Voice Therapy

The opportunity to observe the work overview of a Speech Pathologist, has tremendously solidified my interest in this field. At the Diana Rogovin Speech Center at Brooklyn College, I observed clients of various ages with different speech language disorders including articulation, language, voice, fluency and accent modification. Observing clinicians at the speech center gave me the opportunity to learn how important client-clinician interaction is for the session and how essential it is to build a good relationship with the client. Although I learned the

Some of the duties of a speech pathologist are, but are not limited to, evaluate patients’ levels of speech, language, or swallowing difficulty, identify treatment options, teach patients how to make sounds and improve their voices, work with patients to develop and strengthen the muscles used to swallow, and counsel patients and families on how to cope with communication and swallowing disorders (Duties, www.bls.org, 2015). ‘If the speech-language pathologists work in medical facilities, they work with physicians and surgeons, social workers, psychologists, and other healthcare workers’ (Duties, www.bls.org, 2015).

On Thursday, December 3rd, 2015 at 2:00 PM I observed an hour and forty five minute secession at East Stroudsburg’s Speech and Hearing Center. East Stroudsburg’s Speech and Hearing Center is located on campus, in the town of East Stroudsburg PA, on the second floor of Monroe (building). The clinic at ESU was very clean and organized. It had multiple therapy and diagnostic rooms that were set up nicely and welcoming for a client. The types of population seen at the ESU’s clinic range from any age for speech therapy or audiological visits. The clinical audiologist I observed was Susan Dillmuth- Miller Au.D., CCC-A, FAAA..

Meister and colleagues (2017) completed an investigation to assess the subjective and objective voice results of Wendler’s glottoplasty. Meister and colleagues (2017) examined the effects of Wendler’s glottoplasty on 21 male-to-female transgendered individuals. Areas evaluated included fundamental frequency, vocal range, and voice satisfaction. All participants, except one, raised their fundamental frequency after surgery. The researchers saw a decrease in vocal range, but increase in lower frequencies

Consult speech therapist to assess if any training/ swallowing exercise can be provided in order to maximize patient’s swallowing ability.

A Speech Pathologist would not be needed, as it is a hearing, rather than speech-communication problem. Dr. Stacy’s recommendations for Thomas would to first and foremost attempt to correct the problem with behind-the-ear hearing aids since he is prone to earwax build-up. A traditional behind-the-ear (BTE) hearing would be his best fit. Not only would they aid in amplification, but they might also help to solve the tension in the household. Thomas would be able to use them every day, whether he is at home or not. If BTE hearing aids ended up as an inappropriate or comfortable choice for Thomas, she would then recommend an Assisted Listening Device (ALD), such as a personal amplifier. This would reduce background noise and increase the sound levels. Dr. Stacy could also recommend an infrared ALD system in conjunction with his hearing aids for use such as in a restaurant. In the aural rehabilitation plan for Thomas, Dr. Stacy will evaluate him to ensure his hearing aids are the most appropriate fit. She would perform the assessment based on his diagnosis and extent of his hearing loss, as well as his

Adductor spasmodic dysphonia (ADSD) is a voice disorder due to central motor processing abnormalities which result in decreased control of the laryngeal muscles (Blitzer, 2010). The idiopathic disorder is characterized by involuntary spasms of the laryngeal muscles controlling vocal fold adduction (National Spasmodic Dysphonia Association, 2012). The dysphonic characteristics presented by patients with ADSD are described as strained, strangled, and effortful due to irregular adductions of the vocal folds and the occlusion of air through the vocal tract during phonation(Blitzer,2010; Cannito, Doiuchi, Murry &Woodson, 2012). Patients with muscle tension dysphonia (MTD) present with similar perceptual vocal characteristics however, treatment for the two disorders is quite different. Speech-language pathologists often have difficulty diagnosing and distinguishing between ADSD, a neurological disorder, and MTD, a functional voice disorder (Rees et al., 2007). Correct diagnosis is important and objective measures, such as spectral analysis, are more sufficient in distinguishing the two disorders(Rees et al., 2007).

