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Name the categories of voice tx

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Hygienic Symptomatic Physiologic Psycogenic Eclectic

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Rationale for Hygenic tx

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-Modify/eliminate BEHAVIORAL cause of voice disorder -Modify/eliminate inappropriate vocal behaviors

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Name some vocal risks (bad vocal hygiene)

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Yelling/shouting/loud talking Throat clearing Loud talking Coughing Hard glottal attacks Poor hydration Uncontrolled allergies and reflux Inadequate breath support

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Plan for hygienic tx

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Identify risks specific to pt Do not give long list of items to accomplish Need compliance to be successful

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Symptomatic voice tx rationale

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Modification of deviant vocal symptoms and components (i.e. breathiness inappropriate pitch, loudness, etc.) Decrease muscle tension, hard glottal attacks Increase glottic closure

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Symptomatic voice tx exercises

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Yawn-sigh Chewing Easy onset and linking Chanting Circumlaryngeal massage

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Yawn-sigh rationale

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Lowers larynx Relaxes laryngopharynx Releases supraglottic squeezing Decreases intrinsic or supraglottic tension

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Yawn-sigh steps

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1. Relax jaw 2. Gradually open mouth 3. Allow air to flow in 4. Hold stretch at top of inhalation 5. Exhale w/ or w/o sigh 6. Zero tolerance for neck, shoulder, facial tension

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Chewing rationale

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Disengages laryngeal tension

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Chewing steps

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1. Chewing while speaking

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Easy onset and linking rationale

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Trains continuous airflow Links vowels and consonants Eliminates hard glottal attacks Teaches onset of vowel phonation

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Easy onset steps

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1. Link vowel to preceding consonant * red apples pronounced as redapples - no attack on vowel

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Chanting rationale

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Trains continuous airflow Performed using /m,n/ initial CV forms

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Chanting steps

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1. Start at CV level 2. Move to words, short phrases and then sentences

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Circumlaryngeal massage rationale

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1. Massage at major horns of hyoid 2. Massage at horns of thyrohyoid 3. Massage within thyrohyoid space 4. Massage within suprahyiod 5. Massage along anterior border of sternocleidomastoid

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Physiologic voice tx rationale

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Modify underlying physiology of voice producing mechs: respiration, phonation, resonance Improves balance amongst respiratory support Improves laryngeal muscle strength, control and stamina Improves supraglottic modification of tone Promote healthy vocal fold core Balances subsystems to correct disturbances

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Types of physiologic tx

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Vocal function exercises Lessac Masden Resonant Voice Accent Method Flow phonation Lee Silverman Voice tx Semi-Occluded Vocal Tract Exercises

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Vocal function exercises rationale

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Strengthen/balance laryngeal musculature Improve efficiency of airflow, vibration and phonation relationship May improve glottic closure Used for hyper and hypo function individuals

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Vocal function exercise steps

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1. Warm-up: sustain "eee" with frontal focus 2. Expansion exercise: Pitch glide up, on "oh or "no" 3. Contraction exercise : Pitch glide down 4. Power exercise: Sustain "o" on C, D, E, F and G

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When to use vocal function exercises

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Hypofunction - presbyphonia, paresis, bowing Vocal fatigue Decrease of medial compression

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Leesac Masden Resonant Voice rationale

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Decrease hyper function Decrease VF compression Increase loudness Increase ability to project

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Resonant voice steps

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1. Direct resonantory sensation towards oral cavity, alveolar ridge, cheek bones 2. Begin w. humming CV syllables(/m, n, j, r, z/) or chanting 3. Move towards words, phrases, sentences and conversation

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When to use resonant voice

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Hyper or hypo functional disorders

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Accent method rationale

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Improves coordination of respiration and phonation Increases respiratory drive May increase VF approximation for hypo function Decreases medial compression Teaches flow phonation

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Accent method steps

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1. Establish resting breath 2. Breathing and phoning while rocking body forward and back 3. Produce sustained voiceless and voiced consonants (fricatives) 4. Produce sustained vowels and CV syllables 5. Produce sounds with different rhythms

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When to use accent method

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To increase abdominal breathing To increase aspirated vocal onset To in crease rhythmic intonation in speech To encourage appropriate pitch and loudness

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Flow phonation rationale

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Increases airflow and decreases medial VF compression Frontal tone focus w/o constriction, tension or hard glottal attacks Flowing, connected speech

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Flow phonation steps

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1. Sustained voiceless and voiced fricatives 2. Glides and nasal consonants in CV form 3. "Cup bubble" exercise w/ and w/o voice 4. Gargle w/ and w/o voice Blowing tissue paper w/ and w/o voice

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When to use flow phonation

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Best for hyper function clients but can be used for hypo function as well

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Lee Silverman tx rationale

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Intensive form of tx Delivered 4 days a week for 4 weeks Recalibration of vocal effort and self-perception

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Lee Silverman steps

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1. Sustained loud phonation on "ah" 2. Pitch glides up 3. Pitch glides down 4. Target adequate loudness for; -Functional phrases -Sentences -Paragraph reading -Spontaneous speech

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Semi-occluded vocal tract "straw phonation" rationale

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Facilites matching Increases VT inertance Necessitates greater respiratory drive Increases VF closure Lowers larynx Decreases throat tension Trains frontal focus

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Semi-occluded vocal tract steps

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1. Narrow straw for hyperfunction Wide straw for hypo function 2. Use glass with 2 cm of water 3. Pitch goides 4. Reving 5. Speech patterns *Can do lip or tongue trills

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When to use straw phonation

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Increase closure for: -paralysis -paresis -VF bowing Used for hyper functional client

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Symptomatic techniques for primary and secondary muscle tension dysphonia

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Laryngeal massage Tongue stretches Neck stretches Jaw massage Supraglottic relaxation exercises Yawn sigh Easy onset

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Symptomatic techniques for extra laryngeal tension

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Laryngeal massage Jaw tension massage Neck relaxation stretches Progressive relaxation Rag doll exercise

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Symptomatic techniques for intrinsic or supraglottal tension

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Yawns Tongue stretches Slurping spaghetti Silent laughter - abducts vocal folds opens supraglottic area, owes larynx

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Symptomatic techniques for establishing abdominal breathing

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Sitting and leaning forward, forearms on knees Standing with arms up crossed over head Pavone exercise Sustained /f/ exercise Verbal instructions Lying flat (prone position)

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Symptomatic techniques for increasing adduction in hypo functional pts

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Push pull adduction exercises

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How do push pull adduction exercises woek

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Push/pull arms together or apart while producing short vowel or /m/ initial CV syllable

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Eclectic voice tx

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Uses 2 or more tx philosophies

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