Lessac-Madsen Resonant Voice Therapy PDF is a scientific approach for treating hoarseness. Katherine Verdolini initiated this program during the 2000s in honor of two mentors who contributed to resonant voice theory and motor learning.
Therapists use perceptual measures to guide clients toward the target behavior of resonant voice, which involves vibratory sensations on the anterior laryngeal ridge and ease in phonatory communication.
Voice Exercises
LMRVT stands apart from traditional voice therapy approaches by employing nonspeech exploratory exercises such as humming and pitch glides before quickly progressing to speech exercises with an aim of developing easy phonation. This approach allows therapists to evaluate a therapy program based on its impact in everyday speech production.
Resonant voice training begins with clinicians leading patients through full body introspection and observation to identify their best representations of resonant voice. From there, scanning, gel, show and tell, verbal instructions, scanning glasses or negative practice can all be employed to assist the learning process and attain their best voice representations. Negative practice (alternating between old habits and healthy voices) should also be included as an integral component of this process.
LMRVT goes beyond simply encouraging resonant voice; its voicing patterns are tailored to enhance vocal economy and reduce impact stress on the larynx. This is achieved with a physical yet perceptual easier pharyngeal posture than typical vocal behaviors; additionally, LMRVT’s articulators are placed to maximize vibrations in the anterior oral cavity and its vocal folds are configured in such a way as to minimize impact stress while still increasing output intensity.
Lessac7 proposed that three energies combine to produce the voice: structural action, tonal action and consonant action. Although voice structure can be established through BTG or through positioning articulators for maximum resonance with their optimal resonance positions; for resonant voice LMRVT has its own configuration of vocal folds unique for creating such resonance.
Resonant voice requires widening of vocal folds slightly wider than in an adducted, or loud voice quality, thus producing less intense VF oscillations and producing a sound which is quieter and breathy than usual. Resonant voices offer clear and easy-to-speak qualities and clinical research has proven them more successful at meeting daily voice demands than either an adducted or quiet voice option.
Vocal Hygiene Training
LMRVT (Lessac-Madsen Resonant Voice Therapy) emphasizes personalized self-care for the voice, including hydration and avoidance of laryngeal irritants as ways of lowering risk of nodules recurrences. Patients should talk softly for prolonged periods without using their voice for prolonged use, sleep well at night and make time for rest during the day to ensure overuse does not happen.
Traditional vocal hygiene instruction typically entails an extensive list of do’s and don’ts, including language such as “vocal misuse” and “vocal abuse.” Unfortunately, this approach to learning vocal hygiene was associated with adverse impacts on voice self-efficacy (Broaddus-Lawrence et al 2000). Nowadays, more individualized approaches to training include identification of aspects most likely to improve voice quality while decreasing nodule recurrence rates.
Professional voice users such as singers should take special precautions in using their voices professionally for extended periods, as loud phonation increases the risk of nodules and other issues in their voices.
Recent research indicates that combining LMRVT and vocal hygiene education significantly enhanced knowledge and self-rated characteristics of voice health among teachers with nodules. Although early results are promising, further analysis will be required to ascertain if LMRVT reduces nodule incidence or recurrence after initiating treatment programs.
Vocal hygiene is an integral component of LMRVT therapy and should be integrated as soon as possible into therapy sessions. Our goal is to equip our patients with tools and techniques necessary for avoiding and managing vocal injury so that they may live healthy, fulfilling lives.
As LMRVT evolves, there will be a need to further optimize and standardize voice therapy methodologies. This will ensure greater consistency when providing voice care services and ensure clients receive effective treatments.
Nodules Management
Lessac Madsen Resonant Voice Therapy (LMRVT) takes an integrative, physiological approach to resonant voice production that emphasizes sensory processing rather than performance. LMRVT directs vocal behavior towards producing resonant voices with minimal abduct/adduct laryngeal configuration – thus optimizing health of vocal mechanism while helping avoid fatigue and nodules in voice production.
Katherine Verdolini Abbott developed LMRVT in the early 2000s in honor of two eminent mentors, Arthur Lessac and Mark Madsen. The technique is founded upon resonant voice theory and motor learning principles and employs a scanning, probe-gel, demonstrate, and tell method for guided practice to monitor patients’ resonant voices until they achieve it.
The LMRVT program incorporates various techniques, such as negative practice and repeated training stimuli repetitions to encourage behavioral change and habit formation. These approaches have proven particularly successful at helping patients generalize their resonant voice to conversational speech contexts.
Patients suffering from chronic voice abuse who develop vocal cord nodules often improve their condition through six to 10 sessions of LMRVT over 6 to 12 weeks, but if nodules continue to persist and require surgical removal they must first be evaluated through biopsy to ascertain whether they are benign or malignant before proceeding further with voice therapy or radiation exposure may require voice-freezing treatment instead.
Post-Therapy Program
Maintaining the gains made in therapy through an aftercare plan that emphasizes voice hygiene can help patients prolong the effects of therapy. A personalized hygiene program tailored to each patient highlights specific points that pertain most to them; such as refraining from drinking acidic beverages or foods and keeping water bottles on hand at all times to stay hydrated; others may need advice regarding internal (bodily and psychological) and external practices that contribute to vocal abuse.
Resonant voices can be identified by vibratory sensations along the anterior alveolar ridge and an easeful vocal experience, both characteristic of LMRVT (Verdolini 2000). Resonance has also been proven statistically more effective than vocal rest in healing phonotraumatic lesions caused by excessive use or misuse.
LMRVT differs from many voice therapy techniques in that it uses perceptual measures to guide patients toward the desired behavior: producing resonant voice. Therapists encourage this goal by asking patients to produce sounds they find easy or pain-free; singing, whispering or “doesn’t hurt” articulations all count towards producing this result (Yiu, 2017). Studies have proven this approach more successful than VFE or tube phonation approaches to training the voice (Yiu 2017).
Though opinions regarding motor-learning in nonspeech and speech exercises for voice differ, most clinicians agree that resonant voice training leads to carryover into communication more successfully than other techniques like VFE and tube phonation which utilize nonspeech exploratory exercises before progressing onto semi-occlusions embedded in speech.
One issue to address is the potential risk that inspired patients may try speaking louder than is consistent with their resonant voice practice, increasing the risk of additional phonotrauma and necessitating early intervention from their therapist. Being aware that their inspired patients might attempt louder phonation before they are prepared is important to ensuring effective voice therapy services for these clients.
To maximize the effects of resonant voice therapy, therapists must encourage patients to practice these techniques daily and ideally throughout their lives in order to maintain its positive results and avoid relapse.
