General Tx

Question 1

What are the general concepts of intervention?

Answer 1

1. Instruct Counsel
2. General Physical relaxation
3. Auditory Discrimination
4. Respiratory control
5. Voice production

Question 2

What factors should be included when counseling patients?

Answer 2

o With pediatric clients, instruct parents
o Include basic anatomy, physiology
o Misuse/Abuse
o Patient/family responsibility in process
o Process is gradual
o Some trial and error aspects

Question 3

How do you implement relaxation tx?

Answer 3

o Reduce muscle activity
o Balance reciprocal muscle groups for fine control
o Direct release of tension or imagery
o Progressive Muscle Relaxation: two goals
o 1) release
o 2) awareness: teach to identify when tension present and locate sites of tension
o Jacobson (1938), McCloskey (1977)
o Usually combine with imagery and breathing
o Can do overall body relaxation or spot relaxation

Question 4

How do you implement auditory discrimination tx?

Answer 4

o Begin with ear but over time develop kinesthetic referents
o Need to be made aware of dysphonic features and instances of good voice
o Instantaneous auditory feedback and consistent clinician feedback; fade as develops awareness
o Initially require 100% clinician feedback
o Give clear, mutually agreed upon labels for targets
o Usually combined with production work

Question 5

How do you implement voice production tx?

Answer 5

o Find techniques that work (trial therapy)
o Plan for incremental steps and build consistency of response
o Plan for home practice with stable responses
o Early direct work for short periods: voice work requires high level of concentration

Question 6

What is the overview of Tx structure?

Answer 6

• Basically a behavior modification process:
o Shaping behaviors, moving client gradually to desired goal
• Feedback is critical!
• Instruct- Model- Client Response- Clinician Feedback
• Move through a hierarchy of carefully planned levels
• Program is developed with individual needs and abilities in mind; use trial therapy results and foundation knowledge
• Watch for regression
• Start home program early in process!

Question 7

How does time affect Tx?

Answer 7

• Early voice therapy takes huge amount of client focus; work for short periods (3-5 min) with breaks for other work: relaxation, breathing, ear training
• As client more reliable with target, increase time for focused work
• Early treatment might be 2-3 times per week; as progress noted, reduce frequency

Question 8

When do you discharge?

Answer 8

• Therapy is complete when: client is free of symptoms of dysphonia; produces an efficient voice and handles regressions/recurrences are prevented
• May want to schedule follow-up after designated period; if client had lesions, should follow-up with ENT