Resonant therapy is the solution if you want to unlock the full vocal range as a singer, or experience fatigue, hoarseness or pitch issues as an everyday individual.
Resonant voice techniques aim to optimize vocal resonance while simultaneously minimizing strain on vocal folds, achieved via oral vibratory sensations during easy-onset phonation (humming and voiced and voiceless sounds shaped into phrases and conversations).
Resonant Voice Therapy
Resonant Voice Therapy (RVT) employs exercises designed to help clients access and optimize their vocal resonators. Studies have proven RVT an effective approach for treating vocal fold nodules as well as improving other voice issues.
Vocal fatigue, straining voice, hoarseness and loss of vocal range are issues affecting people of all ages and occupations. Resonant Voice Training teaches the body how to use its own voice without strain, helping clients speak for longer periods in social settings while feeling more comfortable speaking out loud. RVT reduces tension in the voice while helping with breathing support resulting in increased stamina and vocal comfort.
Resonance disorders vary in incidence and prevalence estimates depending on their cause, which can be divided into structural and functional elements. Structural causes include overt and submucous cleft palate; over- or sub-enlarged adenoids which block velopharyngeal closure; post-tonsillectomy scar tissue that limits lateral wall movement, post-tonsillectomy velar hypertrophy due to scar tissue, deep pharyngeal cavity oronasal fistulae as well as naso-palato-pharyngeal disproportion. Functional elements associated with VPD may include apraxia of speech; neurological conditions like stroke and ALS; or behavioral elements including vocal misuse and poor hygiene practices.
A speech-language pathologist conducts a thorough and in-depth evaluation in order to ascertain if RVT is appropriate treatment option for their client, including an acoustic analysis, voice recordings and questionnaire for subjective assessment.
Speech-language pathologists conduct evaluations by assessing clients’ phonatory and laryngeal coordination to ascertain if they have an optimal glottal closure pattern, then instruct them to utter vowels with balanced airflow and barely abducted vocal folds (Lessac 1994; Verdolini-Abbott 2000).
As part of their evaluation, SLPs encourage clients to release muscles in the neck and jaw to open and relax the vocal tract, producing vowels with an optimally healthy and resonant glottal closure pattern. RVT can help resolve vocal nodules and apraxia of speech quickly while also benefiting individuals experiencing fatigue, stamina issues or pitch problems.
Customized Treatment
Speech-language pathologists trained in resonant therapy can identify the appropriate exercises and strategies for each individual patient. The goal is to equip patients with tools for self-managing their voices independently through adaptive strategies like breath control and vocal warm-ups, as well as improve self-awareness while increasing communication abilities through increased vocal strength.
Katherine Verdolini, CCC-SLP created Resonant Voice Therapy as a treatment technique in the early 2000s. She named this approach Lessac-Madsen Resonant Voice Therapy (LMRVT) after two mentors Arthur Lessac and Mark Madsen who pioneered work on Resonant Voice and Motor Learning respectively that laid the groundwork for LMRVT.
Resonant therapy techniques generally focus on supporting the slight ab/adducted position of vocal folds that has been demonstrated through multiple studies to produce maximum voice intensity with minimum effort, often known as biomechanical target. Resonant therapy primarily seeks this goal; functional goals and medical goals like decreasing vocal nodules or improving voice quality may occur as an unintended side-effect (Verdolini & Titze, forthcoming).
Once a clinician guides a patient through basic body stretches and full-body introspection, they begin introducing resonant voice behavior using the scan-gel-show-tell principle; here self-awareness, physical manipulation, demonstration are used in order to help achieve their desired resonant voice in themselves. Once this goal has been accomplished, time should be spent exploring it using simple phonemes in order to familiarize oneself with it.
Specially-designed bridging exercises gradually introduce more complicated voicing patterns until a patient can use resonant voice in daily life. At this point, clinicians can offer guidance in applying resonant voice to louder phonation or other challenging situations; it is important that clinicians avoid inspiring patients to try a resonant voice before meeting all requirements of their program in order to prevent overuse and injury (Verdolini-Marston, Burke, Lessac Glaze & Caldwell 1995).
Voice Evaluation
Whenever someone experiences voice issues, it is essential that they seek professional medical advice from an SLP for evaluation. An SLP assessment offers an in-depth evaluation of vocal fold movement to pinpoint its cause and devise an appropriate treatment plan.
Initial assessments can consist of taking a thorough history, performing vocal sound analysis and using laryngeal videotroboscopy (a scope placed inside your mouth to view vocal folds). From this information collected, your SLP will create a tailored therapy plan designed to optimize your voice.
Resonant voice therapy (RVT) is a collection of techniques designed to teach you to feel and produce the vibrations of your voice in your face and mouth, produce resonant sounds, and gain volitional control of how you produce vocalization patterns. Your therapist will work with you to establish an easy voicing pattern from simple gestures like “ma, me, moo” all the way up to phrases and conversational speech. We will also work to reduce strain and impact between vocal cords in order to reduce injury risks.
Resonant voice therapy not only addresses your underlying condition but can also increase self-awareness of your own voice and sound, an integral component of learning. We will utilize techniques such as lip and tongue trills, humming, straw phonation and buzzy sounds to help you experience and optimize the use of vocal resonators in your own body.
Resonant voice therapy may be combined with other approaches such as speech/voice modification, breathing exercises, elocution training and swallowing treatment to support a complete recovery of your voice. Your therapist will coordinate closely with your primary care physician or otolaryngologist in order to ensure all aspects of care work cohesively as one cohesive team to strengthen it.
At follow-up appointments, your SLP will monitor your progress and make any necessary modifications to the plan for resonant voice therapy. They’ll also give you a home program so that the progress made during office sessions continues to show itself and you experience continual improvements in your voice.
Treatment Plan
The therapist leads their patient in exercises designed to strengthen and activate the resonating areas of their voice. These include semi-occluded vocal tract exercises (lip trills and straw phonation), resonant hums and flow phonation that increase airflow through the pharynx and balance out articulation/voice intensity. Patients also learn proper vocal hygiene activities such as avoiding actions that contribute to fatigue/exhaustion of their voices as well as proper hydration practices.
Resonant therapy‘s clinical goal is for its patient to experience vibratory sensations along their anterior alveolar ridge during easy voicing, translating to an easier feeling phonatory performance. Therapists will guide clients through early exercises until they achieve this quality – often within just the first session! – and gradually increase its complexity until clients can produce normal conversational speech with balanced oral-nasal resonance without effort from day one.
Behavioral speech therapy cannot treat resonance disorders caused by structural anomaly. However, if the issue stems from misarticulation, changing placement on affected sounds may have an impact on perception of resonance and behavioral speech therapy can help reduce articulation error production and subsequent compensatory strategies such as nasal voice production.
Prosthetic management may be used to address neurologically-based resonance imbalances when there are no surgical options and/or the client is unwilling to undergo it. For instance, individuals suffering from VPI (velopharyngeal incompetence) can use an obturator made out of nasal polyps or incompetence in order to reduce airflow through their nasopharynx and compensate for limited velar movement. Antihistamines or steroids may be taken in order to decrease swelling caused by allergies/irritants thus increasing nasal resistance and countering hyponasality.
Community-based SLPs should collaborate with cleft palate/craniofacial teams and otolaryngologists in order to provide optimal speech outcomes for individuals with resonance disorders. Referring these teams during initial evaluation will allow an SLP to determine which team members can assist with optimizing voice outcomes for that individual; then guide client and family through referral process.
