Voice 4 - Intervention Management

surgical risks

• prolonged healing, scarring

• recurrence of lesion

• not meeting operative goals

factors that drive durgery

baseline index of suspicion

lack of expected response to therapy

SLP care in prep for surgery

• voice therapy prior to surgery

• improve coordination of respiration and phonation

• optimize vocal hygiene

• reduce vocal load prior to surgery

• advise patient on timing of surgery

• plan for voice rest

• managing expectations/concerns

general voice rest recommendations

• sub-epithelial pathology = one week voice rest

• epithelial = no vocal rest

post op SLP care

• avoid forceful VF closure

• hydrate

• humidify

• minimize irritants

• too much rest is bad, too little rest is also bad

• gradual increase in voice usage → days 8-15 double the amount of voice use during the day (start at 5-10mins)

• goal is for patient to meet their vocal demands

• long-term voice maintenance

• singing voice considerations

commonly prescribed medications

• antibiotics

• oral steroids

• PPIs

treatment elements

• eclectic “toolbox”

• combo of direct and indirect approaches

• grounded in physiology

• principles of motor learning

direct approaches

focus on manipulating the voice-producing mechanisms (speech subsystems) in order to modify vocal behaviours and establishing healthy voice production

indirect approaches

modify the cognitive, behavioural, psychological, and physical environments in which voicing occurs

• patient education

• counseling

physologic voice therapy

those treatments that directly modify the physiology of the vocal mechanism

symptomatic voice therapy

those treatments aimed at modifying deviant vocal symptoms or perceptual voice components using a variety of facilitating techniques

physiologic voice therapy examples

• accent method

• EMST

• manual circumlaryngeal therapy

• resonant voice therapy

• PhoRTE

• LSVT

• Speak Out

symptomatic voice therapy examples

• amplification

• auditory masking

• biofeedback

• chant speech

• confidential voice

• inhalation phonation

• semi occluded vocal tract therapy

• yawn sigh

3 major obstacles to improving descriptions of our interventions

1. the critical pieces of treatment are rarely self-evident

2. interventions are often composed of multiple clinician actions and modified patient functions with minimal indication of how they are connected

3. the critical pieces of treatment often lack standardized labels and definitions that enable multiple researchers and clinicians to consistently interpret and apply them

ingredients

what the clinician does or selects

mechanism of action

how the treatment is expected to work

target

aspect of functioning directly targeted for change

components of a hygiene program

• identify the behaviours

• describe the effects

• determine when and why it occurs

• modify the behaviours

ways to modify behaviours

1. elimination

2. modification

3. manipulation of the environment

modifications for throat clearing

• dry swallow

• take small sips of water

• use a silent cough

• pant lightly then swallow

• hum lightly

• laugh gently then swallow

reducing tension

• progressive relaxation

• chewing exercises

• yawn-sigh

• EMG biofeedback

• manual circumlaryngeal massage

what changes as we age re: voice?

anatomy, breath support, secretions, hormones

management for the aging voice

• strengthening of respiration/phonation, body alignment/posture, discss expectations, surgery

what are vocal function exercises used for

benign laryngeal lesions, laryngeal paralysis or weakness, functional voice disorders

examples of vocal function exercises

• max vowel prolongation

• pitch glides

PhoRTE loud voice production increases laryngeal muscle acitivity and does what

increases subglottal pressure and improes vocal nitensity and vocal quality

semi-occluded vocal tract exercises

exercises that increase oral air pressure and train glottal and respiratoy adjustements under the influence of increased flow resistance which may prevent excessively strong VF collisions

SOVTE examples

• lip trills

• straw phonation

vegetative vocalization

non-speech phonatory gestures used for MTD

vegetative vocalization examples

• cough/throat clear

• laughter

• yawn

• gargle

• grunt

• cry

• startled gasp

resonant voice therapy targets what

strong easy vvoice, emphasis on SOVT maneuvers → voice with forward focus associated with vibratory sensation in facial bones