TREATMENT
Once your evaluation is completed and results are determined, an individualized therapy program and home exercise program will be implemented.
A therapy program is tailored to your specific goals, whether it is to improve and protect your voice, to be able to breathe during exercise, or to reduce or eliminate a chronic cough. Treatment is usually scheduled once weekly, and the number of sessions needed will vary dependent upon individual needs. Therapy may be accomplished in as few as 4 sessions for some upper airway issues, and will often require 10-12 sessions for restoring voice to peak performance.
Your therapy program may include some or all of the following:
- Re-aligning laryngeal and pharyngeal musculature and body postures used in voice production
- Learning strategies for restoring and preserving vocal function while meeting vocal demands
- Re-aligning the subsystems of voicing: Breath (power) Sound production (vibration) and resonance (quality)
- Align your gender identity and voice to sound more like your authentic self
- Recognizing triggers for upper airway dysfunction, desensitizing laryngeal and pharyngeal structures and restoring them to healthy function.
Read More About:
The goal of Voice Therapy is to habilitate or rehabilitate your voice to a level of function that enables you to fulfill your daily voice and/or speech communication needs. Therapy may be recommended to avoid vocal injury, to recover from an injury and restore healthy habits, to improve communication, or to recover from laryngeal surgery. Voice therapy, delivered by a certified Speech-Language Pathologist with specialty Fellowship training in voice disorders is the gold standard for effective treatment of voice disorders. An individualized therapy program specific to your goals and needs is designed for you, and may take as few as 6-8 sessions, but often will require 10-12 sessions to habituate new skills and replace old habits. An individualized home exercise program is assigned to support your learning and encourage maintenance of healthy habits in functional activities.
Voice Changes:
The larynx (voice box) is made of cartilage, muscle and mucous membranes located at the top of your trachea (windpipe) and the base of your tongue. Your vocal folds (vocal cords) are two flexible folds of muscle tissue that sit at the entrance of the trachea, protecting your airway. The vocal folds open when you breathe to allow air into and out of the lungs, and they close when you swallow to protect your lungs. Sound is created when air from your lungs causes your vocal folds to vibrate close together.
If your vocal folds become inflamed, swollen, develop growths or become paralyzed, they can’t work properly, and you may develop voice changes. These changes may cause the voice to sound, rough, hoarse, strained, breathy, weak, may cause a change in pitch or your ability to sustain your voice, changes in vocal range, or may cause you to lose your voice entirely.
If your voice changes have persisted for more than 2 weeks, it is advisable to seek an evaluation and subsequent treatment with a certified, Fellowship trained speech language pathologist who specializes in voice disorders.
Vocal Fatigue:
Vocal fatigue is a common complaint among people with high voice demands. Individuals who have high voice demands due to their work are often referred to as professional voice users, and may include teachers, call center operators, actors, singers, public speakers, lawyers, preachers, etc. Anyone who uses their voice for their living may be considered a professional voice user. While vocal fatigue is a common complaint in the professional voice user, it may also occur in anyone who uses their voice a lot—or loudly–for recreation (shouting, yelling), chronically speaks over background noise, or lives with family members with hearing loss.
Symptoms of vocal fatigue may include:
- total or intermittent loss of voice
- vocal fatigue at the end of a day or after prolonged use
- increased effort to speak
- rough or hoarse voice quality
- changes in pitch and restricted pitch range
- pitch breaks on words or phrases
- voice fades out at the end of a sentence
- decrease in volume
- loss of intonation or expression
- constant throat clearing
- dryness in the throat and excessive mucous or sensation of mucous
- sensation of lump or pain in the throat
- difficulty swallowing
- shortness of breath
Vocal fatigue can result from many causes. Some medical conditions and medications may contribute to vocal fatigue, as does vocal trauma such as persistent throat clearing, coughing, yelling, exposure to environmental irritants, smoke, dryness from heat or air conditioning. Excessive voice use can lead to vocal fatigue even among those with voice training. Any physical changes to the vocal folds and larynx such as lesions, growths, weakness, paralysis, swelling, hemorrhage may cause you to alter the way in which you use your voice, causing strain and effort, leading to vocal fatigue. When the vocal folds appear normal upon a laryngeal exam, in the absence of any physical finding, vocal fatigue is often due to muscle tension dysphonia (MTD), or voice changes caused by muscle tightness from inefficient use of muscles of the neck and throat.
