Voice therapy


Voice therapy consists of techniques and procedures that target vocal parameters, such as vocal fold closure, pitch, volume, and quality. This therapy is provided by speech-language pathologists and is primarily used to aid in the management of voice disorders, or for altering the overall quality of voice, as in the case of transgender voice therapy. Vocal pedagogy is a related field to alter voice for the purpose of singing. Voice therapy may also serve to teach preventive measures such as vocal hygiene and other safe speaking or singing practices.

Orientations

There are several orientations towards management in voice therapy. The approach taken to voice therapy varies between individuals, as no set treatment method applies for all individuals. The specific method of treatment should consider the type and severity of the disorder, as well as individual qualities such as personal and cultural characteristics. Some common orientations are described below.

Symptomatic

Symptomatic voice therapy aims to directly or indirectly modify the symptoms that are caused by a voice disorder. Techniques are implemented to facilitate the production and maintenance of a voice that is most appropriate for the individual. Symptomatic voice therapy can modify respiration, phonation, resonance, voice, loudness, rate, and laryngeal muscle tension and may assist in gender reassignment voice change.

Physiologic

Physiologic voice therapy may be adopted when the voice disorder is caused by a disturbance in the physiology of the vocal mechanism. Therapy directly modifies the abnormal physiologic activity affecting respiration, phonation, and resonance. Physiologic voice therapy aims to create a balance between the various subsystems.

Hygienic

Hygienic voice therapy involves modifying or eliminating inappropriate vocal behaviours that lead to voice dysfunction. Once behaviours are modified, the voice may improve towards a normal state. The voice is improved without directly targeting physiological mechanisms. Hygienic Voice therapy uses different techniques which are used for both management and prevention for voice disorders. For management of disorders, hygienic voice therapy is usually used in conjunction with other voice therapy methods. Vocal hygiene programs can include many different components but usually includes speech and non-speech aspects. Speech aspects include addressing loudness and amount of use. Whereas non-speech components typically address components such as allergies, or laryngopharyngeal reflux. A vocal hygiene program also may include a component about learning about how the voice works.
Some vocal hygiene guidelines for better vocal health:
  • Avoid phono-traumatic behaviours.
  • Decrease or eliminate use of alcohol, caffeine, and drugs.
  • Increase humidification of the upper respiratory tract.
  • Decrease quantity of speech.

    Psychogenic

Psychogenic voice therapy examines the psychological and emotional factors that cause and perpetuate disordered voice, and focuses on modifying those factors to improve voice functioning.

Eclectic

The various voice therapy orientations are not exclusive of each other. Any combination of orientations can be used in treatment. This is known as eclectic voice therapy.

Procedures

Vocal surgeries

While hormone replacement therapy and gender reassignment surgery can cause a more feminine physical appearance, they do little to alter the pitch or sound of the voice. A number of surgical procedures exist to alter the vocal structure. These can be used in conjunction with voice therapy:
is an artificial device, usually made of silicone, that is used to help laryngectomized patients to speak.

Applications

Physiologic voice therapy

Accent Method

There are many different physiologic voice therapy approaches that can be used in treatment. An example of a holistic approach used in voice therapy is the Smith Accent Method, introduced as a method to improve both speech and voice production. This technique can be used to treat stuttering, breathing, dysprosody, dysphonia, and to increase control of breathing, phrasing, and rhythm.
The main targets of accent methods are:
  • To increase the pulmonary output
  • To reduce tension in muscles
  • To reduce glottis waste
  • To stabilize the vibratory pattern of the vocal folds while speaking.
The accent method is implemented two to three times a week, in 20 minute sessions. The procedure is two-part: diaphragmatic breathing and rhythmic vowel play. During diaphragmatic breathing, the patient is trained to elicit and monitor abdominal breathing and muscle relaxation. Rhythms are then introduced in two beats, with an accent on the second sound. The accented rhythm is then generalized to longer phonation at three speeds, while maintaining proper breathing techniques. The rhythms are then generalized to real speech, through the use of repetition, reading passages, conversations, and monologues.

