Final: Behavioral Treatment Options Flashcards
Vocal Hygeine:
Goal?
Who needs it?
What all is involved in a good vocal hygeine program?
Goal?
- to identify, eliminate, modify causative or maintaining factors
Who needs it?
- Most people
What all is involved in a good vocal hygeine program?
- Can be techniques to limit use of voice, avoid use of loud, effortful voice, maintian good general health habits, or limit laryngeal/lung irritants
Examples of ways to reduce use of voice:
- limit non-essential talking/singing
- use of non-vocal signals to get attention
- use of more gestural, visual aids in lectures
Examples of ways to avoid use of loud, effortful voice
- limit background noise
- move closer
- use amplification
- avoid loud laughing
Examples of ways to maintain good general health habits:
- adequate sleep/rest
- balanced/nutritious diet
- exercise
- minimize stress
Examples of way to limit laryngeal/lung irritants
- increase hydration
- limit throat clearing/coughing
- avoid alcohol/caffeine
- avoid airborne irritants
- avoid meds that affect hydration, blood thinning
- limit talking in presence of cold/allergies
What’s an important thing to do when creating a vocal hygiene program for a client?
Prioritize for them the order of importance. Too much informaiton and they may feel overwhelmed.
Is a vocal hygeine program a treatment of the disorder?
No, it’s a treatment of the behaviors that have led to the disorder
How does behavioral treatment differ from other treatment you may see in our field?
- initial training/education in a short period of time
- out on their own for a short period of time with a spaced follow up
- booster therapy sessions when they forget
What’s the key to success in behavioral therapy?
Client motivation
There is a lot of work they need to do outside of therapy that they need to be aware of beforehand.
When is it necessary to try to alter the person’s attitude of their voice?
- Rectify/recalibrate impression of severity: some may think it’s worse than it is (parents hypersensitie pt) or don’t think it’s bad enough (PD)
- Tolerance/impact: desensitize speaker/listener to impact reations
When do you need to trigger normal or “best” voice?
- False vocal fold phonation
- Psychogenic dysphonias
- Those with strange voicing patterns (too high pitch, loudness, effort
What ways can you trigger normal or best voice?
Passively:
If they can do it, does it mean it’s psychogenic?
Vegetative Phonation
- laugh, throat clearing, etc
- shows that there is some phonation
- Not necessarily psychogenic, could be VF paralysis
What ways can you trigger normal or best voice?
Actively
- Ask if they can change it “Do you have an “other” voice?”
- if you hear a better voice at some point, ask if they can reproduce it
- Trigger true VF phonation on
- inhalation
- falsetto
- glottal fry voice
- Reposture/rebalance larynx
- Laryngeal manipulation
- alter head position
What order should you try when getting client to move from a triggered phonation to normal voice production?
- first: trigger (show them they can do it)
- sustained vowel
- voiced syllables (because with –v syllables they have to Abduct
- fully voiced phrases
- sentences
- conversations
Eliminating voicing as a treatment strategy:
When to use total rest vs modified rest:
Total rest:
- Open lesions that need to heal
- Can’t produce voice w/o substantial effort (break the voice pattern)
- help client realize the frequency of the behavior
Modified rest:
- to reduce edema
- counterbalance heavy use
- entails: limit conversation time, exclusively use primarily 1-on-1 conversations, limit background noise, avoid singing/whispering/lifting/pushing
Eliminating voicing as a treatment strategy:
Whispering?
- easy airflow whisper-maybe use
- forced whisper-avoid
Decreased Phonatory Effort:
What are general relaxation strategies?
Body/torso
- progressive relaxation
- yoga
- imagery
- meditation
- hypnosis
Head/Neck
- specific stretches, ROM: head rolls, shoulder rolls, shoulder lifts, etc
Decreased Phonatory Effort:
Yawn-Sigh
- gives sense of relaxed voice and possibly repostured laynx
- relaxed yawn with extended sigh
- can be moved into a sustained vowel
- can be a started for lower larynx, relaxed phonation
*
Decreased Phonatory Effort:
Laryngeal Massage
- reduce tension in the throat/larynx and reposition larynx
- Thumb/finger encircle hyoid – light circular pressure with downward pull
- Same to thyrohyoid space
- Same to posterior thyroid cartilage area
- Fingers on upper edge of thyroid cartilage – gentle pull down [maybe tongue blade pressing down on tongue?]
- Prolonging vowels throughout
- Increase complexity of speech
Decreased Phonatory Effort:
Confidential Voice
- Goal: use quieter, breathier voice to reduce glottal adduction, reduce effort/tension
- Good in particular for those with polyps, nodules, or swelling
- technique:
- quiet speaking with breathy voice”telling secrets”
- must be breathy, not just dereased loudness
- don’t reduce mouth opening or lower pitch
- to be used continuously
- usually after 4-6 sessions, start to reduce breathiness and increase loudness, might introduce RVT or frontal focus then
Decreased Phonatory Effort:
Chewing Method
- Goal: restore normal posture of larynx and reduce effort
- technique:
- Non-vocal chewing: open-mouthed, relaxed, exaggerated, manipulate imanary bolus
- chewing + phonation: add quiet voice, vary the vowel, vary the pitch
- chewing + speaking: v initated phrases, longer responses, conversation
- fade chewing
Decreased Phonatory Effort:
Vocal Function Exercises
- Goals
- Rebalance/reposture the system
- “strengthen” the voice but without effort
- Use it for: weakness, strain, effort
- technique: 2xd
- Frontal Focus Exercise
- moving focus forward and away from larynx
- initally use twangy, nasal voice
- nasalized productions of phrases (oh me, oh my, oh no)-feel the resonance in the nose)
- vary the rate, intensity, pitch
- Warm up
- sustained /i/
- slightly elevated pitch for as long as they can
- Soft voicing on
- glides: low to high, high to low
- sustain /o/ at varying pitches
- Frontal Focus Exercise
Decreased Phonatory Efforts:
Lessac-Madsen Resonant Voice Therapy
- Goal: establish frontal focus to reduce effort and efficient phonation, limits strong VF adduction and abduction
- Good for: hyper- or hypofunction, should start to see results in 3-4 weeks
- technique:
- 45 min sessions 1xw for 8 weeks, needs evidence of sucess in first session in order to continue
- vocal hygiene
- body stretching/relaxation
- increase body awareness as they voice: scan-gel-show-tell approach:: self-awareness, physical manipulation, demonstration, instruct/tell (last resort)
Decreased Phonatory Efforts:
Semi-occluded vocal tract exercises
- Goal: use semi-occlusion to get a more ideal separation of VF (shifts the pressure differential above and below VF) to give greater “ease” of phonation
- tenchiques:
- hum
- nasal phonemes
- lip trill
- tongue trill with voice
- voiced fricatives
- straw phonation
- do at varying pitches and loudness
- often used as warmups
