Resonant voice therapy (RVT), designed by Katherine Verdolini Abbott, emphasizes oral sensations and gentle phonation to develop healthy vocal habits which match functional demands for voice use.
Resonant voice employing the barely abducted/adducted laryngeal configuration ensures optimal health of vocal folds while protecting them from impact stress and increasing hydration to decrease further risk of phonotrauma.
Physiology
Voice therapy relies heavily on understanding the physiology of voice for it to be successful, particularly with regards to vocal fold nodules and polyps, which are characterized by vocalization patterns involving vibratory vocal fold movement forward when phonation takes place, creating airflow against an opened glottal valve and leading to vibrations at the anterior alveolar ridge. These vibrations occur due to airflow against this valve which opens as vocal folds move forward during phonation.
Resonant voice therapy aims to modify vocalization behavior to help prevent or reduce vocal nodules and polyps. Therapists guide patients toward an easier pattern of vocalization that corresponds with an abducted/adducted laryngeal configuration, in order to reach this goal.
Resonant voice therapy utilizes various techniques to achieve these objectives, including Accent Modification (AM), Lessac-Madsen Resonant Voice Therapy (LMRVT) and Vocal Function Exercises (VFE), all involving producing semi-occluded consonants that cause lips to close together during phonation. Furthermore, discrimination techniques have been utilized between habitual and target resonant voices as an aid to behavioral learning for vocal fold stabilization and generalization into conversation.
LMRVT is founded on the theory that maintaining a healthy voice requires maintaining an adducted glottal closure and balance between vocal function and subglottic pressure, leading to self-perceived more resonant voices, reduced handicap in voice-related aspects of everyday life, as reported by people living with nodules.
LMRVT follows research on motor learning by forgoing mechanical instructions when teaching vocal behaviors. Instead, LMRVT appeals to patient perceptual awareness to achieve lasting changes in speech production habits. This is in keeping with the principle that focussing on mechanics rather than perceptual awareness may compromise immediate performance and long-term retention of a skill, something particularly pertinent to Resonant Voice Therapy where permanent changes must occur in speech production habits.
Biomechanics
Resonant voice therapy aims to achieve healthy vocal fold and glottal mucosa through changing how the voice is produced, targeting mental and physical health, lifestyle, diet and diet changes; in addition, working on voice mechanics such as physical manipulations or behavioral modifications aimed at creating the optimal voice production without injury or irritation is part of its goals.
This approach to voice uses research in motor learning and biomechanics as the foundation of its methods. The principle behind it is that placing too much focus on how to perform tasks, like producing resonant voice production, can hinder both immediate performance as well as long-term retention of skills such as these. Therefore, clinicians employ sensory awareness techniques as opposed to verbal instructions as their initial strategy when teaching voice production.
As part of the process, a clinician guides patients through various body introspection and observation exercises, which may involve looking at various parts of their vocal tract such as range of movement, how breath supports their vocal cords or even how resonant voices feel. Once that process has concluded, sound productions (ranging from simple phonemes to complex words or songs) are guided.
At each stage, the clinician observes for signs of voice fatigue or injury to vocal folds, laryngeal mobility and scar formation. With this information in hand, they are then able to develop an appropriate course of action for patients to reduce injury risks and develop plans that minimize them.
Verdolini has given several presentations on her approach to voice therapy. She conducted a four-day intensive training course for laryngologists and speech pathologists; lectured to them at numerous conferences in both Europe and America (such as First Pan European Voice Conference and Stimmsymposium Salzburg); written two books detailing her method: Lessac Resonant Voice Therapy Spectrum and Adventures in Voice Therapy).
Learning
The voice is an expressive instrument with vast capabilities; yet its fragility requires special care and maintenance to avoid becoming hoarse or weak; in severe cases laryngeal problems may even arise from misuse. Luckily, there are various effective techniques for improving and maintaining one’s vocal health; one such technique developed by Katherine Verdolini called Lessac-Madsen Resonant Voice Therapy (LMRVT) employs principles of motor learning to assist patients improve both vocal quality and technique – with proof from numerous studies showing its success in helping voice users improve both aspects.
The LMRVT approach is a patient-focused voice treatment using perceptual-motor learning principles to teach patients to create healthy and expressive voices. Created in the early 2000s, this technique honors two pioneers of resonant voice research and therapy: Arthur Lessac and Mark Madsen – as well as drawing inspiration from Ingo R. Titze, one of the premier voices experts of his time.
LMRVT involves the clinician leading their patient through a series of body stretches and exercises designed to achieve the most accurate representation of resonant voice. This process follows scan-gel-show-tell, which involves attention to self-awareness, physical manipulation, demonstration and eventually, telling their patient what changes need to take place – until eventually, their voice has emerged in full resonance.
Following this approach is instruction in voice pedagogy, which involves teaching patients how to harness this healthy and resonant sound for singing, acting or speaking purposes. Our ultimate aim is equipping them with tools for maintaining an unaffected and healthy voice throughout their lifetime – this method has been utilized both clinically as well as presented at numerous conferences and seminars.
Compliance
Verdolini Resonant Voice Therapy is an approach that integrates all aspects of an individual, emphasizing goals, values, and sense of identity to create an ideal therapeutic environment that encourages compliance more readily than traditional voice rehabilitation techniques.
This strategy can be especially helpful in treating patients who are resistant to voice therapy and have failed to comply with other forms. By developing rapport and trust with the patient, a clinician can establish motivation in them.
At our clinic, patients are not only encouraged to work hard during therapy sessions; they are also provided with an honest account of what will need to be done outside the clinic in order to maintain or enhance their voice. They receive a tailored hygiene program that emphasizes what matters most – not simply a list of “do’s and don’ts”. They contribute directly to creating their post-therapy program so it meets all their lifestyle considerations as well as any factors which might hinder compliance with it.
Furthermore, this program is tailored to be easily accessible for patients suffering from voice disordered vocal cords as well as clinicians. It incorporates elements of other techniques proven effective at alleviating vocal disorders – such as Casper-Stone Confidential Flow Therapy – for effective voice rehabilitation approaches that give clinicians a framework for dealing with challenging patients.
Verdolini Abbott frequently hosts seminars and webinars covering both the basic science behind and clinical applications of AIV, LMRVT, as well as its combination with Casper-Stone Confidential Voice Flow Therapy (CSCFT), along with newer treatments like Casper-Stone Confidential Voice Flow Therapy. She has published multiple books in these areas as well as clinical manuals, one-and-a-half day training seminars, articles, manual therapies such as Shiatsu/acupuncture she applies in her work as well as her research findings at national/international conferences.
