Voice Therapy Flashcards
Hygienic Voice Therapy
- Focusonbehavioralcauses
- modification/eliminationofthecauses
- organizedandpromotedbyeveryvoicetext
– there is always a cause for a voice disorder; discover, modify/eliminate and the voice improves
– weakness: the cause may no longer be the precipitating factor
Symptomatic Voice Therapy
- Modification of deviant vocal symptoms such as breathiness, inappropriate pitch, loudness, hard glottal attacks
- organized and promoted by Daniel Boone in his text The Voice and Voice Therapy (1971)
– if the voice component is inappropriate, modify that component
– weakness: what is symptom/cause?
Psychogenic Voice Therapy
- Focus is on emotional and psychosocial status of the patient that led to and maintained the voice disorder
– organized and promoted by Arnold Aronson in his text Clinical Voice Disorders: an interdisciplinary approach (1980)
– there is always a psychosocial reason for the behavior that led to the voice disorder; treat the psychosocial problem and the voice improves
– weakness: psychosocial contribution may be over- stated
Physiologic Voice Therapy
- Based on vocal function as evaluated through objective voice assessment
* Improve the balance between respiratory support, laryngeal muscle strength, control and stamina, and supraglottic modification of the laryngeal tone (resonance) - Promotes a healthy vocal fold cover
- Organized and promoted by Colton and Casper (1990) and Stemple, Glaze and Gerdeman (1993)
- Modification of the underlying physiology of the voice producing mechanisms: respiration, phonation, resonance
- Weakness: does not account for behavior
Eclectic Voice Therapy
- Combination of any and all of the previous orientations to affect positive vocal change
- Need to be aware of all management approaches
- Use those which are most effective for the patient and therapist
Hygienic Therapy Approach
General focus :
* identifytheprimaryandsecondarybehavioral causes of the voice disorder
* modifyoreliminatethesecausesincluding: 1. smoking
2. laryngeal dehydration from poor hydration, caffeine intake, and medications
3. voice abuse such as talking loudly over noise at work, coughing, and throat clearing
4. inhalation of large quantities of powder
Secondary causes
* result of the problem as opposed to a cause:
1. Laryngeal area muscle tension due to mass and stiffness
2. Low pitch due to increased mass
3. Increased conversational loudness due to effort to force stiff, heavy folds to vibrate
Symptomatic therapy approach
General focus uses facilitating techniques to: – raise pitch
– reduce loudness
– reduce laryngeal area tension and effort
This direct symptom modification would follow an explanation of the problem and would run concurrently with modification of the abusive behaviors including:
– smoking
– caffeine intake
– coughing and throat clearing
Psychogenic Therapy Approach
emotional instability
- Generalfocuswouldexplorethepsychodynamics of the voice disorder including:
1. detailed patient interview to determine the cause and effects of stress, tension, and depression
2. determination of the exact relationship of emotional problems and voice problem
3. counsel the patient regarding the effects of emotions on the voice problem
4. direct reduction of musculoskeletal tension 5. Support of ongoing psychological counseling
Secondary focus would deal with modification/elimination of the abusive behaviors including:
1. smoking
2. caffeine intake
3. coughing and throat clearing
Physiologic Therapy Approach
- General approach:
- evaluate the present physiologic condition of voice production
- develop direct physical exercises or manipulations to improve that condition:
– demonstratedincreasedmassandstiffnessofthefoldschanging the physical dynamics of vocal fold vibration
– wasrequiredtobuildgreatersubglotticairpressuretoinitiateand maintain vibration which required borderline high airflow rates which in turn caused her to speak too loudly
– attemptedtoovercometheseproblemsbymakingphysical adjustments such as increasing supraglottic tension
The physiologic management program would include:
1. Vocal Function Exercises and Resonant Voice Therapy to improve laryngeal muscle control, strength, and stamina and to balance airflow, laryngeal muscle activity, and resonance
2. Hydration program and decrease in caffeine to improve lubrication 3. Discussion of medications with the patient’s physician
4. Elimination of habit coughing and throat clearing
5. Vocal hygiene counseling for elimination of direct voice abuse
glottal gap, muscle tension
Eclectic Voice Therapy
- The treatment of choice including:
– symptom modification as necessary
– elimination/modification of causes (vocal hygiene)
– attention to the psychodynamics of the problem
– direct physiologic exercise and attention to the mucosal covering of the vocal folds
Strategies for Hygienic Voice Therapy
- Vocal hygiene counseling involves:
– identifying the abusive behaviors
– describing the physiologic effects of those behaviors on the voice production mechanisms
– defining the specific occurrences
– modifying or eliminating the behavior
Typical voice phonotraumatic behaviors
- Shouting- eliminate and teach how to shout
- loud talking
- screaming,
- coughing,
- throat clearing,
- vocal noises
First Session
- Review diagnosis and results
- Show image or video
- go over a & p
- tell them how their dignosis impacts them
-
Chronic Cough Syndrome
- Patient has coughed for months or years
- All medical testing has proven to be negative
- No medications are causing the cough (Lisinopril-ACE inhibitors, Advair)
- LPR is not an issue
– 10-20% of those with LPR have a persistent
idiopathic cough
– Laryngeal sensory neuropathy, irritated nerve
Laryngeal hypersensitivity caused by the cough causes coughing during
* Forced inhalation, Normal drainage, Humidity changes
Cough substitution
* Forceful swallow (Similar routine to chronic throat clearing)
* Hydration- May be sensitive to temperature of water
Additional Diagnostic Questions
- How does the child shout?
- Why does the child shout?
- Does non-play shouting occur?
- Does the child make vocal noises?
- Has the laryngeal pathology created a physiologic imbalance?
- Does habitual throat clearing occur?
Summary of Vocal Hygiene Plan for Children or Adults
- Identify the phonotrauma: – shouting
– loud talking
– vocal noises
– throat clearing - Describe the effect:
– utilize pictures, diagrams, drawings, and video.
Do not hesitate to give simple explanations of anatomy and physiology to children. - Define specific occurrence:
– These will be distinctly different with every individual child. Therefore, no two children will follow the same management plan.
– Psychodynamics of the behavior must also be described - Modify the behavior:
– teach the child how to shout
– modify or eliminate vocal noises – eliminate non-play shouting
– eliminate throat clearing
– balance the physiology of voice production through direct therapy
