Studies on various voice therapies have been evaluated through controlled clinical trials; however, little evidence exists as to the efficacy of individual techniques or processes thought to improve voice function.
Lessac Madsen Resonant Voice Therapy (LMRVT) emphasizes forward focus, smooth phonation and sensory awareness. Patients experience vibrations across their front face including hard palate, alveolar ridge and nasal septum – something Lessac Madsen Resonant Voice Therapy can do.
What is LMRVT?
LMRVT seeks to teach patients how to speak in an optimal, forward focus manner, moving the power of speech away from vocal folds and into neck and mouth regions. By doing so, clinicians can assist their patient avoid overusing and overworking their voice – an often leading cause of laryngeal nodules and polyps. Furthermore, vocal hygiene training ensures further injury protection and assists healing when vocal issues occur.
The therapist will begin by encouraging the patient to listen carefully to his or her own voice, to identify any problems with production such as excessive effort or an unusual sound quality. From there, they will guide them in using resonant voicing based on vibratory sensations felt along the anterior alveolar ridge. Encouragement for patients to notice how this feels is provided when necessary (Verdolini & Titze are currently researching this area of motor learning), with only verbal instructions being used when necessary (Verdolini & Titze are in preparation).
As well as emphasizing resonant voice, clinicians will also create an individualized hygiene program tailored specifically to each patient, which may include proper hydration to mitigate against phonotrauma effects and avoid shouting activities that produce significant levels of vibration and adduction within vocal folds which increase injury risks and risk of nodule formation.
Clinical experience and unpublished experimental data collected by the authors of LMRVT reveal its superiority over traditional voice therapy in healing phonotraumatic lesions and decreasing nodule formation. LMRVT’s resonant voicing approach also proves more successful than prescriptions of complete voice rest, which have been found to prolong recovery from vocal overuse while hindering full laryngeal healing.
Biomechanics
LMRVT seeks to assist patients in producing their best voice with minimal effort, by adjusting vocal fold positions and movements so as to promote healthy laryngeal mechanics and laryngeal mechanics. A crucial component of LMRVT therapy is maintaining vocal fold positions such that healthy laryngeal mechanics are maximized; the barely abducted/barely adducted position plays a vital role. Furthermore, this position reduces muscle tension and fatigue which contributes to improved voice quality as well as smoother phonation.
RVT uses experiential sensory processing and repetition of training stimuli at increasing levels of complexity to maximize its efficacy, contributing to its strong evidence base and its success in treating various voice disorders.
Once again, biomechanics of therapy is important, but also important is understanding its implementation in clinical practice. How a clinician approaches treating voice disorders has an enormous effect on the outcome of therapy; this is particularly relevant with physiologic approaches to voice therapy which assume that our bodies have the ability to restore normal or healthy patterns of function even after injury or illness has caused disorganization in its systems.
To effectively implement this form of therapy, clinicians must ensure their patient is provided with enough guidance for them to make changes in their phonation. This may involve both verbal and nonverbal instruction that reinforce the new methods of sound production. Therapists will first demonstrate what a healthy voice should sound like; then cueing patients to produce sound which matches up with what was demonstrated; until eventually patients can accurately reproduce sound which matches up with healthy voices.
The therapist will then move onto practicing both voiced and voiceless sounds at the word, phrase, and sentence levels. They will encourage their patient to focus on using resonant vocalization during these practices and notice any instances when their old, unhealthy voice returns; this will equip them with tools necessary for using their healthy voice in everyday interactions.
Learning
Resonant voice therapy is one of the many voice training techniques, teaching patients how to speak with an easy forward focus and forward phonation, shifting power away from vocal folds toward anterior laryngeal ridge, nasal cavity, uvula, teeth, lips – helping prevent tension, muscle spasms and vocal fold nodules.
Verdolini Abbott developed this technique in the early 2000s and named it Lessac Madsen resonant voice therapy after two of her mentors: Arthur Lessac and Mark Madsen. Her treatment relies on principles from kinesensics, motor learning and voice biomechanics as well as conducting research.
Studies have demonstrated the efficacy of Resonant Voice Therapy for treating various disorders, such as voice-related handicap. Most studies conducted thus far were small-scale uncontrolled observational investigations with limited samples or specific populations; more evidence must be generated through large-scale randomised controlled trials to further establish its efficacy.
Compliance
As with other resonant voice therapies, patient compliance with home practice regimens is of utmost importance for effective voice therapy. Multiple factors contribute to this challenge, such as vocal targets being intangible and thus demoralizing; also required is extrinsic feedback on performance which motivates goal adherence while aiding motor skill acquisition9. It has long been demonstrated that concretely measurable goal attainment provides more incentive than non-measurable objectives, leading to greater self-efficacy for continuing effort despite obstacles (Keller & Hodge 2003).
LMRVT addresses these concerns by offering a therapy structure with concrete goals, measurable outcomes and immediate rewards through loud speech production. Furthermore, each hygiene program is customized specifically for each patient to emphasize aspects relevant to daily living rather than providing generic list of do’s and don’ts which may not be motivational enough for individual patients.
Finally, clinicians provide guidance in goal setting and replicating clinical outcome measures in home practice. Furthermore, an iOS app that displays cepstral peak prominence (CPP) data has shown great promise in motivating patients to conduct resonant voice practice at home10.10
