LMRVT is a voice therapy program designed to teach healthy voicing patterns to meet functional voice demands. The biomechanical target for LMRVT is minimal ab/adduction vocal fold posturing which has been demonstrated through studies to deliver maximum vocal intensity with minimum injury (Verdolini& Titze, in preparation).
Therapists must teach their patients about maintaining good vocal hygiene practices to avoid phonotrauma and maintain adequate hydration levels. In addition to training resonant voice, this includes teaching them how to avoid phonotrauma while encouraging consistent, adequate hydration levels.
Basic Training Gesture (BTG)
RVT begins with a basic training gesture (BTG). This initial stage teaches patients to detect vibrationotactile sensations during resonant production and balance their phonatory airflow, leading to effortless and healthy phonation – key features distinguishing this method from others.
RVT emphasizes segmentation as a vital aspect of its treatment approach, to break complex behaviors into easily manageable targets known as voice behaviors and facilitate quicker and more accurate feedback from their somatosensory systems.
A speech therapist may employ various methods to guide their patient through various resonant voice behaviors, such as scanning, showing correct gestures and using scan-gel-show-tell. They may also utilize negative practice techniques to help the patient distinguish between their usual and new resonant voices.
The therapist will also implement a conversation training program with their patient to generalize resonant voices into everyday speech contexts, by asking questions such as, “What did you have for breakfast?” and “Do you have anything planned this afternoon?”. A voice therapy session should help patients become familiar with their resonant voice and make conversational settings easier for them. Therapists should foster trusting relationships between themselves and patients to promote adherence to voice hygiene programs tailored specifically for each individual, emphasizing hygiene points relevant to lifestyle – this ensures patients continue working towards improving their resonant voices outside the clinic setting.
Vocal Fold Exercises (VFE)
This manual introduces Katherine Verdolini’s Lessac-Madsen Resonant Voice Therapy (LMRVT). This program teaches patients strategies to enhance their vocal health through physical environment changes and biomechanics of phonation alterations, drawing upon principles from resonant voice theory and motor learning theory as a foundation. LMRVT was named in honor of two mentors Arthur Lessac and Mark Madsen who pioneered work related to both aspects of voice therapy; its pioneering work on these fields provided much inspiration for this technique’s development.
LMRVT seeks to facilitate the barely abducted/adducted laryngeal posture that studies have identified as being most conducive to high vocal intensity with minimal injury, unlike many other voice programs which employ mechanical methods to teach patients how to attain this posture. Instead, LMRVT employs perceptual measures as its starting point; research on motor learning has demonstrated how paying attention solely to mechanics may impede immediate performance and long-term retention of new behaviors.
Through treatment, clinicians will direct patients toward various activities and participations as well as direct intervention tools classified using the RTSS-Voice taxonomy framework – this taxonomy consists of an activity and participation-focused WHO ICF framework that can help categorize different intervention tools and techniques.
Researchers have organized SOVT and other voice therapies into categories according to their shared features, such as using pitch glides or half swallow boom, the requirement to sustain voicing until air runs out, providing feedback on duration and intensity, using abdominal breathing as a form of abdominal relaxation, or using kinesthetic sense of voice pressure as indicators of success.
Bridging Exercises
Some physiologic voice therapy approaches focus on individual subsystems of voice production, such as pitch or loudness, while others strive to enhance whole-voice function. Such approaches, known as voice training or rehabilitation therapies, aim to address all aspects of vocal production instead of just one component at once. Examples of such approaches are Lessac-Madsen Resonant Voice Therapy (LMRVT),16 and Accent Method of Voice Therapy,17 which have both demonstrated promising results through clinical trials.
The bridge exercise is an easy, yet effective, way to strengthen and stabilize muscles in the lumbar spine and pelvis. This helps balance hip extensor muscles with core stabilizing muscles such as rectus abdominus and transverse abdominus; muscles which often get impaired due to sitting for extended periods. Furthermore, this exercise increases hip flexor strength which can alleviate any unnecessary strain placed upon hips and knees.
While bridge exercises can be useful for people suffering from various pathologies, their effectiveness depends on a clinician’s ability to accurately perform them. A successful clinician must possess both artistic approaches to evaluation and treatment as well as scientific rigor; experience continues to teach even master clinicians so this text aims to give novice clinicians access to an array of management strategies.
Hygiene
Hygiene refers to a set of practices designed to keep our bodies clean and healthy, such as covering coughs and sneezes, washing hands frequently and maintaining an clean environment. Hygiene plays an integral part in health care and can prevent many diseases.
A clinician designs an individual hygiene program tailored specifically for each patient to complement LMRVT therapy. This program emphasizes adequate hydration and the avoidance of vocal misuse/phonotraumatic behaviors like screaming (Verdolini, 2002). Furthermore, the program encourages using an abducted/abared posture which has been proven by multiple studies to produce higher voice intensities with minimal effort expenditure; massage of the chin may be recommended by clinicians to ease tension in the larynx.
Post-therapy
LMRVT seeks to educate patients in the fundamentals of resonant voice production so they can apply them in daily speech. A clinician uses perceptual measures and the scan-gel-show-tell technique to guide patients towards achieving a representative representation of resonant quality on simple phonemes – thus teaching the fundamentals while simultaneously minimizing vocal intensity and the risk of further injury.
Studies of motor learning demonstrate that when focused on how a new behavior is carried out, its immediate performance and long-term retention suffer (Verdolini 2004). Therefore, when teaching resonant voice to patients, clinicians typically rely on sensory awareness as the main means to achieving results and only resort to mechanical instructions when perceptual methods fail to produce desired results. The therapist emphasizes a sensation of forward vibration along the anterior alveolar ridge and an easeful experience when singing phonationally. This resonant voice quality corresponds with the barely ab/adducted laryngeal posturing proven to produce maximum vocal intensity with minimum risk of phonotrauma (Verdolini, Drucker, Palmer & Samawi 1998).
A voice therapist creates an individual hygiene program for every patient and addresses factors most likely to hinder compliance outside the clinic, including hydration therapy and restricting loud, demanding speech as well as stressing the importance of daily practice of the resonant voice. They help incorporate Resonant Voice Therapy into everyday routines so patients will more readily practice it at home.
