Voice Therapy Tips for SLPs

“To remediate a voice disorder, we must have the skills to counsel and motivate and to remember that the voice is a mirror of the soul”. Being that voice therapy is a particular specialization within our field, it is imperative for clinicians to research current therapy techniques and select and implement an appropriate voice therapy program. In addition, the SLPs role is to develop an appropriate relationship with the patient and caregivers, consistently provide ongoing education in regards to the voice disorder along with treatment, help the patient develop self-monitoring skills and always refer with sensitivity. Further, the SLP should analyze the patient’s life-style and environmental factors relating to their vocal behaviors, present hierarchies and strategies to reduce and eliminate vocal abuse behaviors, explain and model facilitative techniques, use materials/strategies that interest the patient, collect data, document progress, refine goals, model excellent vocal use and always counsel! Individualization of voice therapy is dependent on the patient’s diagnosis, need for medical intervention and patient motivation.

Long term goals of voice therapy are to:

  • Optimize function of the larynx
  • Eliminate vocal pathology
  • Produce optimal vocal quality
  • Rebalance the subsystems of respiration, phonation, and resonance.

Management strategies may include patient education and counseling, vocal hygiene counseling, elimination of vocal misuse/abuse, management of Gastroesophageal Reflux Disorder (GERD) and Laryngopharyngeal Reflux (LPR), tension reduction exercises, vocal warm-ups, abdominal breathing, respiratory training and easy onset phonation.

Patient education and counseling may include instruction in the anatomy and physiology of the vocal mechanism, along with discussion in regards to the three subsystems. Vocal hygiene counseling includes discussions about hydration (e.g. drinking water, carbonated waters, herbal teas), lubrication (personal steam inhalers, shower steaming, room air humidifier) and vocal rest, whether it be complete or modified. Eliminating vocal misuse/abuse involves educating the patient on the effects of their misuse or abuse (e.g. smoking, alcohol, caffeine, yelling, screaming, habitual throat clearing, and/or coughing).

Management of GERD and LPR involves educating the patient about their diagnosis and discussing medical management. With these specific diagnoses, it is imperative that the patient be compliant with medication. Tension reduction exercises include stretches for the neck, shoulders, back, jaw, tongue, lips, soft palate, and respiratory muscles. Vocal warm-ups include the yawn-sigh, hum-sigh, glides, lip-trills and musical scales. Abdominal breathing and respiratory training involves exercises that focus on the lower thoracic abdomen rather than the shoulder muscles for breathing. Easy onset phonation involves easing into vowel-initiated words and practicing throughout a hierarchy (e.g. nonsense syllables → words → phrases → structured sentences → paragraphs → conversation).

It is extremely important for SLPs to be knowledgeable of Vocal Function Exercises, Lessac-Based Resonant Voice Training and Lee Silverman Voice therapy. Lastly, always remember that comprehension involves compliance. As for anything else, the patient needs to be fully educated and fully understand the exercises prior to independently completing them at home.

-Kristen Meaney, MA, CF-SLP

Lecture: Yvonne Knapp, LIU Post Spring 2017

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Phonological Processes: At What Age Should They Be Suppressed?

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Phonological Processes

Phonological processes are sound errors that typically developing children use to simplify speech as they are developing speech and language skills. A phonological disorder occurs when a child has not outgrown, or suppressed the phonological process past the expected age.

Phonological Process Description Age suppressed
Unstressed Syllable Deletion Children delete the unstressed syllable. (e.g. telephone → telephone) 3 years of age
Final Consonant Deletion Children delete the last consonant of a word. (e.g. hat → ha) 3 years of age
Consonant Assimilation One consonant influences another (e.g. bed → beb) 3 years of age
Reduplication The child repeats the first syllable two times. (e.g. bottle → baba) 3 years of age
Velar Fronting Back phonemes /k/ and /g/ are replaced by front phonemes /t/ and /d/. (e.g. cookie → tootie) ~ 3 years of age
Affrication A non-affricate sound is replaced by an affricate (“ch” or “j”). (e.g. door → joor) 3 years of age
Stopping A fricative sound like /f/ or /s/ or affricate sound like “ch” or “j” is substituted with a stop consonant like /p/ or /b/. (e.g. jump → dump) Between 3 and 5 years of age
Deaffrication An affricate “ch” or “j” is replaced with a fricative or stop like /sh/ or /d/. (e.g. chips → ships) 4 years of age
Cluster Reduction A consonant cluster is reduced to a single consonant (e.g. blue → bu) Between 4 and 5 years of age
Gliding Phonemes /r/ and /l/ are replaced by /w/ (e.g. love → wove; road → woad) 6 years of age
Epenthesis A vowel sound is added between two constants. (e.g. blue → bu-lue) 8 years of age

It is important for parents, caregivers and teachers to be knowledgeable of phonological processes. If any process is evident in the child’s speech past the age of seven years old, it is imperative that they are evaluated by a speech-language pathologist. Phonological processes can lead to significantly reduced speech intelligibility if they are left untreated.

