Strong and clear vocals can increase confidence and help you express yourself more freely in both professional and personal environments. But sometimes, your vocal tract — comprising several resonating chambers such as your throat and mouth — may become out-of-balance and cause difficulty communicating effectively.
Resonant voice therapy techniques reduce vocal cord strain and promote healthy vibrations that support recovery from issues like hoarseness or pitch difficulties. Learn more about RVT techniques here.
Warm-Ups
Warming up is the practice of performing exercises or movements designed to loosen and loosen up muscles prior to exertion; it is widely utilized across disciplines including physical fitness, sports, acting and singing. Warming up has long been used to increase performance by increasing range, flexibility and agility; it may also increase vocal endurance as well as prevent muscle cramps or injuries in particular in vocal cord muscles.
Warming up is an integral component of voice therapy. Vocal warm-ups typically consist of techniques such as humming, breathing and vocalization – the goal being retraining one’s voice for easier voicing with improved/balanced oral-nasal resonance; otherwise known as “resonant voice”. Resonant voice describes sensations such as buzz or vibration when making soft voicing movements with ease.
This approach to treatment is frequently employed to address hyperfunctional voice disorders like aphthous ulcers, vocal cord paresis/paralysis and benign mass lesions. Furthermore, it is useful for dealing with hypofunctional voice conditions including recurrent laryngitis and vocal fold nodules.
Evidence-based treatments offer evidence of their efficacy through numerous randomized clinical trials (RCTs). These trials show positive acoustic and perceptual outcomes among patients suffering from dysphonia; furthermore, RCTs demonstrate significant increases in voice-related quality of life for both treated and control groups.
The RTSS-Voice Framework provides a new way of specifying voice treatment protocols. Through six Delphi rounds, measurable targets and ingredients were identified; after which, 10 vocal rehabilitation experts evaluated measurability and uniqueness of each target/ingredient.
The resultant set of standard operational definitions and labels provides the foundation for creating a new standardized language and lexicon for voice therapy, improving communication among clinicians as well as other disciplines (e.g. otolaryngologists and speech pathologists). Researchers can then use this language to investigate effects of specific clinician actions on specific patient functions – potentially revolutionizing current voice research/practice where whole treatment protocols work for some while not others due to unknown reasons; into one that allows clear specification of which clinician action affects which patient functions – creating a system where entire treatment protocols work for some but not others due to unknown reasons into one that allows precise specification of which clinician action affects which patient function(s).
Pitch Variation
Resonant voice therapy techniques involve creating sensations of vibrations anteriorly in front of the mouth. This includes sensations occurring near the alveolar ridge, nose, teeth and lips; combined with easy phonation techniques this produces sound quality which feels minimally effortful and non-strained; sometimes described as having “the sound of an open door”. Resonant voice therapy has been successfully utilized for treating laryngeal nodules, polyps and vocal fry.
Clinicians have employed various techniques to teach the sensation of resonant voice. These include adduction/abduction exercises (Brown 2003), low frequency speech (McClaren 1995), nasal sound production and voice characterization exercises, Lessac-Madsen resonance training as well as developing an easy phonation pattern combining vibratory sensations in the anterior palate.
These methods all begin from the premise that it is possible to train an ideal configuration of vocal folds during vibration, which reflects a functional open voice, by working to produce resonance without exerting unnecessary strain or effort on vocal cords and producing an audible resonant tone. Over time this should lead to spontaneous speech patterns.
Pitch variation is another effective means of teaching the resonant voice, in which patients are asked to produce an unintelligible sound, such as “da,” one step above their baseline pitch for several repetitions before gradually increasing it with feedback provided starting at 100% frequency for every trial, gradually diminishing as soon as 80% accuracy is attained.
Therapists may use phonation templates with specific durations and loudness levels in order to help clients learn how to control their voice during spontaneous conversation. This concept is essential because many patients tend to drop their resonant voices during normal conversation without realizing they can make adjustments themselves – this form of negative practice known as voice lift therapy can be especially effective at this. A clinician should make sure their client is aware when their resonant voices have dropped off during conversation by drawing it out as soon as it occurs and providing reminders when necessary.
Resonance Placement
Resonant voice therapy centers on learning how to place sounds where they can amplify and carry. This is the cornerstone of singing, creating vocal resonance through its interaction with surrounding structures such as tongue, larynx and facial bones. SLPs must provide patients with opportunities for them to practice feeling and locating their voices – beginning with simple sounds such as humming then gradually progressing onto more complicated sounds such as chanting nasal sounds then vocalizing words or sentences.
A 2017 systematic review concluded that Lessac-Madsen Resonant Voice Therapy significantly improves speech and language disorders, such as muscle tension dysphonia. Lessac-Madsen therapy specifically targets coordination of breathing with phonation for optimal oral-nasal resonance during natural vocalization.
This approach is founded on the theory that increased forward resonance during phonation can reduce strain. This involves increasing vocal fold acoustic vibrations to move more sound energy away from vocal cords into vocal tract and facial areas; and teaching patients how to direct their voice more efficiently for reduced strain in voice quality.
RTSS-Voice does not fully encompass treatments that utilize nonlaryngeal sources of sound (such as tracheoesophageal prostheses, electro-larynges or speaking valves) or those without larynx (such as tracheostomy tubes with associated speaking valves). We anticipate future research will include this additional ingredient into RTSS-Voice.
SLPs may start their treatment by asking patients where they feel their voice. Some will know immediately, while others may need assistance answering this question. An SLP may then explain the various pathways through which sound travels before arriving at their vocal tract.
SLPs can then assist patients to explore how various postures and facial positions affect their sound, such as chin up, chin down and neutral position. Sometimes they will teach a vowel modification exercise or phonation task to demonstrate how the shape of a syllable affects its resonance – this includes vowels such as ah, ay, ee and oh sounds; clinicians then ask the patients to repeat these vowel sounds until one resonates best in their voice.
Negative Practice
Negative practice techniques may be an integral component of resonant voice therapy for some patients. Negative practice is a behavioral treatment which encourages people to perform self-limiting behaviors until successful completion; in doing so, this teaches patients they have control over their own behaviors; for instance, students with bad habits such as tapping pencils during class could use this technique to break these bad habits and change them for good.
Voluntary vocalizations like yelling, glissandos and sirens may be used with this technique to assist patients in finding their normal voices. By increasing oral vibratory sensations they become aware of their volitional control to produce their own resonant voices with volitional control. A clinician guides this technique digitally manipulating laryngeal framework in order to ensure patients produce resonant voices.
Once a clinician has guided their patient through several negative practice sessions, they will introduce voiced sounds into each session. These could include any sound that produces buzzes or increased energy in front of the mouth or face (for instance y-buzz, straw phonation and buzzy /u/). This should make patients comfortable feeling these sensations while starting to relate them back to resonant voice production.
Once the patient is comfortable with this approach, they can progress to practicing resonant voice in phrases and conversations. While this process will take more time and patience from them both, it will help them realize the many ways their resonant voice can enhance their quality of life.
Resonant voice therapy has been shown to significantly increase vocal outcomes; however, its precise ingredients and targets remain elusive. Therefore, the RTSS-Voice uses an innovative combination of taxonomies for voice treatments with Delphi techniques in order to develop expert consensus categories with specific treatment ingredients and targets that may lead to such improvement – known as treatment specification templates – designed to make implementation of voice treatments in clinics more likely.
