LMRVT is an all-inclusive voice therapy technique created by Katherine Verdolini to teach resonant vocal techniques, vocal hygiene practices and self-care strategies. She created it as a tribute to Arthur Lessac and Mark Madsen – two mentors she considers dear.
Studies demonstrate that resonant voice therapy applies successfully to everyday functional speech. However, its mastery should first be accomplished prior to applying it on an everyday basis.
Behavioral Therapy
Resonant voice therapy aims to teach patients how to produce a healthy, robust and full voice with minimum effort, by addressing issues like excessive vocal effort, poor posture and improper breathing patterns as well as providing vital education on adequate hydration levels.
Behavioral therapy is one of the main components of Lessac-Madsen Resonant Voice Therapy and an effective means of eliminating vocal nodules. Used alongside techniques like voice hygiene education and Vocal Function Exercises, behavioral therapy provides optimal voice health care to ensure nodules are prevented or treated as soon as they arise. This method also serves to prevent and treat other voice disorders that might develop over time.
LMRVT is a form of speech language pathology which has proven its efficacy in treating nodules and other vocal disorders. Utilizing evidence-based principles of laryngeal adduction, motor learning concepts and motor learning concepts for improving vocal efficiency. Conceived and developed by Katherine Verdolini Abbott in honor of Arthur Lessac and Mark Madsen as mentors (Vayden 2017), LMRVT encompasses holistic voice treatment as a comprehensive solution; with training resonant training motor learning training and an emphasis on maintaining healthy vocal fold health (Vayden 2017).
Research has demonstrated the efficacy of direct voice therapy as part of Lessac-Madsen RVT to alleviate nodules and other symptoms of vocal dysfunction. Clinicians guide their patient through exercises such as full body introspection and observation, physical manipulation and demonstration, verbal cueing and physical manipulation to find their best representation of resonant tone voice. Negative practice techniques should also be utilized, encouraging generalization of resonant phonation into conversational speech patterns.
Recent results of a comparison between indirect and direct voice therapy were encouraging; however, data is scarce on specific components of Lessac-Madsen Resonant Therapy (LMRVT). A previous study by Roy et al30 demonstrated that laryngeal posturing used during LMRVT for minimalizing nodules and improving vocal health as evidenced by measurements of CPP, CSID, NP which all showed significant improvements after four stages of Lessac Madsen Program.
Vocal Hygiene
Just as brushing your teeth helps preserve a bright smile, vocal hygiene ensures healthy voices by preventing irritation, strain or injury to them. This includes behaviors like proper breathing techniques, limiting alcohol and caffeine intake, smoking less frequently, practicing good posture and relaxation as well as gargling lukewarm water to loosen mucous build up, gargle with warm water for mucous relief and eliminating foods that irritate throats such as spicy or fried foods that could aggravate inflammation in your throats.
Studies demonstrate the efficacy of vocal hygiene education as an effective preventative strategy against voice disorders. Due to its limited success when employed alone, however, voice rehabilitation programs with direct therapy techniques should also include vocal hygiene education in their programming.
Vocal hygiene education often entails a list of “do this, do that” steps designed to optimize voice health, which has often been associated with “vocal abuse” or violent use. SLPs must therefore educate patients in an individualized fashion using meta-therapy and motivational interviewing principles to foster increased patient self-efficacy for change.
Hoarse or raspy voice is one of the hallmarks of poor vocal hygiene, often caused by screaming, overuse of vocal cords or long-term throat infections. Other potential culprits may include medications or conditions like acid reflux and vocal cord nodules. If this problem persists for an extended period, please seek medical advice immediately.
Although anyone is at risk for functional voice disorders, those who use their voices frequently for performance or teaching such as teachers, singers, actors and priests are especially prone to developing issues with their vocal folds. This includes teachers, singers, actors and priests.
Professional and recreational voice users must practice proper voice hygiene to reduce the risk of temporary or permanent conditions arising in their voice. If symptoms of voice disorder exist, make an appointment with a speech-language pathologist in your area to explore how lessac-madsen resonant voice therapy could assist.
Vocal Function Exercises
Vocal function exercises are therapeutic tasks intended to strengthen and increase coordination among the muscles involved in voice production, such as vocal folds, glottal muscle, respiration and articulator placement. Vocal function exercises work best when performed regularly with an emphasis on easy onset and forward placement of tone; they should not be performed if your throat is sore or strain. A general exercise program emphasizing endurance and strength may also increase oxygen flow to promote healthy voice function.
Joseph Stemple created the Lessac-Madsen Resonant Voice Therapy Treatment Protocol as an evidence-based approach to voice therapy with its first comprehensive review occurring in 2017. A 2017 systematic review supported its efficacy in improving vocal quality.
These exercises are based on Lessac’s concept of the trinity of energies collaborating together in producing a resonant voice.7 He taught that structural actions, tonal actions and anterior oral vibrations must all work in harmony for effective voice production.
Studies have demonstrated that voice synthesis engines (VFEs) can significantly increase vocal fold closure force and adduction velocity, likely as a result of increasing vocal fold thickness and coordination among its subsystems.7
The initial VFE serves as a warm-up exercise, where participants should sustain nasalized vowel /i/ for as long as possible at an easy pitch. Exercise two, three and four require voice adduction through SOVT posture with speech sound/o/. During exercises two and three of these, participants are instructed to round their lips slightly but not tightly to reduce sympathetic vibration of lips, and allow adduction without excessive vocal fold tension.
The fourth VFE involves performing downward pitch glide exercises on vowel /o/, using SOVT posture. These should be repeated over several weeks until your client reaches their maximum phonation goal; then establish a maintenance schedule accordingly.
Self-Care
Lessac-madsen Resonant Voice Therapy stands out from other voice therapies by taking a more indirect approach to altering voice function. Instead of emphasizing individual techniques as methods of change, this therapy teaches patients how to speak in such a way as to reduce impact stress and move vocal power away from vocal folds; thus preventing further phonotraumatic damage and alleviating symptoms associated with MTVD such as nodules and polyps. Furthermore, lessac-madsen may also reduce reflux symptoms while improving voice quality and endurance as compared to some other approaches taken.
Katherine Verdolini Abbott created this voice therapy technique, emphasizing forward focus and easy phonation. Its foundation lies in vibratory sensations felt along the anterior alveolar ridge, lips, and higher facial region during voice production that have been described as buzzing or tickling sensations. Once understood by patients, this concept allows therapists to practice voiced and voiceless sounds at word, phrase and sentence levels as well as negative practice to feel the difference between their new, healthy voice and their old unhealthy one.
As the therapist guides their client through resonant voice training, they should help them develop a self-care protocol to facilitate progress towards developing a strong, clean, healthy voice. This may include proper vocal hygiene practices as well as including Vocal Function Exercise into daily life routine. Furthermore, encouraging continued practice of their resonant voice even after therapy has concluded is also critical.
MTVDs are a serious condition, severely impacting many lives. Fortunately, evidence-based voice therapies have proven effective at treating this disorder; such as Conversation Training Therapy (CTT), Resonant Voice Therapy (RVT), and Vocal Function Exercises (VFE). Although these aren’t the only methods of treating MTVDs, these have proven successful at relieving symptoms and decreasing risks of additional phonotrauma.