Client X is a college student referred to the clinic by a music professor due to concerns of possible vocal nodules. During vocal juries, X’s professor commented that her voice became very airy, especially when using her high register. Client has also described her voice as husky, breathy, tense, and hoarse.

I am a 17 year old girl whose one true passion is for my music. Since I damaged my voice due to yelling while having a really bad sore throat one year, I tend to focus more on my singing. I try to constantly practice everywhere I go. I’ll be at home just singing or humming as I do chores or get ready for work. Often times I find myself comfortable enough to start singing at work as I prep the food or wash the dishes. I seem to be improving once again, but I remain cautious of my vocal chords.

The most widely available research pertains to the Lee Silverman Voice Treatment also known as LSVT LOUD. This treatment, in general is used to treat adult dysarthria. This includes not only spastic dysarthria, but also flaccid, ataxic, hyper, hypo kinetic dysarthria. The majority of research surrounding LSVT LOUD, is on Parkinson’s Disease. Gains have been shown with using this treatment with Parkinson’s (cite), and so, it has been become a generalized treatment of all dysarthria’s including both adult and childhood forms. This can be problematic when seeking out an appropriate and effective treatment

The aging process impacts the vocal mechanism as it does any other system of the body. In one of the few studies that reviewed vocal disorders in the geriatric population, the incidence of vocal disorders in people 65 years or older was between 12% and 35%. (Davids, Klein, Johns, 2012). Of that population, 25% had vocal fold atrophy as the cause of their disorder. (Davids, et al., 2012). A 2006 study conducted on 100 assisted-living residents found the incidence of age-related dysphonia to be around 20% (Golub, Chen, Otto, Hapner, Johns, 2006). It further found that the impact of this disorder had a percieved negative impact on quality of life in 13% of the test poplutation (Golub et al., 2006). An inability, or a limited ability to

When I felt that my voice was constrained; either I stretched my arms outwards or placed them on my hips, bending backwards whilst pushing out my chest. I felt that this was a highly energising movement that aided in releasing tension. Vicky explained in lectures that this is because space has opened in the larynx and the vocal folds are able to vibrate more freely. Simultaneously I associate the kinaesthetic action of spreading my arms the sensation of a more open throat. The result of practising this movement along with full body stretches and foam roll exercises has relived the feelings of constraint when I sing above middle C. Consequently, as the term progressed my voice was less strained in the upper register. I was able to comfortably sing the chorus of Don’t dream it over, Royals and If you’re out

The patients also experience changes in their voices and even develop skin ulcerations as shown in figure 1.

While at the facility I observed the conservation between the physical therapist and the patient. The physical therapist asked the patient “on a scale of 1 to 10 what is your pain level today compared to your last visit?” The patient would respond and from there the physical therapist would give them an exercise to do depending on their level of pain or improvement. The physical therapist would then explain what the exercise was and give a short demonstration of how to do it. By simply communicating back and forth they are using physics. The vibrations from their vocal cords gives them a voice and the sound waves that are produced by the vibrations of matter allows them to hear. Vocal cords vibrate at a frequency that is mainly determined by the tension of the muscles that are in control of them as well as the tissue mass and the amount of pressure in the lungs. The vibration release air pulses into the vocal tract, allowing a person to speak. The simplest things we do in life involves physics and without it we would not be able to communicate with each other.

The last option is surgical voice restoration which was introduced by Singer & Blom in 1980(Blom,1995) Not all patients are suitable for this however, It involves a tracheoesophageal speaking valve, a small fistula is surgically created through the tracheal wall into the oesophagus. A small, one way valve is inserted into the fistula and it allows air to be shunted from the trachea to the oesophagus and up through the pharyngo-oesophageal segment creating an acoustic wave form and voice. A longer flow of voice can be achieved as pulmonary air is used as the initiator for voice.