Voice Therapy

1. Voice TherapyVoice Therapy
CDIS 700CDIS 700

2. General Points Regarding Voice TherapyGeneral Points Regarding Voice Therapy
There is no single approach that will work There is no single approach that will work
with all clients/disorders.with all clients/disorders.
Successful therapy will use a holistic Successful therapy will use a holistic
approach that combines:approach that combines:
–Behavioral therapy Behavioral therapy
–Cognitive training Cognitive training
–CounselingCounseling

3. A “Typical” Therapy SessionA “Typical” Therapy Session
Engage the client in general conversation. Engage the client in general conversation.
–Note how the client’s voice sounds when they are Note how the client’s voice sounds when they are
relaxed and therapy doesn’t seem like it has relaxed and therapy doesn’t seem like it has
officially begun.officially begun.
Segue into how the client’s voice was and how Segue into how the client’s voice was and how
practice of techniques from the previous practice of techniques from the previous
session.session.
Pick one or two techniques to work on during Pick one or two techniques to work on during
the session.the session.
End a bit early to assign “homework” for the End a bit early to assign “homework” for the
next session. Be sure to leave time to address next session. Be sure to leave time to address
questions.questions.

4. Facilitating ApproachesFacilitating Approaches
Your authors provide a discussion of 25 Your authors provide a discussion of 25
therapeutic techniques that may be used to treat therapeutic techniques that may be used to treat
voice disorders.voice disorders.
Review the DVD that accompanies your bookReview the DVD that accompanies your book
Here we will cover some of the fundamentals:Here we will cover some of the fundamentals:
–RelaxationRelaxation
–Respiration trainingRespiration training
–Elimination of abusesElimination of abuses
–Yawn-sigh techniqueYawn-sigh technique
–Vocal Function ExercisesVocal Function Exercises

5. RelaxationRelaxation
Voice symptoms: diplophonia, dry throat Voice symptoms: diplophonia, dry throat
and mouth, harsh voice quality, elevated and mouth, harsh voice quality, elevated
pitch, functional dysphonia, shortness of pitch, functional dysphonia, shortness of
breath.breath.
Progressive relaxation is a common type Progressive relaxation is a common type
of relaxation training: of relaxation training:
http://www.youtube.com/watch?v=KmxfjjamcuY&feature=relatedhttp://www.youtube.com/watch?v=KmxfjjamcuY&feature=related
Accompanying techniques: yawn-sigh, Accompanying techniques: yawn-sigh,
open-mouth approachopen-mouth approach

6. Respiration TrainingRespiration Training
Voice symptoms: Shortness of breath, “squeezing” Voice symptoms: Shortness of breath, “squeezing”
out words, hyperfunctional voice. out words, hyperfunctional voice.
Clinician must be able to demonstrate good Clinician must be able to demonstrate good
diaphragmatic breathing and explain how respiration diaphragmatic breathing and explain how respiration
works in client-appropriate terms.works in client-appropriate terms.
Start small and gradually increase length of Start small and gradually increase length of
utterance; do not let the client phonate longer than utterance; do not let the client phonate longer than
they can sustain a good quality voice.they can sustain a good quality voice.
Compare and contrast voicing with good respiration Compare and contrast voicing with good respiration
and poor respiration. The client should be able to and poor respiration. The client should be able to
switch between the two and note the difference on switch between the two and note the difference on
voice production.voice production.
http://http://www.youtube.com/watch?vwww.youtube.com/watch?v=YMp-Zqbud_0=YMp-Zqbud_0

7. Elimination of AbusesElimination of Abuses
Review with all clients those behaviors that constitute Review with all clients those behaviors that constitute
vocal abuse, including hard glottal attacks, using vocal abuse, including hard glottal attacks, using
inappropriate pitch, etc. inappropriate pitch, etc.
Counsel clients on these abuses/misuses. Ask them to Counsel clients on these abuses/misuses. Ask them to
identify which of these behaviors they use and how they identify which of these behaviors they use and how they
might avoid them. Work to provide alternatives to might avoid them. Work to provide alternatives to
abusive behaviors.abusive behaviors.
Therapy ideas for childrenTherapy ideas for children and and tips for adultstips for adults

