Voice therapy in children

Question 1

What are the guidelines for management?

Answer 1

Provide education

• vocal production
• characteristics of vocal behaviour

Use simple explanations of terminology
- pictures, puppets etc.

Make it relevant

• Link rationale and outcome of therapy to child’s current needs and life.
• Important for motivation
• Need to be convinced that therapy is necessary and beneficial.

Therapy goals needs to be explained in a relevant way.

Family and significant others need to be included.

Therapy planning and charting of progress

• Fit to developmental age of child
• Determine vocal abuses
• Specific examples of steps
• Use visual aids

Techniques appropriate for child’s developmental age

• relevant to child’s world
• Specific events and situations

Question 2

What is the Boone Voice Program for Children?

Answer 2

Program based on the therapeutic approaches described in Boone book.
Provides clincian with step-by-step procedures to remediate voice disorders in school-age children.
Describes different voicing techniques such as chewing, eliminating hard glottal attack and changing focus.

Question 3

What is the Ten Step Voice Therapy Outline?

Answer 3

1. Taught correct standard of a voice parameter.
2. Taught to identify incorrect voice in others.
3. Taught to identify correct voice in others.
4. Recognises incorrect voice in him/herself
5. Differentiates between poor and correct voice
6. Identifies situations where uses poor voice.
7. Identifies situations where voice is good.
8. Carryover - good voice used SOME of the time.
9. Carryover - good voice used MOST of the time.
10. Carryover - good voice used ALL of the time.

Question 4

What is the Andrews Voice Therapy for Children?

Answer 4

4 phases:

1. General awareness of problem and benefits of therapy.
2. Specific awareness - identifies poor and good vocal behaviours and discriminates between them.
3. Production - produces target behaviours, establishes control in immediate environment.
4. Carryover - habituating target for increasing periods periods of time.

Question 5

What is Listening Training?

Answer 5

1. Awareness of differences in others: child signals abnormal voice.
2. Gross discrimination of differences in others: same/different technique.
3. Fine discrimination of differences in others: 3 levels of vocal performance eg. high, middle, low loudness, pictures used to demonstrate levels.

Question 6

Negative practice

Answer 6

Deliberate use of undesirable voice habit.
Use cautiously - only in therapy! This is not for all children.
Able to use negative practice when capable of producing desired voice.
2 steps:
1. Gross differences - use 2 types of voice (good and bad).
2. Fine differences - 3 or 4 different types of voice.

Question 7

What is charting used for?

Answer 7

Purpose:

1. Establish baselines.
2. Document changes during therapy, after and at follow up.
3. Analyse therapeutic process
   - Initially chart vocal abusive behaviours
   - Chart use of specific voice production techniques taught in therapy.

Question 8

Prevalence of disorders in children.

Answer 8

6-9% of school-age children but only approx. 1 % receive treatment.
Because:
- disorder does not affect academic performance.
- difficulty convincing parents that something needs to be done.
- Requires medical exam before treatment.
- Teacher awareness of voice disorders.

Question 9

What are some preventative measures?

Answer 9

Educate classroom teachers.
Educate parents.
Use a team approach:
- Work with music and PE teachers.
- Screen vocal health and hygiene and give a lesson on vocal hygiene during music lessons.