Voice Therapy Flashcards
What are van Riper’s components of voice therapy
- Recognition of the problem by the patient
- Production of a new, more appropriate sound
- Stabilization of the new vocal behaviour in many contexts
- Habituation of the new voicing behaviour in all situations
What are the 6 schools of voice therapy
- Hygienic voice therapy
- Symptomatic voice therapy
- Psychogenic voice therapy
- Physiologic voice therapy
- Holistic voice therapy (one size fits all)
- Eclectic voice therapy
In hygienic voice therapy, what is the rationale for hydration?
the excitation of moist vocal folds takes less pulmonary energy. Moisture protects the folds from injury and helps reversing existing lesions
Describe irritable larynx syndrome
- a hyperkinetic laryngeal dysfunction resulting from an assorted collection of causes in response to a definitive triggering stimulus
- Involves symptoms of tension, dysphonia and chronic cough.
- Sensory trigger: airborne or esophageal irritant
What is symptomatic voice therapy?
-a collection of different techniques and you use whatever works with your client
What are the four categories or symptomatic voice techniques?
- Relaxing techniques for a hyperfunctional system
- Activating techniques for a hypofunctional system
- Techniques targeting secondary aspects of voice production
- Techniques related to counseling and awareness
Describe chant talk
easy, continuous phonation in the style of religious chant or legato singing is beneficial for all kinds of vocal hyperfunction. (relaxing)
- Legato singing and breathy production
- Alternate chant and regular voice in 20 second intervals
- Record different voices and discuss differences
- Carry over relaxed approach into conversational speech
Describe Froeschel’s chewing
- beneficial for both vocal hyperfunction and muscular tension dysphonia. (relaxing)
- Voice is softer and more nasal
- Explain to patient how chewing can reduce tension
- Pretend chewing of a tasty food (if necessary, start with real food), exaggerate the chewing motions, take ‘large bites’ and chew with a ‘full mouth’.
- Add soft phonation and start mumbling with a full mouth. The tongue must move around (not just jaw motion)
- Alternate chewing and word production. Expand to longer phrases and counting
- Provide auditory feedback
- Expand to conversational speech and reduce chewing
-Describe establishing a new pitch
there is no optimum pitch but pitch adjustments may be beneficial for many patients. (secondary)
- Explain the problem and the direction of the desired pitch adjustment
- Optimum pitch can often be determined via biological vocalizations
- Provide instrumental feedback (Visipitch)
- First establish pitch on stable monopitch and monoloudness vowels, words and phrases
- Once new pitch has been stabilized, work on pitch and loudness inflections
- Transfer to conversation and spontaneous speech
Describe glottal fry technique
- Rationale: True “Strohbass” can only be produced with very short and relaxed vocal folds and requires little subglottic air-pressure
- Helpful for patients with mass-lesions such as nodules or polyps since the relaxed vocal fold wraps around the lesion
- Can be used to temporarily “clear” dysphonic voices
- Use the normal glottal fry on vocal offset to facilitate the approach
- If necessary, try glottal fry on inhalation phonation
- Practice isolated vowels and short words
- Practice short sentences: ‘Easy does it’ etc.
- Alternate normal and Strohbass voice to achieve a more relaxed voice
Describe inhalation phonation
- Rationale: Inhalatory adduction results in a high- pitched voice
- Particularly useful for functional or psychogenic dysphonias
- Facilitating technique for patients with ventricular fold phonation
- Use shoulder elevation to facilitate inspiration for inhalation phonation
- Change between inhalation and exhalation voice
- Match voice quality and pitch between inhalation and exhalation voice
- On inspiration, sweep down to habitual pitch
- Drop the facilitating shoulder movement
- Move on to words, phrases, conversation etc. on inhalation and exhalation
Describe the yawn-sigh technique
- Rationale :Relaxed yawning reduces laryngeal tension, lowers the larynx and widens the pharynx
- Procedure: Yawning phonation: one word per yawn -Use an open-mouth sigh to extend the duration of phonation
- Practice words with low vowels and syllable-initial /h/
- Transfer relaxed voice to normal speech
Describe the half-swallow boom technique
- Rationale: The approximation of the vocal folds during swallowing is used to facilitate voice. This approach is most useful for patients with unilateral vocal fold paralysis, partial laryngectomy, bowing or falsetto voice
- Procedure: Swallow. Right on top of the swallow, say ‘boom’. If indicated, combine with head rotation. Expand the phrase length after the boom, then phase out the boom as the carry-over improves
- We are using the swallowing maneuver to bring the larynx up high and the to get the vocal folds closed and we use this adduction to start voicing
What are the two techniques within psychogenic voice therapy that we discussed?
- Cognitive-behavioural therapy
- Progressive muscle relaxation
What are the three techniques of physiological voice therapy we discussed?
- Coblenzer’s concept of reflexive breath replenishment
- The Alexander technique (posture)
- The Feldenkrais technique (redefine movement ranges)
