Verdolini Abbott, K. (2009). Lessac-Madsen Resonant Voice Therapy in a Young Woman With Vocal Fold Nodules. In J.C. Stemple & E. Hapner’s Voice Therapy: Clinical Studies (5th Ed) published by Plural Publishing of San Diego.
Workshop on Voice Therapy Spectrum and Adventures in Voice. Invited training seminar at Pittsburgh Voice Conference hosted by University of Pittsburgh Voice Center in Pittsburg, Pennsylvania.
1. Background
Lessac-Madsen Resonant Voice Therapy (LMRVT) clinician manual is grounded in fundamental research of voice biomechanics, vocal fold mechanics, motor learning and perceptual-motor approaches. Designed to teach principles of resonant voice production while providing instruction that avoids phonotrauma, this manual combines basic scientific foundations with perceptual-motor approaches and has undergone clinical trial (Katherine Verdolini Abbott Ph.D CCC-SLP as principal investigator), producing highly favorable results in teachers with phonogenic dysphonia.
LMRVT clinicians train patients to produce clear, quiet and effortless non-adducted vocal fold sounds without any adduction of vocal folds and an expression similar to puppy whimpering (similar to puppy whining) when starting up the voice sound, producing vibrational sensations along the anterior alveolar ridge and sounding open and clear (Verdolini 2000). A resonant voice can be defined as sound which feels effortless to produce but produces vibratory sensations along its edges as it opens out completely (Verdolini 2000).
Patients are educated on the significance of good hygiene practices. Clinicians emphasize personalized approaches rather than an exhaustive list. Patients learn daily vocal hygiene fundamentals including how to utilize their resonant voice throughout the day for maintaining good phonatory habits; vocal hygiene spray or lozenges may be suggested by clinicians to assist in this effort.
There have been various approaches to teaching the principles of resonant speech through training programs designed for resonant voices; some programs use rhythmic exercises or nonspeech activities while others utilize specific consonants like fricatives (/m/, /n/ and /NG/), fricatives (/m/) and nasals (/NG/) (Kotby & Fex, 1998; Orbelo Li Verdolini Abbott 2014, Stemple 2005).
LMRVT relies on perceptual measures to guide patients towards developing a resonant voice instead of following a set list of sounds, which helps avoid vocal fold adduction and potential phonotrauma. Furthermore, LMRVT’s resonance-based method may reduce chances of contributing to phonogenic dysphonia development.
2. Methods
Lessac Kinesensics method of voice training is founded upon principles of perceptual-motor learning and speech kinesiology, creating a holistic approach to voice therapy that utilizes full-body introspection and observation to assist patients in discovering their natural voice. This approach, using the scan-gel-show-tell principle of motor learning, involves paying close attention to breath, body positioning and vocal manipulations. It’s taught through an intensive two-day seminar available both online and in person. This seminar covers basic voice science for adduction, resonance and vibration; as well as step-by-step instructions in Lessac-Madsen Resonant Voice Therapy (LMRVT) and Casper-Stone Confidential Flow Therapy (CSCFT). It is tailored specifically for speech-language pathologists who wish to implement this approach into their practices.
LMRVT is an evidence-based voice treatment approved by the National Institutes of Health that has undergone clinical trial funding from their grant, and has demonstrated promising results for teachers with phonogenic voice disorders. Clinicians can utilize LMRVT’s comprehensive approach in treating all spectrums of voice disorders including those caused by phonotrauma.
Utilizing adduction, resonance and vibration has proven successful for treating various vocal ailments among singers, such as nodules, muscle tension and an atrophic larynx. Furthermore, its use has proven useful in treating voice disorders across other professions like teaching and nursing.
Not only is voice therapy used to address vocal disorders, but this technique has become popular within the field of aural rehabilitation to address trauma-induced acoustic injury (Spitz 2007). Aim of rehabilitation is to restore normal speech production sound as soon as possible so clients may continue communicating efficiently.
