General Tx principles, approaches (1) (Guidelines for voice Tx (Explain…
General Tx principles, approaches (1)
Why client might not go for this
dont know they need referral
Might be on long wait list
Why this is important
You can't determine presence, absence of VF pathology via perceptual analysis. Could be nodules, could be cancer where no amt off voice therapy will change voice quality
What evidence says about voice Tx
Seems to work
Most available Tx for voice disorders have limited data to support efficacy (case studies, poor case control studies)
Very few large scale randomised efficacy trials. Single case studies have been replicated w positive results
Restore normal voice
Improve vocal profile
Improve, restore laryngeal function
Eliminate, reduce some benign mass lesions (making vocal fold nodules smaller)
Protect client from regressing, causing further vocal problems eg. vocal hygiene, alternative means of comm.
Eliminate vocal tract discomfort associated w phonation. Muscle tension dysphonia, eliminate extraneous extrinsic tension. But might not be able to alleviate all tension
Enable client to reach vocal potential, assist in communication adjustments in irreversible conditions. Parkinson's disease, cannot eradicate voice disorder but want to max vocal potential.
What to tell clients?
It is not a medicine. Voice is a motor skill. Boosting you to give you the skill but you have to do it yourself. Empower clients to participate all the way thru. Need to establish what your roles are. Just like when you learn to walk, you toddled by holding onto people and slowly learnt to stand, walk. Building new muscular pattern again
Service delivery models
Clinical surrogates-parents, teachers-teach them to deliver the Tx
In service programs-vocal hygiene, voice conservation
Group workshops, mini seminars for at risk groups eg. teachers. Having dysphonic quality impacts child's ability to learn
Practical demonstration eg. in classrooms, simulations
Occupational, professional voice users. Teach them how to best use their voice. Demo in workplace env
Tailor the no. of sessions, check in via phone with them in between
Voice Tx notes
Should not be chosen bcos of its popularity but bcos of its known effectiveness, efficacy
Everyone comes w their own baggage of problems, history, aetiological factors, voice use demands, medical complexities, occupational, social issues, patient motivation. Some might not unds why Tx is needed. No set regimen for voice
Respiratory issues eg. lung transplants, cystic fibrosis
What goals, expectations are, idea about adherence-use of digital media where you can see if they are doing it right. Ask them to email you to check.
Phonotrauma instead of vocal abuse, misuse, use natural items
Do not teach what you have not mastered yourself!
What is considered successful?
Helps educate client, outline regimen that will result in greatest chance for success, failure of rehab process. Info gained in diagnostic sessions provides clinician w data collection that helps in educating pt about disorder, disease
What should be happening vs. what is happening. Imbalance in systems, power-source-filter model. Telling them which elements are not working. Might be direct, indirect Tx
Tx program must provide mechanism to structurally aid VF function, can then be enhanced by behavioural modifications. Stretches, mindfulness for relaxation
Guidelines for voice Tx
Explain normal voice physio, patient's problem
Pt to verbalise how voice sounds and feels. Pt vs. SLP might have diff perceptions. You sound normal to others but you know it is not normal. "I just don't sound like me"
Get to know patient's attractor state (if they fall back to old habits--> need to know what they have been doing before so you can watch out for those markers!
Use auditory, visual, tactile, kinaesthetic feedback
Audio record all sessions-what do you feel has changed? is it more vibrant, more tired? Listen to you, listen to themselves
Progress slowly through initial stages of Tx, expt with techniques
Model all Tx tasks: record the demo and give them
Instructions regarding practice-short and freq. 5 min 5 times a day, 5 repetitions every hour
Prognostic statement at start of Tx-sometimes voice disorder might not be able to be eliminated, need to let them know
Trial and error, need to have step up, step down approach
Pt's recognition of, response to the problem
Pt's motivation to follow Tx plan
Appropriateness of pt's expectations. Some pts want a quick fix.
Willingness to cease, reduce phonotraumatic behaviours, make lifestyle changes
Psychiatric problems-if someone has depression, has impact on processing, retaining info. Make sure you write information down
Disorder must be responsive to Tx. Spasmodic dysphonia is resistant!
Patient's laryngeal, general health status very impt!
Therapist-adequate unds, competency, rapport