Client: Date: Time:

Subjective
The patient was referred to voice therapy by her ENT after being diagnosed with vocal nodules. Patient was
previously evaluated by the SLP and was diagnosed with moderate dysphonia characterized by roughness,
strain, and breathiness.
Objective
1. Patient will use confidential voice while at home talking with family members 70% of the time, as
determined by patient and family report.
The clinician demonstrated how to use confidential voice to the client when counting from 1-10. The
client then used this therapy technique to count from 1-10 5x. When counting in the confidential voice
the client needed visual cueing to decrease her loudness level. The client accurately used this voice in
3 out of 5 opportunities. When asked to use the confidential voice to read a passage 5x the client
accurately used the confidential voice in 5 out of 5 opportunities.
2. Patient will complete 20 repetitions of the yawn-sigh method 2x/day for 5 days a week.
The client completed 20 total repetitions of the yawn-sigh method during the session. The client
completed 5 repetitions of each of the four steps. The four steps are as follows: yawn with gentle
phonation; yawn with gentle phonation of words beginning with /h/; yawn while saying phrase such as
how are you; “think yawn” and say phrase. The clinician demonstrated how to do each step and then
prompted the client to do the same.

Assessment
The patient demonstrated understanding of the two techniques introduced during this session. The clinician
discussed how these techniques will be completed at home. The patient has a good prognosis due to high
motivation levels. When the clinician asked if the patient could notice a difference in her voice when using the
techniques, she expressed that it sounded better to her and less harsh.
Planning
Client will use confidential voice and complete repetitions of the yawn-sigh method at home and will report back
to the clinician. Weekly sessions are recommended to determine if exercises are helping the patient improve
their voice quality.

JMU Speech-Language Clinic

Name, B.S. Date Name, M.S., CCC-SLP Date

Graduate Clinician Clinical Educator