“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