8. Yawn Sigh TechniqueYawn Sigh Technique
Relaxes the vocal mechanismRelaxes the vocal mechanism
Voice symptoms: functional dysphonia, spasmodic Voice symptoms: functional dysphonia, spasmodic
dysphonia, nodules, polyps, vocal fold thickeningdysphonia, nodules, polyps, vocal fold thickening
Accompanied by digital manipulation/laryngeal Accompanied by digital manipulation/laryngeal
massage if necessary.massage if necessary.
Demonstrate the technique, beginning with a yawn Demonstrate the technique, beginning with a yawn
and sighing with an open mouth. Add a vowel on and sighing with an open mouth. Add a vowel on
the sigh, then proceed to words that start with /h/ the sigh, then proceed to words that start with /h/
= = hahhah..
Once the client has mastered this technique, they Once the client has mastered this technique, they
should remember the feeling that accompanies the should remember the feeling that accompanies the
yawn-sigh, and should be able to obtain the same yawn-sigh, and should be able to obtain the same
effects without actually engaging in the technique.effects without actually engaging in the technique.
Sample of student cliniciansSample of student clinicians

9. Stemple’s Vocal Function Exercises
1. Warm-up. Sustain /i/ as long as possible on a
comfortable note.
2. Stretching. Glide from the lowest to the highest note
in the frequency range, using /o/.
3. Contraction. Glide from the highest to the lowest note
in the frequency range, again using /o/.
4. Adductory Power Exercises. Sustain the notes C, D, E,
F, and G (still using /o/) as long as possible. Middle C for
females, one octave below for males.
Do twice in a row (first very quietly) about twice daily.
Many variations on these exercises: see
YouTube example

10. How Can We Document Progress?How Can We Document Progress?
According to Andrews (2006), we can:According to Andrews (2006), we can:
–Gather tape recordings of the pre- and post-Gather tape recordings of the pre- and post-
therapy voice.therapy voice.
–Obtain videorecordings of the vocal folds pre- Obtain videorecordings of the vocal folds pre-
and post-therapy.and post-therapy.
–Obtain instrumental measures (e.g., the Visi-Obtain instrumental measures (e.g., the Visi-
Pitch or electroglottograph) when available.Pitch or electroglottograph) when available.
–Make graphs, or use rating scales, quizzes, Make graphs, or use rating scales, quizzes,
etc. to chart progress.etc. to chart progress.

11. Sample Dismissal Criteria Sample Dismissal Criteria
(Andrews, 2006)(Andrews, 2006)
Voice doesn’t sound tenseVoice doesn’t sound tense
People don’t ask if I have a coldPeople don’t ask if I have a cold
Voice doesn’t tire quicklyVoice doesn’t tire quickly
Voice carries well/people don’t ask me to speak Voice carries well/people don’t ask me to speak
up/people can hear meup/people can hear me
My voice sounds livelyMy voice sounds lively
I understand how to protect my voiceI understand how to protect my voice
Voice is clearVoice is clear
Voice is expressiveVoice is expressive
I sound confidentI sound confident

12. Dismissal Criteria (cont.)Dismissal Criteria (cont.)
Reduction of hard attacks by 80%Reduction of hard attacks by 80%
Elimination of throat clearingElimination of throat clearing
Normal looking vocal foldsNormal looking vocal folds
Resolution of vocal nodules or pathologyResolution of vocal nodules or pathology
Clearance from otolaryngologistClearance from otolaryngologist
Replenishing breaths used 90% of the Replenishing breaths used 90% of the
timetime

13. Summary
No “cookbook” approach to voice therapy.
Impossible to cover all techniques in class;
be prepared to learn on your own
Be flexible and be ready to substitute one
technique for another depending on
client’s needs.