Treatment techniques Flashcards
Relaxation
Progressive or deep relaxation for stress management.
More effective to use relaxation to reduce muscular tension and to energise muscles used in voice production.
Tasks include a range of motion, muscle stretch and physical energising tasks.
Precautions: history of head/neck injuries, cervical arthritis, back pain, spinal cord problems.
Breath control and support
Aim to achieve and develop abdominal/diaphragmatic breathing.
Teach P to pull in abdominal muscles - train exhalation phase.
Forward resonance
Bring voice forward in the vocal tract so that speaker is able to feel vibrations of voice in facial bones and lips - alters voice focus from throat to face.
Useful with functional or organic dysphonia associated with hyperfunction.
LMRVT
Lessac-Madsen Resonant Voice Therapy
Voice problems dur to hyper or hypo adduction of vocal folds.
Contraindications - vocal fold haemorrhage.
Will not help for spasmodic dysphonia.
Principles:
Involves vocal hygiene and voice work.
8 sessions - 1 per week, 30-45 mins.
Vocal hygiene.
Involves:
Resonant voice training
Resonant voice words, phrases, scales
Resonant voice chant
Chant talk
Useful for patients with functional dysphonia using hard glottal attack.
Cross between speaking and singing.
Chanting - encourages easy, continuous flow of phonation, decreased hard glottal attack, involves elevation of pitch and limited pitch variability.
Results in increased proprioceptive feedback - vibrations felt through nose and cheek area.
Elimination of hard glottal attack/easy onset phonation
Key to reducing hard glottal attack is in timing of airflow with phonation
Reduces vocal hyperfunction.
- Yawn/sigh
- Aspirate initiation of voicing
- Delayed phonation approach
- Downward slide
- Blending
- Elongation of vowel sounds and increased duration of voice continuant consonants
- Identify hard vs easy onsets
- Negative practice
- Exaggerated oral movements/open mouth approach
- Prolongation of final /l/
Altering tongue position
Useful for P who have adopted faulty positioning of tongue.
Improves quality and resonance of voice
Proper positioning of tongue - oral resonance cavities to function more naturally in their amplification of voice.
A. Posterior tongue position: occludes pharynx, hollow-sounding resonance, focus of voice appears to be pharyngeal
B. Anterior tongue position: Thing quality - baby-talk voice, lacks full resonance of back vowels, immature.
Inhalation phonation
P learns to produce voice during inspiration rather than expiration - true vocal fold approximation and vibration - high pitched vocalisation.
Progress from initiating voice on inhalation to voice produced on exhalation.
Useful for any voice P not using true vocal fold vibrations eg. ventricular dysphonia, functional dysphonia, occasionally puberphonic patients, spasmodic dysphonia (use inspiratory speech to replace expiratory speech on permanent basis).
Breathy phonation: the confidential voice
Useful for P with hyperfunctional laryngeal behaviour associated with vocal abuse/misuse (reduction of hyperfunction in functional dysphonia and in vocal hyperfunction resulting in vocal fold thickening and nodules).
P concentrates on making voice very breathy - decreased loudness, decreased rate and increased awareness of expiratory airflow.
- Seems to create a more open and relaxed airway.
This should only be used for a circumscribed period of time.
Confidential voice is not a whisper.
Chewing approach
Used to reduce generalised vocal hyperfunction - reduces tension in vocal tract and laryngeal areas.
Encourages mouth opening and reduces mandibular tension.
Promotes more optimum vocal fold size/mass adjustments and better VF approximation.
Influence loudness, pitch and quality in hyperfunctional disorders without VF pathology.
Organic disorders - useful for VF thickening, vocal nodules, polyps, contact ulcers, chronic laryngitis.
Digital manipulation, pressure and massage
Used to reduce ‘cramping’ in extrinsic and intrinsic laryngeal muscles
P with musculoskeletal tension as in MTD and psychogenic disorders
Induces relaxation, promotes lowered laryngeal postion –> ease of phonation.
Push/pull technique
Designed to force effortful closure of glottis.
Used to improve vocal fold adduction (hypofunctional laryngeal behaviours) - RLN palsy, bowing of VF, used to elicit lowered pitch in puberphonics and voicing in patients with psychogenic aphonia.
Potentially abusive - use carefully and sparingly.
Effects noted fairly quickly - not necessary to prolong use.
Pushing - push against a wall, push down on chair etc.
Pulling - pulling up on heavy desk, pulling up chair etc.
Voice eliciting techniques
Used to elicit voice in patients with psychogenic dysphonia.
Used to elicit normal voice in dysphonic patient with no positive laryngeal findings.
- spontaneous laughing, coughing etc.
Oral resonance therapy
Goal - to increase oral cavity space anteriorly and posteriorly - reduces vocal hyperfunction.
- Promotes optimum approximation of vocal folds.
- Involves exercises to increase oral cavity space - palatal, pharyngeal, and lip, tongue and jaw exercises.
Use with MTD or other (hyper)functional dysphonias - particularly with tension in jaw and neck.
Projection exercises
Projection - maximising listener intelligibility with minimal speaker effort.
Essential components - strong breath support for speech (foundation) and overarticulation (enhances perception of increased loudness and max. production of words).
Useful for conversational settings in presence of loud background noise, telephone use, classroom teaching, public speaking.
Not sufficient for stage projection.
