Verdolini’s clinical experience and experimental data demonstrate conclusively that LMRVT’s minimally ab/adducted posturing rapidly heals phonotraumatic nodules faster than vocal rest; furthermore, practicing resonance voice practice easily transfers into loud speech practice.
Studies of motor learning demonstrate that an emphasis on mechanics may reduce immediate performance and long-term retention of new skills, leading to immediate performance issues and loss. Therefore, LMRVT employs sensory methods as its first choice to teach resonant voice behavior before turning to mechanical instructions when necessary.
Assessment
A clinician guides their patient to focus on feeling vibrations on the anterior alveolar ridge and an ease in producing speech production – this quality is known as resonant voice. Once this sensation has been established, clients are then guided through a series of increasingly complex voicing patterns until their speech production becomes effortless, known as bridging. Therapy supports clients as they practice voiced and voiceless sounds at word, phrase and sentence levels until their voices can easily produce in conversational settings.
The scan-gel-show-tell technique is used by therapists to guide clients until they can demonstrate the best representation of a resonant voice. This involves body awareness training as well as hands-on manipulation, demonstration and verbal instructions when necessary. Unlike some other forms of voice training, this approach emphasizes “how” rather than “what.” This method follows research findings in motor learning which suggests that excessive attention on mechanics hinders both immediate performance and long-term retention; consequently therapists utilize perceptual guidance rather than mechanical instructions (Verdolini & Titze in preparation).
To maximize success, therapists stress hygiene points tailored specifically for each individual patient and encourage resonant voice usage as part of daily life, which has been found to increase compliance and ensure greater compliance (Verdolini 2002). Furthermore, the therapist avoids setting an exact timeline for finishing therapy as this could increase risk for laryngeal irritation and increased risk for phonotrauma (Verdolini 2004), thus enabling faster improvement without excessive strain on vocal folds.
Treatment
LMRVT stands out among voice therapy techniques by combining biomechanical training with functional and behavioral goals, such as encouraging patients to speak with a forward focus to shift power away from vocal folds towards front of face, making phonations easier while decreasing strain and risk of phonotrauma (Verdolini, 2002).
Lessac’s7 theory that speaking requires three forms of energy: structural action, tonal action and consonant action is embedded within LMRVT. While structural training gestures focus on building fundamental muscle strength and coordination; tonal and consonant components are highlighted through early exercise progressions to facilitate easy phonation in the anterior oral cavity by positioning articulators to support optimal resonant formation. A clinician then instructs their patient in practicing these new strategies for speech at word, phrase and sentence levels until they can demonstrate smooth conversational style speaking using moderate voice.
As part of their treatment, each patient receives a personalized voice hygiene program designed to give them all of the tools needed to continue developing a resonant voice outside of clinic. A study led by Verdolini indicates that inspired patients may attempt to use loud voices outside before fully mastering a resonant one (Verdolini-Marston, Burke, Lessac Glaze & Caldwell 1995).
LMRVT encourages patient behavioral change such as adequate hydration, reduced voice use and good vocal posture and rest to reduce phonotrauma risk. Furthermore, clinicians teach their patients self-sensitizing to their phonatory habits so they are aware of when they lapse back into throat voice, helping reduce recurrence of phonotrauma as well as increase effectiveness of LMRVT (Verdolini 2004). LMRVT has proven its worth as an evidence-based voice rehabilitation technique and is beneficial in treating muscle tension dysphonia as well as vocal fold nodules on vocal folds (Verdolini 2004).
Home Exercises
Encourage your patients to practice their new healthy voice at home in challenging situations, particularly through recording themselves using resonant voice. Review recordings as evidence between their old unhealthy and new healthy voices; further encourage easy phonation at word, phrase and conversation levels – remind them that resonance can feel like vibrations along the anterior alveolar ridge, nose lips and facial bones; while effortless phonation involves minimal effortful voicing and not tension-based articulation.
Under the Lessac-Madsen Resonant Voice Therapy Protocol, 30 participants received four hour-long treatment sessions each spaced one week apart. To define an effortless voice production zero point on scale, investigators and participants discussed instances when effortless voicing occurred while humming or producing voiced fricatives; their experiences then served to anchor exercise anchors for Resonant Voice Therapy scale exercises.
Ingo Titze’s Flow-Resistent Tube exercises (commonly referred to as straw phonation) and Joe Stemple’s Vocal Function Exercise are two additional treatments which utilize the principles of resonant voice therapy. You can view Titze’s YouTube video demonstrating straw phonation here and here for Stemple.
