Voice Therapy for the Professional Voice
Department of Otolaryngology–Head and Neck Surgery, Drexel University Collegeof Medicine, 1721 Pine Street, Philadelphia, PA 19103, USA
The practice of speech-language pathology includes prevention, habilita-tion, and rehabilitation of communication, swallowing, or other upper aero-digestive disorders; elective modification of communication behaviors, andenhancement of communication[1]. The American Speech-Language-Hearing Association (ASHA) states that the speech-language pathologistshould provide prevention, screening, consultation, assessment, treatment,intervention, management, counseling, and follow-up services for speech,voice, language, swallowing, cognition, and sensory awareness for commu-nication, swallowing, and upper aerodigestive functions. In the area of treat-ing voice disorders, the speech-language pathologist is concerned not withdiagnosis and treatment of laryngeal diseases or other physiologic disorders,but rather with understanding, analyzing, and modifying vocal function.If, perceptually, the voice is within normal limits for the patient and isbeing produced in a reasonably efficient, nonabusive manner, then interven-tion by a speech-language pathologist need not be conducted. It is notwithin the speech-language pathologist’s scope of practice to provide specialtraining that develops range, power, control, stamina, and the esthetic qual-ity required for artistic expression. The speech-language pathologist is con-cerned with the voice that presents with a current or potential problem,identifying and analyzing the problem, and then helping the voice user mod-ify vocal behaviors to use the vocal mechanism with optimal efficiency. Inthe case of the professional voice user, increased demand and expectationsfor voice quality may be present and should be considered when judgingnormalcy of the voice. Responsibilities in ameliorating voice problems
This article is taken in part from Marx Schneider SL, Sataloff RT. Speech language inter-vention
d
voice therapy. In: Merati A, Bielamowicz S, editors. Textbook of laryngology. 1stedition. San Diego (CA): Plural Publishing, Inc.; 2007.* Corresponding author.
E-mail address:
Ó
2007 Elsevier Inc. All rights reserved.doi:10.1016/j.otc.2007.05.013
oto.theclinics.com
Otolaryngol Clin N Am40 (2007) 1133–1149
include: analyzing vocal behaviors perceptually and objectively; analyzingvocational, educational, and psychologic factors that may interact withvocal behaviors and precipitate, maintain, or exacerbate vocal difficulty;and designing and implementing an individual program for modifying vocalbehaviors[2].Similar to physicians and their subspecialites, speech-language patholo-gists vary in their backgrounds and experience in the treatment of voicedisorders. Furthermore, the curricula that speech-language pathologistscomplete during education and training vary widely and typically only ad-dress normal and disordered voice production at a general level. Curriculararely provide education or knowledge about the professional voice. Beforemaking a referral to a speech-language pathologist for voice therapy, there-fore, his or her background and training should be considered.This article focuses on the speech-language pathologist’s treatment of voice disorders with special emphasis on the treatment of professional voiceusers. There are many factors to consider when working with professionalvoice users. The following is not meant to be an inclusive list but is intendedmerely to provide a framework of key considerations. Evaluation and treat-ment of a professional voice user requires increased sensitivity from the cli-nician. At first, when listening to the patient’s voice, it may sound normal.Sounding normal is relative, however. The professional voice user typicallyhas increased awareness of minute changes in the voice production andquality. A speech-language pathologist must therefore be ‘‘super sensitiveto super speaking.’’ The goals of the professional voice user or performerare typically different from those of a nonperformer and must be consideredas such. With that in mind, it is important to learn the patient’s expectationsand provide a realistic perspective on the possible outcome of therapy basedon the diagnosis and response to trial therapy techniques during the initialassessment.Further consideration must be given to body and self-awareness issues inperformers versus nonperformers. Body and self-awareness, in this sense, re-fers to the patient’s awareness of his or her own behaviors and the ability tomake changes as instructed. Professional voice users may have increasedawareness of vocal behaviors, depending on their previous depth of training.Body and self-awareness are important skills to develop or maximize in thevoice user. They aid the patient in developing, recognizing, and maintainingtechniques for efficient voice use.Environmental contributions also should be noted. As a professionalvoice user, the patient may be in detrimental performance situations thatmay not be obvious to a treating clinician. These may include poor acousticswhile performing, interference of costumes and clothing, positional factors,and so forth, which can be significant contributing factors to suboptimalvoice performance. The clinician must therefore ask specific questionsor even attend a rehearsal or performance to make a complete assessmentof conditions.
1134
SCHNEIDER & SATALOFF
Psychologic factors also commonly contribute to voice problems. Thevoice can be described as an emotional part of each person. Studies by Fo-nagy, described by Sundberg[3], have indicated that articulatory and laryn-geal structures and respiratory muscle activity patterns change in relation to10 different emotions. This finding indicates an emotional/psychologic con-nection to the voice. Psychologic factors may be related to the patient’sresponse to the voice disorder and its effect on his or her life. Or, the voicedisorder may be the manifestation of a larger psychological issue that iscausing a voice disorder, as in psychogenic voice disorders. In either case,treatment should be tailored to the needs of each patient with careful historytaking and thorough examination. The speech-language pathologist may actas a patient advocate speaking with the physician and acting as a catalyst fora referral to the appropriate psychologic professional as deemed necessaryby the physician.Emotional factors also can affect the patient’s overall response to thevoice disorder. Is the patient able to cope with the voice disorder? Howwill it affect his or her current life, voice demand and expectations, and ca-reer? Are past vocal experiences, the diagnosis, or other people’s responsesaffecting therapy sessions or outcomes[4]? These basic questions should beaddressed with the patient.Treating voice patients requires the interaction of many disciplines. Pa-tients and clinicians alike benefit from a team approach to the voice patient’scare. Treatment by an interdisciplinary team is important when treatinganyone who has a voice disorder and crucial when treating the professionalvoice user. The members of the team may include a laryngologist, speech-language pathologist, singing voice specialist or singing teacher, actingvoicespecialist,voiceresearcherorscientist,singingcoach,orpsychologist(Table1).Relationshipswithotherartsmedicinespecialistsarealsoimportant,includingneurologists, pulmonologists, gastroenterologists, endocrinologists, physiat-rists, psychiatrists, and others.In some centers the interdisciplinary team may be in one facility, but notalways. Whenever possible, it is beneficial for voice therapy and singingvoice therapy to be completed by two different professionals. When this oc-curs adequate time is spent on both areas of the voice, the clinicians canwork together to target areas in the speaking and singing voice, and eachclinician can advise the patient within the area in which they are working,regardless of the individual background. If team members are not withinthe same facility it is important to build relationships within the communityto maximize patient care.In specific cases other specialists may be included in the interdisciplinaryteam. The voice researcher or scientist can provide valuable insight and per-spective regarding the care of a voice patient because of his or her specificknowledge and skill set in acoustic measurement and voice production. Re-ferral to a singing voice coach may also be useful following rehabilitationwork with the speech-language pathologist and singing voice specialist.
1135
VOICE THERAPY FOR THE PROFESSIONAL VOICE
Search History:
Result 00 of 00
00 results for result for
p.
Voice Therapy for the Professional Voice
3.8K
Reads
53
Readcasts
3
Embed Views
More From This User
Notes
Load more