Sources: Super Duper Publications; Mommy Speech Therapy.

-Kristen Meaney, MA, CF-SLP

 

Sensory Integration

Sensory Integration

Does your child demonstrate oversensitivity to certain noises, tastes, smells, or textures? They may be showing signs of sensory defensiveness. Sensory defensiveness is a negative reaction to a stimulus that most people would not perceive as negative. Children with sensory defensiveness show negative reactions to one or more types of sensations (e.g. touch, texture, taste, smell, or sound). Children with sensory defensiveness over-react to sensory input and become easily frustrated and/or bothered. These children may have difficulty processing sensory information. There are four different types of sensory defensiveness, including tactile defensiveness, gravitational defensiveness, auditory defensiveness and oral defensiveness.

  • Tactile defensiveness involves the tactile system, which is our sense of touch. Children with tactile defensiveness may overact to touch experiences, avoid daily activities (e.g. brushing their teeth, taking a bath), avoid light touch (e.g. taps on the shoulder, kissing, etc.), or seek deep pressure.
  • Gravitational defensiveness involves the vestibular system, which is our sense of movement and balance. Children demonstrating gravitational defensiveness may have abnormally fearful emotional reactions to something like swinging or climbing.
  • Auditory defensiveness involves fearful reactions to sound, such as covering ears when exposed to loud noises. Children with auditory defensiveness may display atypical emotional reactions when they hear a vacuum cleaner or leaf blower.
  • Oral defensiveness involves taste, smell, and tactile input. Children with oral defensiveness may be picky eaters, gag from certain textures, tastes, and/or smells during meals, and/or dislike brushing their teeth.

Sensory stimulation kits are utilized by parents, speech-language pathologists, occupational therapists, and teachers. Sensory kits are used to expose children to new feelings and encourage responses.  Sensory kits can be used for children of all ages to build schema, describe sensations, incorporate motor movements and play. When a child plays with a sensory bin, they are playing with a variety of materials and textures which stimulate the mind beyond what other toys can achieve. Sensory stimulation can help children develop focus, expand vocabulary, engage their mind through senses, improve fine motor skills, etc. Sensory kits can be paired with any of your favorite books! Here are some examples of easy sensory bins to make:

 

-Kristen Meaney, MA, CF-SLP

Source: Super Duper Publications

Central Auditory Processing Disorder in Children (CAPD)

Central Auditory Processing Disorder (CAPD) is defined as a breakdown of auditory information beyond the physical ability to hear, at the level of the central nervous system. In other words, CAPD occurs when the central nervous system has problems processing information that comes through listening. Research suggests that 3% to 20% of children have CAPD, and that a significant number of those children also have attention issues, along with Attention Deficit Hyperactivity Disorder (ADHD).

Although children with ADHD, autism, pervasive developmental disorder, and other global deficits may demonstrate poor listening skills, they do not necessarily have CAPD. Other disorders such as these often affect a child’s ability to attend to and interpret auditory information because they usually affect the same areas of the central nervous system. This can make the differential diagnosis quite difficult. However, CAPD is not a symptom, nor a result of global deficits (Bellis, n.d.).

Children with CAPD display several behaviors similar to symptoms associated with sensorineural hearing loss. For example, children with CAPD often demonstrate significant difficulty in the presence of background noise. In addition, they may have difficulty recognizing subtle differences between sounds in words or may have difficulty with interpretation of longer strands of auditory information, such as verbal directions. In school, children with CAPD may have difficulty spelling, reading, and understanding information presented verbally in the classroom. In addition, these children may demonstrate a significantly higher performance in classes that don’t rely heavily on listening (Bellis, n.d.). These behaviors may become apparent in the early school years, such as kindergarten or first grade, or at a later stage of the child’s life. This is likely due to increased academic demands placed on children in the elementary grades.

To diagnose CAPD, an audiologist administers a variety of tests that require the child to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Most CAPD assessments require the child to be at least seven years of age because younger children do not have the advanced brain function to interpret auditory stimuli of each assessment.

Speech-language pathologists help to treat children with CAPD and incorporate goals targeting the child’s strengths and weaknesses. It is important to provide the child with a quiet environment, especially when listening to important information and completing homework tasks. In addition, it is important to have the child keep a visual day planner and write down important information as soon as it is presented. Parents and caretakers should decrease their rate of speech when talking to the child and allow more time for the child to answer questions. Furthermore, it is extremely important to follow any goals and/or recommendations set up by the child’s audiologist and speech-language pathologist.

-Kristen Meaney, M.A. CF-SLP