Treatment for vocal fatigue is voice therapy, delivered by a trained, certified Speech-Language Pathologist with Fellowship training in assessment and treatment of voice disorders. At Vocal Concepts, your Fellowship trained speech pathologist will guide you through vocal exercises to improve breathing to power the vocal fold vibrations, reduce throat strain, and find your optimal pitch and volume for a strong, healthy speaking voice. The goal is to learn to speak efficiently with minimal vocal effort.
Neurologic Voice Disorders:
- Neurologic voice disorders occur as part of an underlying neurologic condition such as Parkinson’s disease, multiple sclerosis, myasthenia gravis, or ALS. They can also happen as the result of a stroke. These disorders can affect the strength of the muscles of the larynx, or “voice box,” and impact control of the voice. Voice changes and changes in speech can be the first sign that a person has a neurological condition, and may be an early indicator of stroke, and should not be ignored.
- Neurologic voice disorders include a wide range of diagnoses that can affect the voice. These could include local laryngeal conditions such as spasmodic dysphonia, conditions that involve the head and neck region such as essential tremor or segmental dystonia, or conditions that involve the entire body, such as Parkinson’s disease, ALS, or stroke.
- Neurological voice disorders can make a person difficult to understand, and make communication with loved ones and caregivers difficult. This can lead to decreased quality of life and depression. While there is usually no specific cure for the underlying neurological disease, treatment is typically aimed at minimizing symptoms and improving function. Treatment may involve care from a speech-language pathologist and an otolaryngologist. Improving voice and speech function can improve quality of life
- Vocal Concepts is a preferred SPEAK OUT! & LOUD CROWD provider. www.ParkinsonVoiceProject.org (please see the link for the graphics from Parkinson Voice Project, or see The Wellness Group SLP services page and scroll down…)
- SPEAK OUT! is a therapy approach for people with Parkinson’s disease to improve their voice and speech. SPEAK OUT! is completed in 12 sessions over four weeks. Clients report improvement in their ability to be heard and understood, as well as improvement in their overall quality of life. LOUD Crowd is a maintenance group therapy that meets once weekly to maintain skills developed during SPEAK OUT!
- SPEAK OUT! & LOUD Crowd were developed at Parkinson Voice Project.
Aging Voice:
Presbyphonia is the medical term used to describe the age-related changes that can affect an individual’s voice. As we get older, our voices change. Some of this stems from other processes related to aging: we lose muscle mass, our mucous membranes thin and become drier, our lung capacity decreases, and we lose some of our fine muscle coordination. These changes can also occur in the larynx (voice box), and may present as vocal fold (or vocal cord) atrophy or “bowing.”
Voice problems that develop with age can affect you socially and emotionally, potentially leading to isolation and depression. As we age, muscles of the larynx (“voice box”) can decline in strength, and elasticity can be lost, potentially resulting in age related vocal fold atrophy. This can cause the vocal cords to have a bowed appearance which could cause less vocal fold contact, or vibration, and allow for escaping air, or breathy sounding voice. These changes can be dependent on genetics, the chronological age of the individual and the demands made on the voice. Presbyphonia may be more apparent when attempting to sing, exerting the voice, or using the voice in high demand situations. People with presbyphonia may experience some of the following symptoms:
- Reduced volume or projection of the voice
- Reduced vocal stamina–worsening with use
- Voice weakness
- Higher pitch in men
- Lower pitch in women
- Tremor or shakiness of the voice
The overall aim of therapy for presbyphonia is to improve the quality and reliability of the individual’s voice. This is done through:
- Promoting good vocal health and hygiene
- Reducing vocal fold trauma (e.g. reducing coughing and throat clearing)
- Vocal warm up exercises
- Decreasing tension in the larynx, around the neck and in the shoulders
- Increasing speaking volume/projection and articulation
- Relaxation
- Breathing exercises to improve breath management
Vocal Concepts voice specialists use the latest techniques and bring years of experience to evaluating your voice problem and helping make your voice stronger so you can stay engaged in all the things you love to do.
