Abstract: Voice production involves the coordination and balance of the vocal subsystems (respiration, phonation, resonance). This course will focus on voice therapy techniques, including stretch and flow and SOVT, concentrating on increasing airflow to unload laryngeal tension and improve coordination. Participants will review and practice the hierarchical levels of each technique.
Description: Coordination of the three vocal subsystems - respiration, phonation, and resonance - is critical for normal voice production. Respiration is the foundational level of support and the drive behind phonatory onset and offset (Watts & Awan, 2019). It also contributes to the degree of engagement of supraglottal musculature during voicing. Many etiologies of dysphonia involve problems with glottal competence resulting in increases or decreases in transglottal airflow and measures of subglottal pressures (Watts & Awan, 2019, Gartner-Schmidt et al., 2015). These variations in aerodynamics adversely affect the initiation of phonation (voice onset) and the efficiency of maintaining phonation. Improvements can be related to improvements in aerodynamic measures and subjective judgments by the clinician and the patient (Gartner-Schmidt et al., 2015). For patients with persisting glottal incompetence (e.g., unilateral vocal fold paralysis), the improvements may not reach the range of normal limits. Still, subjective improvements such as reduced shortness of breath when speaking and decreased straining to speak can be appreciated.
Clinicians treating voice disorders need to be familiar with a variety of direct therapy techniques to have the flexibility to meet each client’s level of ability (Watts et al., 2015). Clinicians typically incorporate breath work into their therapy plan via indirect treatment methods (e.g., diaphragmatic breathing), and patients develop improved speech breathing patterns. However, some patients require direct interventions that focus on breathing as a formal treatment component to learn to balance the functions of ventilation and speech breathing (Lewandowski & Gillespie, 2016). These techniques include stretch and flow or flow phonation, resonant voice, semi-occluded vocal tract exercises, and vocal re-education therapy. Plans initially designed for hyperfunction (e.g., stretch and flow) may be modified for patients with hypofunctional voice disorders to experience a more functional quality of voice (Drake et al., 2016).
The purpose of this course is to review voice therapy techniques that directly focus on airflow, including the rationale, impact on anatomy and physiology, and to practice the hierarchical levels of these strategies. While beginner clinicians may benefit from this information, those with an existing understanding of voice anatomy and physiology may benefit more from this course. The course agenda will incorporate time to practice specific therapy techniques and modifications to better enable clinicians to begin to utilize techniques in their clinical practice.
General timing of course (broken down by minutes per topic) 0-10: Review of Anatomy/Physiology and Vocal Subsystems 11-21: Introduction of Stretch and Flow (SnF) 22-40: Hands-on practice of technique 41-51: Discussion of modification of SnF 52-62: Introduction of SOVT 63-73: Hands-on practice of technique 74-84: Discussion of modification of SOVT 85-95: Introduction of Vocal Re-education Therapy (VRT) 96-105: Hands-on practice of technique 105-109: Discussion of modification of VRT 110-120: Questions
Presentation Format & Methods: Powerpoint with interactive lecture and opportunity to practice in small groups
Supporting Research: Reference 1: Watts, C., & Awan, S. (2019). Laryngeal Function and Voice Disorders: Basic Science to Clinical Practice (1st ed.). Thieme.
Supporting Research: Reference 2: Gartner-Schmidt, J. L., Hirai, R., Dastolfo, C., Rosen, C. A., Yu, L., & Gillespie, A. I. (2015). Phonatory aerodynamics in connected speech. The Laryngoscope, 125(12), 2764–2771. https://doi.org/10.1002/lary.25458
Supporting Research: Reference 3: Watts, C. R., Diviney, S. S., Hamilton, A., Toles, L., Childs, L., & Mau, T. (2015). The effect of stretch-and-flow voice therapy on measures of vocal function and handicap. Journal of Voice: Official Journal of the Voice Foundation, 29(2), 191–199. https://doi.org/10.1016/j.jvoice.2014.05.008
Supporting Research: Reference 4: Lewandowski, A. & Gillespie, A. (2016). The Relationship Between Voice and Breathing in the Assessment and Treatment of Voice Disorders. Perspectives of the ASHA Special Interest Groups. OneSearch for Abilene Christian University. (n.d.). Retrieved July 2, 2022, from https://eds-p-ebscohost-com.acu.idm.oclc.org/eds/detail/detail?vid=1&sid=f62c2dfa-9ac0-4f1e-95ac-ad0fe910474e%40redis&bdata=JkF1dGhUeXBlPXNzbyZzaXRlPWVkcy1saXZlJnNjb3BlPXNpdGU%3d#AN=127269945&db=ccm
Supporting Research: Reference 5: Drake, K., Bryans, L., & Schindler, J. S. (2016). A Review of Voice Therapy Techniques Employed in Treatment of Dysphonia with and Without Vocal Fold Lesions. Current Otorhinolaryngology Reports, 4(3), 168–174. https://doi.org/10.1007/s40136-016-0128-y
Learning Objectives:
As a result of this presentation, the participant will be able to outline anatomical and functional implications that indicate a need for direct treatment of speech breathing.
As a result of this presentation, the participant will be able to describe levels of hierarchy and modifications to airflow-based voice therapy techniques.
As a result of this presentation, the participant will be able to demonstrate competency with foundational levels of treatment hierarchy for airflow-based treatment techniques.