General voice therapy

Question 1

What are the aims of voice therapy?

Answer 1

• Restore normal voice
• Improve vocal profile
• Improve/restore laryngeal function
• Eliminate/reduce benign lesions.
• Protect client from regressing or causing further problems.
• Eliminate vocal tract discomfort during phonation
• Enable client to reach vocal potential and assist in communication adjustments in irreversible conditions

Question 2

What are some service delivery options?

Answer 2

• Consultation - direct and individual
• Clinical surrogates - parents, teachers
• In-service programs - vocal hygiene etc
• Group workshops/seminars
• Practical demonstrations

Question 3

What are some guidelines for voice therapy?

Answer 3

• Explain normal vocal physiology and the patient’s problem. (use power/source/filter model)
• Get patient to verbalise how voice sounds and feels.
• Get to know patient’s attractor state
• Use auditory, visual, tactile and kinaesthetic feedback.
• Audio record all session
• Progress slowly through initial stages and experiment with different techniques
• Model all therapy tasks.
• Instructions regarding practice - short and frequent!
• Prognostic statement at the start of therapy.

Question 4

What are some prognostic considerations?

Answer 4

• Patient’s recognition of and response to problem
• Patient’s motivation
• Appropriateness of patient’s expectations
• Willingness to cease abusive behaviours
• Psychiatric problems.
• Disorder must be amenable to therapy.
• Patient’s laryngeal and general health status.
• Therapist - understanding, competency, rapport.

Question 5

What are some different therapy approaches?

Answer 5

• Symptomatic - use of facilitative techniques
• Physiological - activity using exercise and manipulation
• Modification of lifestyle and environment
• Psychodynamic voice therapy
• Holistic - draws on all approaches

Question 6

Successful voice therapy depends upon?

Answer 6

1. Medical diagnosis
2. Voice diagnosis
3. Appropriate therapy/treatment plan
4. Client/clinician therapy contract
5. Motivation from client/family
6. Actual self-discipline on client’s behalf

Question 7

How would you document performance assessment in a session?

Answer 7

1. Good voice/poor voice rating using numerical scale
2. Client effort rating scale
3. Anecdotal report from client and listeners.
4. Length of time target is maintained.
5. Reduction in frequency of a specific behaviour

Question 8

What are some individual reference measures?

Answer 8

• Ratings using instruments such as vocal abuse scales, voice handicap index etc.
• Repeated readings of the same material recorded and perceptually rated.
• Visual real-time feedback provided by visipitch, voiceprint etc.
• Acoustic analysis, document change in target areas (eg. max. phonation etc)
• Improved appearance of vocal folds.

Question 9

What are some norm-referenced measures?

Answer 9

Comparison of performance to norm-referenced measures through objective assessment (F0, pitch range, perturbation, intensity)

Question 10

What are some criterion-referenced measures?

Answer 10

Meeting specific treatment goals.

Question 11

What are the criteria for termination of therapy?

Answer 11

• Elimination or decreased signs of pathological tissues changes.
• Improved vocal quality acceptable to patient
• Elimination of physical symptoms
• Use of new vocal behaviours with no return of symptoms
• Maximum improvement/compensation in an irreversible condition
• Lack of improvement after appropriate therapy trial (1-2months).