Resonant Voice Therapy programs teach clients to produce speech that maximizes laryngeal health, thus decreasing roughness, strain and monotone severity in auditory perceptual judgements, videostroboscopic examinations and acoustic measurements.
Unpublished experimental evidence strongly supports LMRVT to heal phonotraumatic lesions as opposed to spontaneous speech.
Efficacy
Verdolini created Lessac-Madsen Resonant Voice Therapy (LMRVT) in the early 2000s to honor two mentors, Arthur Lessac and Mark Madsen – pioneers in resonant voice and motor learning respectively. LMRVT operates under the principle that vocal behavior can be learned, rather than inherited; its approach combines elements from acoustics, voice science and psycholinguistics; this article will analyze LMRVT for its efficacy, biomechanics and learning standards.
Studies and presentations assessing the efficacy of verdolini resonant voice therapy include:
Helou, L., Wang, W. and Rosen, C. A. (2018) Intrinsic laryngeal muscle response to psychological stress: Psychological and cardiovascular predictors. Presented at the IVth International Symposium of Vocal Arts Medicine and Voice Care held in Salzburg Austria.
Nanjundeswaran, C., Van Swearingen, J. and Verdolini Abbott, K. (2016). Treatment of Exertion-Induced Paradoxical Vocal Fold Movement Utilizing Buteyko Breathing Techniques at Philadelphia. Pennsylvania Symposium: Care of Professional Voice 39th Annual Symposium.
Ziegler, A. and Verdolini Abbott, K. (2013) The Role of Cognition in Resonant Voice Development and Phonation Production at Hobart Tasmania Australia presented at 2nd Australasian and Asia Pacific Laryngology Conference
LMRVT can also be an invaluable way to improve the voice quality in healthy individuals, by increasing endurance and aiding healing post vocal cord injury. Singers and actors may find this treatment invaluable as it enhances timbre, resonance and clarity of their voices.
Additionally, LMRVT can also be utilized to treat other voice disorders, including laryngeal cancer and presbyphonia. Overall, LMRVT offers an effective, evidence-based and clinically pragmatic solution for treating adult and pediatric voices alike; singers will find its use particularly helpful. Furthermore, it can facilitate recovery from numerous disorders, including voice nodules, vocal cord polyps and trauma damage; it can easily adapt to different client populations and settings while helping clinicians enhance their clinical reasoning and judgment skills.
Biomechanics
Resonant voice therapy not only creates a more natural voice, but is an incredibly effective means of treating vocal fold nodules. One study led by Verdolini compared complete voice rest, resonant voice therapy and spontaneous speech, finding that those participating in resonant voice therapy healed their laryngeal lesions faster than in any of the other groups (Verdolini-Marston, Burke, Lessac Glaze & Caldwell 1995). These results suggest large vibrations associated with resonant voice may reduce production of pro-inflammatory mediators produced during cyclic tensile strain while increasing concentrations of anti-inflammatory mediators while increasing concentrations of anti-inflammatory mediators.
The clinician assists their patient in retraining their voice toward barely abducted or adducted posturing, producing forward vibrations in front of the mouth. This voicing pattern is known as resonant voice as it produces relatively large yet low-impact vibrations of vocal folds; providing a balance between intensity and impact stress to safeguard vocal folds against injury.
Following initial training of resonant voice, the clinician instructs their patient on how to apply this voice behavior during louder phonation and other challenging situations that pertain to daily living. Furthermore, vocal hygiene education is provided, along with tips for optimal hydration in order to reduce the effects of phonotrauma (Verdolini 2004).
As with all forms of motor learning, when instructing patients in resonant voice behavior it is vital that clinicians utilize sensory awareness rather than verbal instructions alone to teach. Research on motor learning shows that overemphasizing how to perform new motor skills impairs immediate and long-term performance of said skill; so clinicians guide patients through resonant voice behaviors by emphasizing how their sound of the voice is perceived while encouraging practice outside the clinic setting.
Encourage your patients to utilize their resonant voice frequently at home, particularly when communicating with others. Record yourself speaking both resonant and nonresonant vocalizations so they can better hear how resonant sound in real-world environments such as work or public spaces. Furthermore, provide them with a list of voice exercises they should perform throughout the day; and encourage them to do this practice at least three times daily.
Learning
Voice therapy techniques depend heavily on a patient’s learning ability and style. A voice therapist should aim to appeal to their sense of touch and sight rather than verbally instruct them on how to produce particular sounds; research in motor learning indicates that direct attention paid to speech production mechanics interferes with its immediate and long-term performance and retention (Verdolini 2004).
Voice therapists should encourage patients to pay closer attention to how the sound they produce makes them feel, rather than how it’s produced. Research on voice therapy has demonstrated that paying attention to how one feels about their voice makes changing patterns of usage simpler, because the focus has shifted from mechanical approaches to emotional ones (Verdolini 2004).
Verdolini’s expertise lies in clinical research related to vocal nodules and resonant voice therapy; she has presented it at numerous conferences and professional meetings as well as teaching voice therapy courses at several universities.
Her work has been published in professional journals and books. Some of her publications can be found at the Library of Congress and online repositories.
Verdolini Abbott, K. Principals of Vocal Health for Young Singers. Invited paper presented to the Kodaly Music Educators OAKE Conference held in St Louis Missouri 1986.
Helou, L., Wang, W., Rosen, C.A. & Verdolini, K. (2016) Physiological assessment of human voice phonation using high-speed videoendoscopy, electroglottography and magnetic resonance imaging at high speeds during phonation using high-speed videoendoscopy in Philadelphia Pennsylvania at the Twenty-Eighth Symposium for Care of Professional Voice (PSCV 28) 2017. Paper presented.
Verdolini, K. Semi-Occluded Vocal Tract in Resonant Voice: Biomechanics and Biology. Key-note speaker at National Center for Voice and Speech’s Symposium on Semi-Occluded Vocal Tract held in Salt Lake City, Utah.
Compliance
Resonant voice therapy aims to maximize oral resonance for strong yet healthy phonation. According to recent research, this technique may also be effective at alleviating vocal nodules caused by excessive glottal closure during voice production; Resonant Voice Therapy uses a pattern of closure optimal for voice production that permits maximum throat vibration without causing tissue damage.
This research project included 48 patients diagnosed with adducted hyperfunction of the larynx and conducted at a University of Wisconsin Voice and Swallow Clinic. Eligibility criteria were decided upon by both a UW laryngologist and speech language pathologist. Patients were randomly allocated either to a control group, resonant voice therapy group, or multiple practice group for intervention purposes. Their chosen intervention included weekly personalized exercises and cues that they were expected to carry out at home and throughout their daily lives. The MP4 group received several different digital recordings to playback on portable MP4 players: (1) short clinician videos of both standard and individualized exercises, (2) weekly patient “self-as-model” recordings recorded via portable camera phones (1 minute each), and (3) 11-min testimonial videos from past patients who reported positive voice outcomes.
After reviewing their resonant voice therapy home practice requirements and videos, patients were retrospectively asked to rate how adherent they were with the protocol; their responses strongly correlatoed with total practice frequency, suggesting they did follow it.
Attrition from this study occurred, with four of its participants withdrawing due to organic limitations or poor treatment adherence – not an uncommon occurrence among behavioral studies designed to promote health behavior change14-18. Internal barriers include motivation, forgetting practice sessions, fatigue during workouts and pain during exercises14-18.
Strategies have been suggested for improving adherence in other health behaviors, like physical training. Voice therapy could benefit from applying these approaches as well. Such strategies might include motivational interviewing, providing feedback to patients regarding their progress and building therapeutic alliances between client and therapist.
