Voice Therapy Techniques

Question 1

Resonant Voice

Answer 1

Any voice production that is both easy to produce and vibrant in the facial tissues
Low-impact, large-amplitude vibrations
Neither pressed nor breathy
Neither taxing nor restricted to low intensity

Question 2

Resonance

Answer 2

a reinforcement of vocal fold vibration by the vocal tract air column

Question 3

Sensations of Resonance

Answer 3

Bony structures pick up vibrations from acoustic standing waves in the oral cavity propagated to brain, skull, not so much the air
Sound radiates primarily from mouth and nostrils

Question 4

Nonlinear Source-Filter Theory

Answer 4

Acoustic pressures in the vocal tract may either help or hinder vocal fold oscillation

Question 5

Inertance clinical definition

Answer 5

occurs when there is a delay between stimulus (pulse of air from the opening TVFs) and response (acceleration of the vocal tract air column)
-this is one of the mechanisms that sustains vocal fold oscillation

Question 6

Compliance

Answer 6

occurs when there is a response in advance of the stimulus

-this hinders sustained vocal fold oscillation (e.g., may cause voice breaks)

Question 7

Inertance research definition

Answer 7

When compression occurs above the glottis during the opening phase, and rarefaction occurs during the closing phase, this facilitates TVF oscillation

Question 8

Facilitate Inertance

Answer 8

Semi-occlusion of the vocal tract (SOVT)

Question 9

Semi-occlusion of the vocal tract (SOVT)

Answer 9

already built into many successful voice therapy approaches

may be done in nonspeech and speech exercises

Question 10

Theoretical effects of SOVT

Answer 10

Modeling studies suggest semi-occlusion may: increase vocal tract inertance (which facilitates TVF vibration), decreased PTP, increased harmonic content, increase vocal economy, decrease hyperadduction

Question 11

Effects during SOVT

Answer 11

May alter vocal tract spaces (more inertance)
May balance laryngeal muscle activation and improve vocal economy/efficiency
May prevent large collision forces during loud voicing

Question 12

Effects immediately after SOVT

Answer 12

Several studies suggest improved voice quality
Increased spectral energy around the singer’s formant cluster in one subject and vocal tract configuration remained changed

Question 13

Treatment considerations

Answer 13

target population
rationale (biomechanical target, mechanism of change)
Credentialing requirements
evidence
what-how-if

Question 14

Lee Silverman Voice Therapy

Answer 14

Population: Parkinson’s Disease (other neurogenic dysarthrias, cp, vocal fold bowling)
Target: LOUD
Rationale: singular focus on increased loudness ot increase neural drive, sensory recalibration, high intensity, quantitative feedback

Question 15

Lessac-Madsen Resonant Voice Therapy

Answer 15

Population: hyperadduction (e.g., phonotrauma), hypoadduction (e.g., MTD, bowing, paresis)
Target: barely ab/adducted TVFs “resonant” voice quality
Rationale: uses speech-embedded semi-occlusions to train optimal vocal tract configuration for efficient/low-impact voice

Question 16

LSVT Treatment Schedule

Answer 16

16 sessions, 2 or 4x/week (4 or 8 weeks)
Daily homework BID
Daily “variables”:
Sustain /a/ as long and loud as possible x6
Glide up to highest pitch on /a/, sustain loudly 2-3 seconds
Glide down to lowest pitch on /a/, sustain loudly 2-3 seconds
10 functional phrases, loudly (also reading, conversation)

Question 17

LMRVT Treatment Schedule

Answer 17

8 sessions over 4-8 weeks
Vocal hygiene, stretches
Exploratory exercises using semi-occluded consonants (nasal, voiced continuants)
Heirarchical progression
Hum-chant-phrases-simple conversation-complex conversation
Daily home exercises; vocal communicator
Emphasis on sensory targets, self-assessment

Question 18

CSCFT

Answer 18

Improved voice in young women with nodules

Question 19

CSCFT Treatment Schedule

Answer 19

Begin with establishing airflow (originally unvoiced), move to vowels (/u/), words, phrases, conversation
Tactile/visual feedback (finger, tissue)
Incorporate resonant voice cues m, z, v, zh (flow into resonance)
Similar program structure to LMRVT

Question 20

Flow-Resistant Tube Exercises

Answer 20

Population: hyper-and hypoadduction
Targe: Barely ab/adducted vocal folds, abdominal breath support, inertive vocal tract
Rationale: narrowing and lengthening the vocal tract creates inertance; glides “stretch” and back pressure “unpresses” vocal folds; nonspeech exercises minimize cognitive load

Question 21

FRT

Answer 21

Series of nonspeech exercises all performed through a thin tube
glides, accents, singing, reading

Question 22

Vocal Function Exercises (VFE)

Answer 22

Populatio: hyper- and hypoadduction
Target: “balance” of subsysems; probably also barely ab/adducted TVFs
Rationale: uses semi-occlusions (lip buzz) to train balanced airflow/adduction/resonance; very soft productions train coordination; pitch glides stretch TVFs

Question 23

VFE Schedule

Answer 23

Four exercises, BID
All exercises performed as softly as possible with voice “engaged”
Warm-up: nasal focused /i/ on C, long as possible x2 (can substitute labial frication)
Stretch: Glide to highest pitch on buzzy /o/ x2
Contract: Glide to lowest pitch on buzzy /o/ x2
Power: Max sustained buzzy /o/ x2 each on C, D, E, F, G