This two-day seminar, offered both via webinar and face-to-face formats, provides step-by-step instruction in Lessac-Madsen Resonant Voice Therapy (LMRVT), designed by Katherine Verdolini. This course explores this approach to voice therapy from perspectives such as biomechanics, biology, and learning.
This novel technique optimizes loudness intensity by encouraging vocal behavior towards an abducted laryngeal position. Patients are taught how to use their resonant voices daily in daily life situations – thus decreasing any chance of further phonotrauma outside the clinic.
What is LMRVT?
Lessac-Madsen Resonant Voice Therapy (LMRVT) is an innovative new approach to treating voice disorders, including nodules and polyps. Created by Dr. Katherine Verdolini in honor of two mentors Arthur Lessac and Mark Madsen (Verdolini 2002), LMRVT specifically targets specific signs and symptoms associated with these conditions while also working toward preventing future nodule formation while increasing vocal endurance.
Contrary to many voice therapies, LMRVT targets both aspects of vocal behavior. On one side is training for resonance voice production which facilitates barely ab/adducted laryngeal posturing that has been proven by multiple studies to optimize vocal intensity with minimal phonotraumatic injury (Verdolini 2004). On the other side is how vocal behavior should be managed and reinforced (Lynch & Morrelli Vocal Therapy (LMRT).
Attaining this goal involves integrating biomechanical with behavioral modification through an individually tailored vocal hygiene program designed by the clinician for each patient, emphasizing hydration and lifestyle habits that reduce effects of phonotraumatic stress on vocal folds.
Additionally, clinicians teach patients how to integrate new therapy techniques into their existing daily activities in order to increase the likelihood of consistent use outside the clinic. This approach responds to several studies which indicate that consistent practice outside of clinic is an even more critical indicator of voice outcomes than what kind of voice therapy approach was employed.
LMRVT stands out as being different than other voice therapies due to its special characteristics; however, no empirical data exist which provide statistically significant results when comparing it against clinical standards for treating nodules and polyps. However, it has been demonstrated that this method works and generates high patient compliance compared to most other voice therapy programs. LMRVT has been shown to be superior to Casper-Stone Confidential Flow Therapy when treating patients who experience screaming or hyperadduction (Verdolini, 2010). A comprehensive training program in Lessac-Madsen approach can be found through Dr. Verdolini Abbotts Lessac-Madsen & Resonant Voice Therapy DVD; any voice clinician should own one for optimal success!
The Basic Training Gesture
Initial training gestures should focus on teaching patients to vocalize using simple sounds in an enjoyable and comfortable manner. A typical vocal sigh from high to low pitch with multiple repetitions of vowels such as /ol/ or /m/ or /n/ is the initial exercise used, followed by similar ones using other vowels (/m/ or /n/, for instance). The goal of these training exercises is to localize oral vibratory sensations near the front of the face while simultaneously demonstrating balanced phonatory airflow that minimizes laryngeal adduction (Verdolini, Drucker Palmer Samawi 1998).
The therapist then implements single consonant voicing exercises with an emphasis on pronouncing them without releasing the larynx, leading to powerful yet effortless voice production that reduces vocal fold stress. Following this exercise regiment are exercises designed to strengthen and develop resonance through various means involving various consonants as well as words or phrases within therapy sessions.
Arthur Lessac, the developer of Resonant Voice Therapy (RVT), describes resonance as the trinity of energies: structural action, tonal action and consonant action. Verdolini Abbotts Resonant Voice Therapy technique primarily addresses structural and tonal components while not regularly using Lessac’s third element, consonant action.
Resonant voice therapy includes raising patient awareness of their new resonant voice, encouraging them to notice when their throat voice resurfaces and vice versa. Furthermore, therapists employ negative practice techniques to assist their patients in distinguishing between their new healthy resonant voice and past unhealthy voices. Vocal Function Exercises (VFE), which consist of four structured exercises designed to balance breath support with easy phonation, may also be included as part of a treatment plan by your therapist. Click HERE for an example video featuring Dr. Ingo Titze demonstrating straw phonation. VFEs make a valuable addition to Lessac-Madsen Resonant Voice Therapy. Through training the body not to adduct with excessive force, VFEs help reduce further risks of phonotrauma in individuals who already possess vocal nodules or polyps.
The Tonal Component
Lessac-Madsen Resonant Voice Therapy‘s second component, Tonal Approach, involves teaching clients to feel easy phonation in the larynx and anterior oral vibrations during phonation, using basic training gestures combined with tonal voicing exercises and conversation practice to develop this skill set. Tonal therapy may also include instruction to reduce vocal effort while speeding up phonation rate while increasing speed; its incorporation can be found within several other Lessac-Madsen techniques like Accent Method or Vocal Function Exercises (VFE).
Lessac-7 identified three energies at play within voice production: structural action, tonal action and consonant action. While research on the first two is well established, consonant action remains understudied and there is limited research regarding treatment components believed to improve voice production towards more optimal function. Therefore, further study on its efficacy must take place within clinical practice settings.
There are currently several resonant voice therapies in use, from single technique therapies such as Accent Method or VFE to multiple technique approaches like Lessac-Madsen Resonant Voice Therapy and Stemple’s Voice Function Exercises that target different aspects of vocal production such as Lessac-Madsen Resonant Voice Therapy or Stemple’s Voice Function Exercises (Stemple, 2017). Furthermore, an ever-increasing body of literature exists on resonant voice therapy generally, with recent systematic reviews showing it improves vocal outcomes among patients suffering dysphonia (Yiu, 2017).
Though many therapies have been evaluated through controlled clinical trials, little data exists regarding specific voice outcomes or individual techniques used. The results from these trials, however, indicate that resonant voice therapy could serve as an effective treatment option for various disorders.
For maximum effectiveness of resonant voice therapy, it is vitally important that patients continue practicing at home. This can be accomplished through offering them a vocal hygiene program tailored specifically to the lifestyle of each patient and encouraging them to do resonant voice exercises at various points throughout the day.
The Consonant Component
Resonant voice therapy entails instructing the patient on how to arrange his or her oral cavity so as to allow high frequency energy from sound waves to resonate in their vocal tract, minimizing impact stress on vocal folds while increasing vocal output. It’s used both by actors wishing to produce loud voices as well as those suffering from dysphonia looking to improve articulation and volume of their voices.
Resonant voice training’s aim is to foster natural, free and easy phonation that feels effortless and energetic. At first treatment sessions, the clinician encourages their client to become aware of how their voice feels before using sensory methods for guidance during resonant training – this way clients don’t focus on mechanical aspects which research in motor learning indicates could impair performance and retention (Verdolini 2004).
Lessac-Madsen resonant voice therapy‘s effectiveness is less certain, however. Some studies have reported positive outcomes while others have not (review in bibliography). Most of these observationsal studies involve small sample populations or are uncontrolled with limited control mechanisms – poor quality studies should be employed instead for best outcomes in this field of research. Hence the need for large scale, randomised controlled trials.
Although its limitations exist, this approach seems to offer some promise for both therapists and clients. A good place to begin would be encouraging clients to adopt resonant, resonant articulation while practicing word, phrase and sentence levels of dialogue with a therapist who highlights differences between their “habit” voice and new “healthy” one – negative practice can be especially powerful here to give clients a stronger internal control of their voice quality.
Understanding and treating voice dysfunctions are challenges faced by clinicians; understanding its function and managing any associated vocal disorders are equally complex endeavors. There is growing evidence to demonstrate the LMRVT can be an effective method in dealing with vocal disorders due to its focus on resonant phonation, experiential sensory processing and multiple repetitions of training stimuli at increasing complexity.