Performing Voice:
Like traditional speaking voice therapy, the goal of therapy for the performing voice is to restore the highest level of vocal function possible, and train skills to prevent recurrence of the voice problem. Unlike speaking voice therapy, Singing/Performing voice therapy is voice rehabilitation which targets unwanted changes specifically in the singing or performing voice. The focus is on addressing issues with vocal range, endurance, and voice quality. Therapy for the performing voice may be indicated due to vocal fatigue or for optimal recovery from vocal fold injury or surgery. Vocal exercises are tailored to the specific style and performance goals of the individual. Some individuals may also experience changes in their speaking voice, and in those cases, they may complete a course of speaking voice therapy first before starting singing/performing voice rehabilitation.
Performers are encouraged to work with a trained Voice Pathologist and Singing Voice Specialist who, working together with you, your medical team, and your other voice professionals will collaborate to provide optimal care for your singing voice.
Jean Skeffington, Voice Pathologist and Singing Voice Specialist, has many years of experience as a professional performer and voice teacher, and understands the demands of a performing career. She understands how these demands may take a toll on the reliability of the voice–impacting enjoyment, confidence, and even careers. Along with her first-hand knowledge, experience, and education in vocal performance, Ms. Skeffington has specialty Fellowship training in voice disorders, and expertise in the care of the singing and performing voice. She is ready to work with you to help restore you to your highest level of function and safely return you to doing what you love!
Gender affirming voice therapy:
Gender affirming voice therapy is for individuals who want to adapt their voices to communicate in a way that aligns with their gender identity. Transgender voice care can help lessen the discomfort or distress that might accompany gender dysphoria, a difference between gender identity and sex assigned at birth.
Voice, speech, and communication changes involve using the voice production mechanism in new and often unfamiliar ways. Your speech-language pathologist will work with you to help avoid vocal trauma through this process.
Changing how you speak, your speaking style, choice of language, and voice is highly personal, and can take years. Changes can feel unfamiliar or even uncomfortable in the beginning. A specialist can help you determine your goals and create an individualized plan, as well as show you how to avoid vocal trauma as you change your voice and speech.
If you have been diagnosed with shortness of breath (dyspnea) due to:
- Irritable Larynx Syndrome (ILS)
- Vocal Cord Dysfunction (VCD)
- Paradoxical Vocal Fold Motion Disorder (PVFMD)
- Exercise Induced Laryngeal Obstruction (EILO)
- Laryngospasm
- Chronic cough or throat clearing,
Your medical provider may have referred you for therapy with a Speech-Language Pathologist who specializes in these problems, and offers Respiratory Retraining Therapy and Cough Suppression Therapy.
Respiratory Retraining Therapy, provided by a speech-language pathologist trained and skilled in upper airway disorders management, is therapy for laryngeal breathing difficulties. It is a behavioral program that identifies dysfunctional breathing patterns. It is designed to give you the tools to manage, retrain, and restore healthy breathing patterns, and integrate these patterns into functional activities of daily life. An individualized home exercise program is assigned to support your learning and encourage maintenance of healthy habits in your daily activities.
The Speech Language Pathologist (SLP) will use a combination of exercises including compensatory techniques and direct treatment strategies to improve the safety of oral intake by reducing your risk for aspiration and maintaining quality of life.
Signs and Symptoms of Dysphagia include:
- Coughing/throat clearing during or right after eating or drinking
- Wet or gurgly sounding voice during or after eating or drinking
- Extra effort or time needed to chew or swallow
- Food or liquid leaking from mouth or getting stuck in mouth
- Recurring pneumonia or chest congestion after eating
- Weight loss or dehydration from not being able to eat enough
Medical issues which may contribute to swallowing problems include: oral, pharyngeal, or esophageal motility and structural abnormalities, Stroke, traumatic brain injury, Parkinson’s Disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease), Alzheimer’s Disease and other neurological disease, Cancer in the mouth, throat or esophagus Injury or surgery involving the head and neck, laryngo-pharyngeal reflux.
This is accomplished by focusing on rebalancing the subsystems of voice: respiratory, phonatory, and resonance. Singing voice therapy can help the singer (amatuer, trained, or professional) train their singing voice in a safe and structured way following a vocal fold injury or surgery. Vocal fold nodules, muscle tension dysphonia, vocal fold cysts, and pseudocysts can be treated with this therapy. Therapy differs from a traditional voice lesson, and must be performed by an American Speech-Language and Hearing Association accredited speech-language pathologist.
Singing/Performing Voice Therapy is an individualized program designed to help restore your singing/performing voice to peak performance, and to avoid future injuries.