Pediatric Voice Therapy Notes

Pediatric Voice Therapy Overview

Maya Braden presents on pediatric voice therapy, sharing insights on adapting techniques for children in voice treatment.
Maya has extensive experience in pediatric voice treatment, being the clinic manager at the pediatric voice clinic for almost six years, with a combination of voice therapy skills and performance backgrounds.
She acknowledges the gaps in identification and treatment for pediatric voice disorders, highlighting the unique challenges of working with children in voice therapy.

Introduction to Pediatric Voice Therapy

• Maya Braden's Background

  • Clinic manager of the pediatric voice clinic at UW Madison for almost six years.

  • Background in vocal arts and various treatment techniques.

  • Specializes in performance and music, particularly Russian music performance.

  • Experience as a national panelist on pediatric voice treatment.

  • Published works on resonance disorders and pediatric voice therapy.

  • Involved in research on patient and parent perceptions in pediatric voice therapy and adherence issues.

Purpose of the Talk

• Discussing how to adapt voice therapy techniques for children.

• Addressing two specific clinician populations:

  • Pediatric specialists who treat children with voice disorders.

  • Adult voice specialists managing pediatric voice cases.

• Aim is to provide valuable insights and applications for both clinician groups.

Pediatric Voice Disorders

• Incidence and Identification

  • Prevalence of voice disorders in children ranges from six to twenty-four percent.

  • Suggests significant under-identification of these disorders in pediatric populations.

  • Difficulty in gathering accurate data on the prevalence of voice disorders.

  • Common misconceptions exist about childhood voice disorders, leading to delays in treatment (e.g., "They'll grow out of it").

Reasons to Evaluate and Treat Pediatric Voice Disorders

• Determining etiology of voice disorders essential for effective treatment.

  • Most common cause is vocal fold nodules but other serious conditions can arise (e.g., recurrent respiratory papillomatosis, subglottic stenosis, vocal fold paralysis).

• Impact on quality of life and communication development:

  • Studies (e.g., Nadine Conner, 2006) show children are aware of their voice issues and that it impacts their communication abilities, social interactions, and personality development.

  • Negative listener perceptions of children with voice disorders lead to further social and personal implications (e.g., being labeled negatively by peers/adults).

Understanding and Changing Treatment Approaches

• Common treatment pitfalls

  • Traditional pediatric voice therapy often overemphasizes vocal hygiene and negative behaviors, overlooking constructive feedback.

• Effective treatment should incorporate positive reinforcement and teach children what to do rather than merely instructing them not to do certain things.

• Emphasis on teaching children adaptive, functional voice skills that they can apply in daily interactions.

• Tailoring approaches and techniques to the individual needs of each child based on their condition (hyperfunction vs. hypofunction).

Key Treatment Approaches and Techniques

• Pre-treatment considerations: visualization for identifying the etiology and severity of voice issues.

• Importance of participatory therapy involving parents and encouraging functionalities at home.

  • Developing individualized treatment goals for the child based on their specific situations and needs (e.g., school, sports).

• Voice therapy strategies:

  • Semi-occluded vocal tract exercises, resonant voice therapy, vocal function exercises, flow phonation, belly breathing exercises, etc.

  • Using playful, interactive methods to engage children and promote adherence to therapy (e.g., games, storytelling).

Specific Therapeutic Techniques

Semi-Occluded Vocal Tract Exercises

• Encourage proper alignment and vibration of the vocal folds using methods like lip trills and straw phonation.

• Use of tangible feedback (e.g., blowing bubbles using straws) for children to visualize airflow and voice production.

• Engaging storytelling aids to replace traditional therapy methods.

  • Incorporating playful vocal mimicry of animals, vehicles, etc., to make practice enjoyable for children.

Resonant Voice Therapy

• Utilizing the optimal vocal fold posture during phonation to minimize the risk of trauma while promoting effective communication.

• Simple descriptors for children to understand the concepts (e.g., "buzzy" voice).

• Hierarchical approach to learning from basic phonation to conversational speech while monitoring progress and self-evaluation.

Vocal Function Exercises

• Structured exercises to rebalance respiration, phonation, and resonance systems effectively.

• Providing clear, measurable tasks allows children to participate and track progress actively with their voice therapy.

Addressing Low Functioning Variables

• Children with hypofunction requiring different strategies to strengthen vocal capabilities while ensuring gentle voice use.

• Focusing on optimizing breath control, improving vocal fold closure, and working towards functional capacity in voice production.

Discharge Criteria and Continuing Care

• Important to establish realistic discharge goals based on individual progression and growth.

• Ongoing assessment of voice skills and individualized follow-up care required after therapy concludes.

• Importance of family engagement and addressing the family vocal environment plays into long-term success and adherence to vocal hygiene.

Approaches for Very Young Children

• Play-based therapy for toddlers who may not be ready for structured therapy.

• Involvement of parents to model healthy voice use and reinforce positive behaviors.

Conclusion and Q&A

• Questions raised regarding materials and methods for promoting successful therapy encounters.

• Encouraging active parental involvement and providing adaptable approaches according to each child and family situation.