Therapy for Hyperfunction and Muscle Tension

Question 1

indirect techniques

Answer 1

• head and neck exercises
• chewing techniques
• progressive relaxation

Question 2

direct technique

Answer 2

laryngeal massage/digital manipulation

Question 3

types of head and neck exercises

Answer 3

• chin
• head turns
• head tilts
• jaw open wide
• jaw forward thrust
• shoulder shrugs
• shoulder blade pinch
• shoulder circles
• head roll
• shoulder stretch

Question 4

chin exercise

Answer 4

• look straight ahead and extend your head out over your body
• hold in this position for 3 seconds and then drop your head down to your chest

Question 5

head turn exercise

Answer 5

• look straight ahead
• turn your head toward your right shoulder for 3 seconds
• turn your head back to the center and then toward your left shoulder for 3 seconds
• do not turn your body, only your head
• always focus your eyes out over a distance of 6-8 feet

Question 6

head tilt exercise

Answer 6

• look straight ahead
• center your attention on an object in front of you
• tilt your head sideways to the right shoulder and hold for 3 seconds
• bring back to beginning position and tilt head to the left shoulder for 3 seconds
• do not raise shoulders to meet ears and always focus on the object in front of you

Question 7

jaw open wide exercise

Answer 7

• open mouth as wide as you can and fold for 3 seconds
• exhale gently as your mouth opens
• close mouth
• air will gently flow back in through your nose

Question 8

jaw forward thrust exercise

Answer 8

move bottom jaw forward to mimic an underbite and hold for 3 seconds

Question 9

shoulder shrug exercise

Answer 9

• raise and lower each shoulder one at a time making sure that each shoulder is down before the other goes up
• breathe out each time you lower a shoulder

Question 10

shoulder blade pinch exercise

Answer 10

• pull shoulder blades back simultaneously, trying to pinch the blades together
• hold this for 3 seconds than relax forward
• breathe out as you relax the shoulder to its resting position

Question 11

shoulder circle exercise

Answer 11

• move your shoulders forward, down, back in a circular motion
• reverse the direction
• rotate each shoulder for 30 seconds

Question 12

head roll exercise

Answer 12

• drop your head forward and roll your head slowly from one side to the other and back again
• do not force the movement
• the movement should resemble a pendulum
• as the muscles relax, try to produce a smooth vocal sigh
• listen for clear tone

Question 13

shoulder stretch exercise

Answer 13

• place left elbow in right hand with left hand on right shoulder and pull gently on left arm
• do the same for the right arm
• do this exercise 3 times for each arm

Question 14

chewing technique: step 1

Answer 14

sit looking into a mirror

Question 15

chewing technique: step 2

Answer 15

pretend to chew a piece of cotton candy

Question 16

chewing technique: step 3

Answer 16

chew in a relaxed manner with the mouth opening and closing
- use exaggerated movements of the tongue and mouth
- pretend to be moving the cotton candy around in your mouth

Question 17

chewing technique: step 4

Answer 17

begin to phonate quietly while chewing
- the movements of the tongue should change the sound of the phonation
- phonation on “ah” or “uh”
- you may want to put an /n/ or /l/ in front of the vowel

Question 18

chewing technique: step 5

Answer 18

chew/phonate on exhalation until relaxed voice is achieved
- each repetition should last 3-5 seconds

Question 19

chewing technique: step 6

Answer 19

simultaneously chew/phonate and begin to produce 2 or 3 word phrases such as “Miami”, “New London”, “Marina”, “Yolanda”, “I am in”, “I am over”, and “I am up”
- alternate between phrase and vowel production
- always begin your phonation on an exhalation

Question 20

chewing technique: step 7

Answer 20

when phonation of short phrases is relaxed while chewing, move onto longer sentences using different pitches and intensities
- gradually reduce the exaggerated chewing but remember to open for all vowels

Question 21

chewing technique: step 8

Answer 21

cotinue this daily until tension in the larynx is diminished for conversational speech

Question 22

progressive relaxation: step 1

Answer 22

sit in a comfortable position so you feel relaxed with your head facing forward

Question 23

progressive relaxation: step 2

Answer 23

breathe in and out slowly with eyes closed
- concentrate on the breathing

Question 24

progressive relaxation: step 3

Answer 24

raise your eyebrows to tense up the forehead
- release after 5-7 seconds and let the forehead totally relax for 10 seconds
- be aware of how the relaxation feels

Question 25

progressive relaxation: step 4

Answer 25

squeeze your eyes close tightly
- focus on how the tension feels
- release after 7 seconds and allow your eyes to be completely relaxed
- how does that relaxation feel?

Question 26

progressive relaxation: step 5

Answer 26

crinkle up your nose and hold for 7 seconds
- think about how that feels
- relax and be aware of what the relaxation feels like

Question 27

progressive relaxation: step 6

Answer 27

tighten up your jaw
- bite together for 5-7 seconds
- pay attention to how that tension feels
- release and let your jaw become totally relaxed
- be aware of how relaxed your jaw feels

Question 28

progressive relaxation: step 7

Answer 28

squeeze your larynx for 7 seconds as if you are swallowing
- feel how that tension feels
- relax and allow your laryngeal area to become completely free from tension
- focus on how that relaxation feels

Question 29

progressive relaxation: step 8

Answer 29

between each area, the person who administers this technique can remind the client to relax and think of their breathing
- breathe out slowly as you relax
- use a quiet, peaceful tone of voice with the client

Question 30

laryngeal massage/digital manipulation: step 1

Answer 30

have the client phonate /a/ while you massage his/her neck and watch for any signs of discomfort

Question 31

laryngeal massage/digital manipulation: step 2

Answer 31

begin on the hyoid bone which is located above the thyroid notch
- use the thumb and middle finger to massage in a circular motion
- move anterior to posterior, slowing down as you move posteriorly

Question 32

laryngeal massage/digital manipulation: step 3

Answer 32

use the same motion, but on the thyrhyoid space
- this space may be absent in extremely tense larynxes
- as the tension reduces, this space should open up

Question 33

laryngeal massage/digital manipulation: step 4

Answer 33

place your thumb and middle finger on the upper portion of the thyroid cartilage and massage in a slow circular and downward motion
- you want to try to move the larynx into a lower position in the neck