This program incorporates performing voice techniques designed to encourage resonant vocal production, including exercises varying prosody and accent for full use of all vocal registers.
LMRVT is the ideal program for patients who suffer from hoarse vocal qualities. Studies have proven that its minimally ab/adducted laryngeal posturing produces the maximum vocal intensity while simultaneously limiting vocal injury (Verdolini & Titze, in preparation). Furthermore, sensory methods of instruction are prioritized over mechanical ones when providing instruction (Verdolini & Titze).
Semi-Occluded Vocal Tract Exercises
There are various approaches to voice therapy involving semi-occlusions, but Lessac Madsen Resonant Voice Therapy (LMRVT) and Tube Phonation are among the more researched. LMRVT incorporates both nonspeech exploratory exercises as well as speech articulation training into its program and has been shown to significantly improve production of normal acoustic tone production. While some researchers question its ability for motor learning purposes alone, others see nonspeech exercises as integral parts of voice therapy processes.
Vocal Straw Exercises or Vocal Cord Acoustic Resistance (VCRA) are an integral component of Lessac Madsen’s approach to treating voice disorders. VCRA involves speaking or singing into a partially blocked-off straw that allows backpressure from speaking/singing into throat and vocal folds; this allows unloading and vibration efficiency by loosening and relaxing vocal cords.
Research confirms the efficacy of VCRA in improving acoustic quality, reducing phonatory effort, and increasing vocal endurance. Studies conducted using Voice Function Exercises (VFE) also demonstrate positive results by restoring or improving vocal range and pitch stability of healthy individuals.
Exercises have been linked with improved vocal efficiency and economy. VFE exercises cause the Thyroarytenoid (TA) muscle to become more active while Cricothyroid (CT) becomes less so, causing top edges of vocal folds to move further while bottom edges stay still, decreasing tissue collision during phonation.
Lessac-Madsen approach incorporates bridging exercises that increase difficulty of resonant voice behavior to facilitate its transference into everyday communication, including imitation and conversational phrases that fit the patient’s lifestyle. A clinician guides clients using scan-gel-show-tell, physical manipulation, and demonstration until they can successfully reproduce this sound without effort outside of clinic.
Y-Buzz
Y buzz is a variation on humming that uses vibration to induce facial, nose and mouth vibration. This sound allows one to locate resonance points behind two front teeth as well as feel energy flow up from your nostrils through nasal bridge and cartilage to your brain. Furthermore, this practice works to release tension while relaxing the voice; forcing natural resonance forces the voice into natural resonance which can then help strengthen and retrain it over time.
Lessac Kinesensic Training provides a holistic approach to voice and body work. This method emphasizes full-body introspection and observation to assist students in finding their most resonant voice representation; various cues like scan-gel-show-tell can be used as guides during this discovery process.
Once a resonant voice has been found, it becomes easier to transition into other forms of speech without strain or tension. Research indicates that using one’s resonant voice allows students to use their voices more comfortably for longer than traditional therapy techniques and helps develop greater sense of control over one’s own voice.
The Y buzz can be especially useful for actors seeking to curb excitement or nerves from turning into an unpleasant tone in their voices, particularly before scene work or auditions. Students have reported that using this tool keeps them grounded in the present and prevents emotions from taking over during scenes or auditions.
Resonant voice should not be confused with nasality; rather, this technique requires having fully open vocal folds. While Y-buzz may initially prove challenging for some people to master, once it becomes part of one’s repertoire an impressive improvement can occur in their resonant voice performance. According to studies on this subject matter, it has been found that resonant voices typically exhibit less shimmer and irregularity while being heard more easily over noise pollution.
Resonance Therapy
Voice therapy entails helping patients achieve a barely ab/adducted vocal fold posture that research has indicated will result in minimal phonotraumatic damage (Verdolini 2000). The Resonant Voice Program was specifically created to accomplish this biomechanical goal. As well as functional goals like speaking clearly and loudly with strong and clear voices, health outcomes such as decreased nodules and polyps can often result from this therapy as by-products.
LMRVT stands out as an approach that offers direct training of speech production by starting with nonspeech exploration of semi-occlusion, such as VFE or tube phonation, before immediately moving on to semi-occlusion exercises such as y-buzz and pitch glides that use semi-occlusion before progressing quickly into connected speech production that includes vowel vocalizations. This provides clinicians with a standardized set of training techniques for producing this vocal quality across environments and forms of communication.
This approach provides clinicians with a faster path from resonant voice training to functional and medical outcomes, making this technique accessible sooner for patient use. However, there may be concerns that inspired patients may attempt to implement this resonant voice technique into loud speech prior to clinic determination; this could cause high rates of re-injury as well as increases the possibility of additional granulomas formation.
This approach is unique because it addresses hypo- and hyperadducted laryngeal behavior by using perceptual measures to direct patients toward resonant voice characterized by vibratory sensations on the anterior alveolar ridge and ease in speaking and singing. Resonant voices have been proven by clinical practice as well as experimental data to decrease nodules, polyps, reflux symptoms while simultaneously decreasing phonotraumatic injuries (Verdolini 2000).
Resonant voice training has received limited research; however, evidence supports its effectiveness in improving voice quality as well as clinical and physiological parameters associated with adduction. Unfortunately, the results of the current study are inconclusive; therefore larger scale randomised controlled studies must be conducted.
Humming
Humming is an easy and effective vocal warm up that can be used to prepare the voice for more demanding exercises, like stretch and flow or lip trilling. Humming requires no muscle tension like other vocal exercises such as stretch and flow or lip trilling do; therefore providing you with a great way to practice speaking or singing without straining the throat or tightening up vocal folds. Humming can also help train the voice in different directions such as up, down, left and right for healthy vocal development.
Researchers evaluated the efficacy of humming by reviewing journal articles published between 1974 and 2014 with keywords “Lessac Madsen Resonant Voice Therapy and Humming,” searched in Elsevier ScienceDirect Complete, Medline and Proquest Medical Library New Platform databases. Nine studies met the inclusion criteria; two randomized controlled studies (RCSs) and seven observational ones (OISs); quality of evidence rating was moderate for all nine of them.
One study demonstrated that humming can reduce supraglottic hyperfunction in patients with muscle tension dysphonia by decelerating vocal fold adduction during prephonatory adjustment phase and relieving transient laryngeal closures. Furthermore, humming resulted in greater values of minimal angle and less steep slope of glottal area waveform.
Humming can help improve vocal volume, strength and injury prevention through encouraging proper phonation techniques and helping patients recognize sensory information in their own speech. Therefore, patients are advised to incorporate vocal hygiene training as part of their humming practice, along with personalized post-therapy programs for optimal results.
Lessac Madsen Resonant Vocal Therapy (LMRVT) therapy providers design patient-specific plans using this approach, emphasizing vocal hygiene and performing various resonant voice exercises. Once implemented into a practice program for each individual client, this ensures the skills learned will transfer seamlessly into everyday life without risk of injury outside the therapy room.