Symptomatic Voice Therapy

Chant-Talk

There is a wide variety of treatments that fall under symptomatic voice therapy. An example of a symptomatic voice treatment method is the chant-talk approach. The chant-talk approach uses pre-existing characteristics found in chanting-styled music, such as rhythm and prosodic patterns. The therapy is used to reduce phonatory effort, which causes vocal fatigue. Chant therapy is used to minimize hyperfunctionality by affecting loudness and voice quality. The technique employs the continuous tone quality found in music chanting. More specifically, it elevates the pitch of the voice during phonation, prolongs the vowels, de-stresses syllables, and lessens word-initial glottal attacks.
The goals of the chant-talk approach are to use voice quality and pitch techniques to decrease the effort used while talking. The technique is first demonstrated through the use of recordings, with the patient subsequently asked to imitate the specified voicing patterns. Once the chant has been mastered, the patient is asked to read aloud in chant and in normal register in 20 second alternation. Patients are asked to reduce chanting to a minimal, while maintaining vowel prolongations and softened glottal word onsets. Sessions are recorded in order to provide auditory feedback.

Resonant Voice Therapy

Resonant voice is a technique often taught to actors and singers to improve voice production. Resonant voice therapy teaches clients to use resonant voice in order to reduce vocal fold trauma. Resonant voice is produced with minimally adducted vocal folds. This technique reduces the force of the vocal folds vibrating against each other, which reduces trauma and allows healing. A variety of different programs, including Lessac-Masden Resonant Voice Therapy, Humming, and Y-Buzz, have been studied and used to help teach resonant voice.
Each program uses slightly different strategies to teach resonant voice. However, they all have similar hierarchical structures and share the goal of producing a strong, clear voice with minimal effort. In the aforementioned programs, the client begins by trying to produce resonance during nasal consonants and vowels, then progresses to using this technique in words, sentences, and conversations. During voice therapy, clinicians often help patients conceptualize resonant voice by discussing where the patient "feels" their voice. Patients with dysphonia often describe their voices as vibrating in the throat. Resonant voice is described as vibrating higher and further forward, and being felt at the alveolar ridge and in the maxillary bones.
Range Expansion and Stabilization Techniques and Exercises
Range Expansion and Stabilization Techniques and exercises target symptoms such as reduced pitch range, reduced loudness, and voice instability which are often related to a variety of different voice disorders. There are three main exercises that work to target these symptoms. The first is called a "stretching" exercise and targets pitch range. The client is asked to find their comfortable pitch, and then slowly go up 1/3 of an octave using a gliding technique, and then gently go back to their comfortable pitch on one inhale. This procedure is followed by an exhale and rest for 1–2 seconds, then should be repeated 2-3 times. As the client improves, octave levels can be increased. The second is called a "resistance" exercise and focuses on loudness. The client is asked to use their comfortable pitch and go from a soft to loud voice for 3–4 seconds, followed by an exhale. It is important to train the client to do this without straining their voice. The third is called an "endurance" exercise, the client is instructed to hold a note as long as they can by controlling their exhale.

Vocal pedagogy

[Vocal pedagogy] for [singing], particularly [opera]

  • Dialect training for actors who need to speak with a particular dialect or accent
While many transgender women wish to sing like cisgender women, it will require a lot of training for one to achieve a feminine-sounding voice. This is why most people who haven't gone through male puberty before beginning hormone replacement therapy have a higher chance of retaining this quality. See castrato for more information.
Voice therapy is sometimes undertaken by trans women and trans men to make their voices better match their gender. Voice feminization is the desired outcome of surgical techniques, speech therapy, self-help programs and a general litany of other techniques to acquire a female-sounding voice from a perceived male-sounding voice. Voice masculinization is the use of the same procedures and techniques to acquire a male-sounding voice.