early on
2) voice breaks, wavering, breathiness
3) loss of focus

Question 32

What is the rationale for VFE exercise for 1?

Answer 32

1) warming up the muscles

2) as pt works to increase duration, they are improving their ability to valve the exhaled air

Question 33

What is VFE exercise goal 2?

Answer 33

“stretching” = glide from your lowest to highest note on the word “knoll”, “whoop”, a tongue trill, or lip trill with no voice breaks

Question 34

What is the rational for VFE exercise 2?

Answer 34

1) stretches the VFs

2) slow, controlled contraction of the CT

Question 35

What are 2 initial expectations for VFE exercise 2?

Answer 35

1) difficulty maintaining tone focus

2) voice breaks

Question 36

What is VFE exercise 3 goal?

Answer 36

“contracting” = glide from a comfortable high note to your lowest note on the word “knoll”, “boom”, tongue trill, or lip trill with a goal of no voice breaks

Question 37

What is the rational for VFE exercise 3?

Answer 37

slow, controlled contraction of the TA

Question 38

What are 2 initial expectations of VFE exercise 3?

Answer 38

1) difficulty maintaining tone focus

2) voice breaks

Question 39

What is VFE exercise 4 goal?

Answer 39

“power” = sustain the musical notes C-D-E-F-G for as long as possible on the word “old” without the /d/ (middle C for females, octave below for males) with the goal of efficient voice production flow rate

Question 40

What are the 3 rationale for VFE exercise 4?

Answer 40

1) low-impact adductory strengthening
2) sustained contraction of adductors (IA, LCA)
3) sustained engagement of the TA and CT

Question 41

How are VFE notes obtained?

Answer 41

matched to a pitch pipe, audio recorder, or keyboard/piano

Question 42

VFE homework includes: (2)

Answer 42

1) daily record charted by pt

2) est. time to complete = 8-10 weeks

Question 43

During the first few days of VFE, what might some pts experience?

Answer 43

minor laryngeal aching

Question 44

All VFEs are done… (6)

Answer 44

1) 2x each, 2x per day
2) as softly as possible, but engaged
3) with monitoring for breaks, wavering, breathiness
4) with extreme care to use forward focus without tension
5) with care to use easy onset without breathiness
6) with appropriate breathing technique

Question 45

How should you explain VFEs to pt.? (4)

Answer 45

1) admit it seems silly
2) compare to workout program (PT, weights, etc.)
3) stress necessity of systematic exercise
4) explain that times do not increase due to increased lung capacity

Question 46

What are 4 VFE pt advantages?

Answer 46

1) easily understood/reasonable model
2) systemic, permits for plotting progress
3) pt must attend to the voice at least 2x a day
4) involves doing something positive vs. a “don’t do”

Question 47

Approximately how many weeks do you do the full VFE progeam 2x each 2x a day for? 1x each 1x a day?

Answer 47

2

1