The author has extensive clinical experience with Lessac-Madsen Resonant Voice Therapy and its associated techniques, having presented at various conferences and seminars as well as publishing her work in several peer-reviewed scientific journals and textbooks, such as Journal of American Speech-Language-Hearing Association Journal as well as textbooks such as Edgar Press’ Using Lessac Madsen Vocal System: A Manual for Clinical Practice which can be found worldwide bookstores. Her most recent clinical research study involved conducting randomized controlled research into its effects upon singing teachers phonotrauma treatment using LMRVT which she published extensively.
3. Results
Katherine Verdolini developed Lessac-Madsen Resonant Voice Therapy (LMRVT) during the early 2000s in memory of two of her mentors: Arthur Lessac and Mark Madsen. Based on research into resonant voice, motor learning, consistent practice, controlled practice sessions are central elements in LMRVT’s implementation as a comprehensive evidence-based treatment of psychological voice disorders.
Research to date indicates that LMRVT can effectively reduce laryngeal musculoskeletal tension and improve vocal fold position, as well as enhance subjective measures of voice quality and function, including increased ease of voice production and decreased throat pain. While these studies appear promising, their outcomes remain uncertain and it remains to be determined if improvements resulted from solely from manual techniques like LMRVT itself, or more indirectly as a result of factors like improved vocal hygiene or increased confidence.
LMRVT stands out by placing equal emphasis on both the “how” and “what” aspects of voice rehabilitation. LMRVT clinicians emphasize the significance of regular, consistent resonant voice practice alongside eliminating internal and external voice abuse; patients are advised to limit use of such practices whenever possible while making any necessary modifications to their environment; before using their voice they are to complete soft, controlled resonant exercises as warm-up. Also they should keep water close by.
The clinician takes great care in tailoring each hygiene program specifically to each patient, emphasizing those elements relevant to their lifestyle and post-therapy needs rather than simply listing do’s and don’ts. Patients are therefore actively encouraged to participate in their therapy and help form their post-therapy programs themselves, in line with research indicating this approach as the most successful way to ensure long-term learning and compliance; random and variable practice methods are used according to research evidence which supports their use for increasing likelihood that a new skill will be learned over time; finally random and variable practice methods may also increase learning likelihood over time.
4. Conclusions
Lessac-Madsen Resonant Voice Therapy provides SLPs with an ideal opportunity to educate their clients on voice health and the voice. Multiple research studies demonstrate its efficacy as an effective treatment technique and tool to address various voice disorders.
Resonant voice therapy should only be utilized sparingly and when felt to be beneficial by both client and therapist.
Concerns surrounding the use of resonant voice include patients becoming inspired by the sound of their voices and speaking more loudly outside of clinic before mastering more basic exercises. While this could be seen as positive aspect of training, attempting to produce loud voices before full restoration occurs could cause additional injury; further study must be performed on this potential issue before concluding if indeed this poses any problems.
Resonant voice may also prove beneficial in helping patients to the precontemplation stage of changing their behavior. Many individuals who seek voice evaluations are already aware that certain behaviors have negatively affected their vocal health; they just need help making informed decisions about the best ways to enhance both vocal function and quality of life. An SLP should assist these patients with making informed choices regarding improving vocal function and quality of life.
Lessac-madsen comprises various therapeutic techniques that can be employed alone or combined to treat voice conditions. This clinician manual offers a clear and comprehensive introduction to its foundations. Clinicians will find this manual an efficient tool for integrating the Resonant Voice Technique into clinical practice and helping their clients build healthy vocal habits that will last a lifetime. The author would like to extend a special thanks and gratitude to the Delaware Voice Consortium for supporting and participating in this project. Nemours in Wilmington, DE (Dr Patrick Barth); Christiana Hospital in Wilmington (Dr Jonathan Romak); and University of Delaware Communication Sciences and Disorders PhD students (Mss Marianna Rubino, Mr Umit Dasdogen, Martin Vivero and Christopher Apfelbach).
