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Voice Tx techniques (Semi-occluded vocal tract (Purpose is to improve VF…
Voice Tx techniques
Semi-occluded vocal tract
Purpose is to improve VF adduction, vocal registration, narrowing of supraglottic tract to achieve best acoustic power transfer from glottis to lips.
SOVT exercises create env where resonances of vocal tract interact productively w airstream as VF vibrates. Balances all the subsystems of voicing, power, source, filter. Results in VF adduction that is not too pressed or not too breathy.
Source and filter are linked
Suitable for all voice clients and all age groups
SOVT exercises can be easily modified, adapted to meet needs of clients. Enhancing bernouli effect
Recommended for vocal fatigue, RLN paresis, VF nodules
Studies suggest that indv w normal voices present clear, brighter, more sonorous voices after performing semi-occluded exercises. Bcos of effective reinforcement of VF vibration via proper phasing of supraglottal acoustic pressures bcos of vocal tract resonance
Vocal tract length, cross section is changed causing an impedance match b/w vocal tract, VF. Impedance matching feeds energy back to glottis. Produces in-phase velocity b/w supraglottal pressure, airflow.
Current prac in vocal rehab
Limited periods of absolute voice rest
Voice rest commonly recommended after VF surgery, VF haemorrhage or moderate-severe damage to prevent worsening of injury, scarring of VF
Kaneko et al (2017)
3 days of voice rest followed by voice Tx may lead to better wound healing of VF cf. 7 days of voice rest. Appropriate mechanical stimulation during early stages of VF wound healing may lead to favourable functional recovery
Trial of voice Tx should come before any surgical Tx for benign diagnosis eg. humming, voiceless fricatives
Desjardins, Shaw Bonhila (2020)
Impact of respiratory exercises on voice outcomes. Systematic review
Expiratory muscle strength training (EMST)
4/5 included EMST studies reported some +ve effect on voice acoustically.
Disordered voices: some impv in sound pressure lvl, freq variability in semitones, max phonation time, utterance length (Parkinson's disease, multiple sclerosis, hypotonic children), results varied b/w studies
Single subject designs
Train lungs to exhale forcefully, set resistance to make valve open
Focus on abdominal breathing pattern
4 articles had 3 interventions that focused on control of abdominal muscles during phonation
Population: professional singers, MTD dysphonia of diff aetiologies
2/3 Tx took place during single Tx session
2/3 Tx, intensity, freq range, jitter, shimmer, dysphonia severity index, MPT remained same after session
One study evaluated stimulation training focusing on coordinating respiration w phonation, acquiring abdominal breathing pattern--> improving in subglottal pressure, fundamental freq, sound pressure lvl. Significance of impv NOT assessed!
Examples of Voice Tx methods using SOVT
Straw phonation (Titze)
Voice re-education technique-optimises facial vibration sensations from increased intraoral acoustic pressure
Clients can recognise forward, resonant sensations. Useful for carryover for connected speech, does not allow for semi-occlusions
Pitch glides, vocalising song thru straw
Test for nasality: should sound the same when you pinch your nose
Hyperfunction-nodules, polyps
Why we use straw: more evident changes are higher velum, lower laryngeal position, wider pharynx during straw phonation
Can use drinking straw or stirring straw
Narrower straw- wider vocal tract
Vocal fn exercise (Stemple)
Dev as psychologic approach for treating voice disorders via direct manipulation of underlying anatomy, physiology impt for healthy voice production
From 21 appraised studies, it was apparent that exercises are efficacious in enhancing vocal fn in indv w disordered voices, indv over 60 years diagnosed w presbylaryngeus, professional voice users
In indv with normal voices, elite voice uses eg. singers, exercises were effective in enhancing existent physiologic voice parameters (in normal ppl) eg. pitch range, airflow rate, MPT, dynamic range.
RCT, systematic reviews
For pts with hyperfunctional, hypofunctional voice disorders
Useful for all age groups
Forward resonance
Lessac Madsen Resonant voice therapy (Verdolini)
What is covered in lecture?
To rest or not to rest
Respiratory exercise
Muscular relaxation
Creating more pressure in vocal tract.
Vocal folds open, positive pressure in vocal tract above pushes vocal folds apart even more
Vocal folds close, -ve pressure in vocal tract above pushes VF together even more
Give push at the right time, can phonate longer (swing analogy)
What lit says about appropriateness respiratory exercise for improving voice outcomes?
Not appropriate
If respiratory fn alr optimal for meeting vocal demands
If respiratory exercises X target respiratory parameters that need impv
If respiratory exercises X accompanied by generalisation exercises to voice tasks
If respiratory exercises not intense to induce respiratory changes sufficient to overcome laryngeal deficits
Appropriate
If respiratory fn is impaired
If respiratory fn is not meeting vocal demands
If respiratory exercises target respiratory parameters that need to be improved
If changes in respiratory function are successfully generalised to voice tasks
If respiratory exercises show respiratory changes that are enough to overcome laryngeal deficits