Voice therapy approaches

Question 1

Auditory Feedback:

Answer 1

real time amplification, loop playback, external metronomic pacing

Question 2

Change of loudness

Answer 2

• Decrease Loudness: Young Children-increase awareness from whisper, quiet voice to awaken someone, normal voice, voice across the room, to yelling; Sound-level meter

• Increase Loudness: recorded feedback, explore appropriate pitch to achieve louder voice; respiration training (little evidence indicates particular way of breathing);Sound-level meter for LSVT, Lombard Effect-voice louder when reading/speaking against increasing competing noise @ 75dB speech-range masking.
o Parkinson’s

Question 3

Chanting

Answer 3

monopitch, alternate between chant and normal intonation, chant to prolonged speech with soft glottal onset, add yawn-sigh or open-mouth

Oral resonance- anyone that drops their voice back, raspy voice, glottal fry

Multiple tension dysphonia, paresis and paralysis

Question 4

Chewing

Answer 4

visual feedback of a mirror in isolation, with nonsense words, ie. Ah-la-met-erah or wan-da-pan-da, chew and produce words and phrases, auditory feedback, & just think it

People who have a tight jaw or do not open their mouths when they speak.

Question 5

Confidential Voice

Answer 5

breathy, light voice, don’t want to awaken someone or library voice, reinforce the 5 levels of loudness

Oral resonance patients- because patients shouldn’t whisper

When a patient has no carryover they can use prolonged speech.

Question 6

Counseling

Answer 6

not easy to separate the person from the voice, symptom of serious personality problems or may cause psychological maladaptive reactions, be sensitive to patient’s attitude & self image, Voice Handicap Index measures this

Medial compression and pull down for patients with paralysis or paresis

Strained voice – push back or pull down

Circumlaryngeal massage

Question 7

Digital Manipulation

Answer 7

anterior pressure, during the yawn-sigh method digital monitoring of laryngeal height, digital pressure on the lateral thyroid cartilage for better vocal fold approximation with head turn when needed

Question 8

Establish new pitch

Answer 8

will improve vocal quality & loudness with Visi-Pitch with split screen capabilities permits comparison of model & trial productions using words which begin with vowels, phrases, sentences, reading in monotone, real life conversation
• Falsetto or glottal fry

Question 9

Focus

Answer 9

Thin Quality when tongue is high & forward, Cul-de-sac resonance when tongue is elevated in back of mouth, Produce back sounds when have front of the mouth focus: Kuh, Guh, Produce anterior sounds when have posterior focus: peep or pipe. Poor Vertical Focus when voice is focused deep down in throat, Produce: nasal consonants in the “facial mask” m/n/ing
• Oral resonance

Question 10

Glottal Fry

Answer 10

from 24-72 Hz which is produced in a relaxed manner with little airflow & subglottic air pressure, open mouth approach & protrude the tongue producing /i/ on both inhalation & exhalation

Question 11

Head Positioning

Answer 11

normal straight head, neck extended forward with head tilted up or down, neck flexed unilaterally with head tilted left or right, head upright & rotated left or right

Question 12

Hierarchy Analysis

Answer 12

people or situational strengths to weaknesses, ie. best voice: talking with my mom verses worse voice: meeting new people.

Question 13

Inhalation phonation

Answer 13

high pitched sound palms up/down
• Strokes
• Gives higher pitch to someone who is low

Question 14

Laryngeal Massage:

Answer 14

after Yawn-Sigh is attempted

Question 15

Nasal-Glide

Answer 15

monosyllabic productions CVC units “man a man a man”

• See if a person can change their pitch- any nasal control

Question 16

Open Mouth Approach:

Answer 16

chewing

Question 17

Pitch Inflections:

Answer 17

using the Visi-Pitch within specific words, keeping loudness the same

Question 18

Redirected Phonation

Answer 18

coughing, gargling, humming, laughing, singing, throat clearing, trilling, uh-hmm
• For someone who is aphonic.

Question 19

Relaxation:

Answer 19

Visual Imagry, release tension in various body parts, open throat via open, prolonged yawn

Question 20

Respiration Training

Answer 20

body position, lieing down, standing, sitting, outgoing airstream, sighing, prolonged exhalation, sustained voiceless phonemes verses vowels up to at least 20 seconds, children blowing on pinwheels, tissue paper as they time themselves

Question 21

Tongue Protrusion

Answer 21

/i/ while going up/down in pitch, producing arpeggios, sustaining vowels, producing /mimimimi/

Question 22

Visual Feedback:

Answer 22

Nasometer with digital feed back (Kay Pentax), Speech Apps (Bla Bla Bla) or (Sound Level Meters), use LapTops or Smartphones with permission, YouTube video

Question 23

Yawn-Sigh:

Answer 23

prolonged easy, open mouth exhalation, imagine the approach