Lessac Madsen Resonant Voice Therapy (LMRVT), developed by Katherine Verdolini Abbott and named for Arthur Lessac and Mark Madsen as tribute, has undergone both basic science research as well as clinical trials that demonstrate its efficacy.
Clinicians guide patients towards their target behavior of resonant voice by employing scan-gel-show-tell methods until the individual can reproduce it accurately, using motor learning research as their basis.
Basics
This course aims to introduce SLPs to Lessac Kinesensics as an approach for body, voice and speech training and its potential use for individuals suffering from phonogenic voice disorders. Participants will gain an overview of its physiology and motor learning underpinnings as well as clinical data demonstrating its efficacy demonstrated through published evidence as well as unpublished efficacy studies.
LMRVT distinguishes itself by encouraging vocal behavior towards an abducted/adducted laryngeal posture which research has indicated produces maximum loudness intensity with minimal voice strain (Verdolini 2000). This biomechanical target serves both functional and medical goals (e.g. reducing nodules).
After providing an introduction to Lessac Kinesensics theory of human voice and body, a clinician will lead their patient through a series of Resonant Voice Training Gestures (BTGs), while monitoring how each BTG affects louder phonation from them. Subsequently, more complex voicing patterns will gradually be introduced until eventually producing normal conversational resonant voices are achievable across various linguistic contexts.
The clinician will also demonstrate how to tailor each hygiene program specifically to each individual, emphasizing those points that matter for that person rather than forcing a one-size-fits-all program on them. Finally, they will present an overview of LMRVT benefits and limitations across a range of clinical situations.
Assessment
Katherine Verdolini Abbott, PhD, CCC-SLP developed Lessac Madsen Resonant Voice Therapy (LMRVT) as a tribute to Arthur Lessac and Mark Madsen – her mentors – by training clinicians worldwide in applying Lessac Kinesensic body, voice and speech training techniques with clients suffering from phonogenic disorders; conducting both basic science research on LMRVT; holding membership in both American Speech-Language-Hearing Association and International Association of Voice and Speech Trainers as well as receiving compensation through teaching public venues or private sessions and writing series of clinician and patient manuals published through Plural Publishing.
LMRVT’s primary goal is the physiological training of resonant voice. The technique favors slightly ab/adducted laryngeal posturing that easily transfers to loud speech; studies have confirmed this technique’s efficiency at producing vocal intensity with minimal effort required – thus fulfilling both functional and medical objectives (reducing nodules/polyps) (Verdolini 2002).
Additionally, clinicians tailor an individualized vocal hygiene program for each client in the clinic to complement the work completed there. This involves following specific hydration protocols designed to minimize screaming; an activity which typically involves hyperadduction with unusually high amplitudes of vibration (Verdolini 2004) that has been shown in one clinical study to be significantly more acoustically damaging than vocal rest (Verdolini 2004). Random and variable practice also use randomization as evidenced by research findings regarding long-term learning benefits.
Treatment
This two-day seminar offered both in webinar and face-to-face formats provides a framework to comprehend voice therapies from perspectives of biomechanics, biology, learning and patient adherence. A specific treatment method called Lessac Madsen Resonant Voice Therapy (LMRVT) is discussed at length including step-by-step instructions and evidence for its efficacy; clinicians learn to implement LMRVT with their clients while receiving training on various voice exercises for immediate application with patients.
Katherine Verdolini Abbott devised LMRVT in the early 2000s, in honor of mentors Arthur Lessac and Mark Madsen – pioneers in resonant voice therapy and motor learning respectively. Based on this assumption, its purpose is to facilitate functional goals such as clear and strong voices through voicing configurations that optimize loudness intensity without excessive vocal fold tension or phonotraumatic lesions forming; moreover, studies conducted have demonstrated that resonant voice behavior tends to heal more quickly than vocal rest compared with vocal rest alone.
One of the key aspects of LMRVT is the focus placed on how a new way of producing voice should work. Recent research on motor learning suggests that instruction that emphasizes mechanical methods may impair long-term retention; as a result, clinicians guide patients through full-body introspection and observation as needed, using physical manipulation and demonstration when necessary until the patient demonstrates quality that appears representative of resonant voice production (Verdolini 2004). Instructions focused solely on mechanical methods are typically only used as last resort (Verdolini 2004).
As part of their therapy, in addition to resonant voice training, comprehensive voice hygiene programs are included as part of therapy. This may include hydration to decrease effort required for resonant voice production and decrease phonotrauma risk; behavioral modifications that support this approach such as avoiding loud noises (Verdolini 2005); as well as adapting aspects of the therapy so it fits seamlessly into each patient’s everyday life and increase compliance with post-therapy self care activities.
Evaluation
Katherine Verdolini Abbott is an acclaimed voice clinician who has conducted both basic science and clinical research on Lessac Madsen Resonant Voice Therapy (LMRVT). She has presented LMRVT both online and face-to-face, training many clinicians in its use, writing a book about it, and speaking in many countries worldwide about this groundbreaking approach to voice use which emphasizes some forms of vocal use as potentially more therapeutic than voice rest for vocal fold injury; her groundbreaking approach also stresses that loud voice can be safely trained!
LMRVT emphasizes resonant voice training and hygiene programs. Physiologically speaking, this involves teaching vocal behavior toward an abducted/adducted laryngeal position which has been shown in multiple studies to optimize loudness intensity while decreasing injury risks for voice-related problems. Furthermore, LMRVT trains acoustic characteristics which promote healthy voicing such as open sound quality, forward vibrato and unimpaired resonance resonance.
An important element of this approach is emphasizing patient compliance. According to research led by Verdolini, patient adherence to post-therapy home programs after therapy sessions are more critical than therapy itself (Verdolini-Marston, Burke, Lessac Glaze & Caldwell 1995).
LMRVT also ensures patients can apply this new approach outside the clinic easily by integrating hygiene and resonant voice training into daily life routines. While this approach could encourage some to attempt loud phonation before their voice has fully developed resonant resonance, which could result in additional phonotrauma; further investigation would need to be completed on this concept, yet it remains an intriguing notion worth investigating further.
