VFAs
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| 1: Auditory Feedback | Real-time amplification
Looping playback of what was just said
Delayed auditory feedback
Masking
Metronome
- Should be immediate
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| 2: Change of Loudness | Decreasing loudness, increasing loudness, increasing variability
Children: develop awareness of different voices
Adults: discuss perception of loud and soft speakers
LSVT
Auditory & Visual feedback helps
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| 3: Chant Talk | Smooth and connected with no breaks between words
Evaluated pitch, prolonged vowels, lack of syllable stress, softening glottal attack
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| 4: Chewing | For those who speak like ventriloquists
Video feedback
Model exaggerated chewing
Often used with open-mouth approach
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| 5: Confidential Voice | Voice not loud enough to awaken someone sleeping nearby
Increases breathiness, sloe speaking rate
Temporary use
oral reading and through hierarchy of speaking tasks
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| 6: Counseling | Educate pt about normal voice and voice disorders
Explore pts reaction to his or her voice
Explore factors which ay be causing an unhealthy voice
Know when to refer to mental health professionals
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| 7: Digital Manipulation | Nudging thyroid cartilage inward to shorten VFS
Nudging thyroid cartilage to decrease tension
Gently pushing thyroid wall to approximate VFs (VF paralysis)
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| 8: Elimination of Abuses | Identifying vocal abuses with checklist
Educate patient about continued misuse and abuse
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| 9: Establishing new pitch | Best pitch produced with least amount of physical and cognitive effort
Best loudness and quality
Patient may have more than one habitual pitch
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| 10: Focus | Good focus is in middle of mouth above just above the tongue
High and forward sounds thin and babylike - practice posterior sounds
Low and posterior - practice anterior sounds
Low vertical - practice nasals
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| 11: Glottal Fry | Relaxes VFs and reduces hyperfunction
Have patient phonate /i/
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| 12: Head Positioning | Alternate head positioning changes resonance characteristics of the vocal tract
Used with other VFAs
Use vowel stimuli
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| 13: Hierarchy Analysis | Expose pt to situations which cause the most-least anxiety and worst-best voice
Tx begins by recaptioning those situations that produce best voice
Help client generally good voice to anxiety inducing situations
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| 14: Inhalation phonation | Best taught via modeling, elevate shoulders during inhalation
Model exhalation voice that matches inhalation voice
Once patient masters that model a lower pitch on exhalation
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| 15: Laryngeal massage | Used with patients suffering from puberphonia, MTD, VF paralysis
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| 16: Masking | Works well with severely dysphonic or aphonic patients
Masking using speech frequencies
Pt produces voice for 10 seconds without masking then with masking for 10 seconds
Record change in voice during masking and play it back
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| 17: Nasal/Glide stimulation | Using nasal and/or glide sounds often facilitates easy voice onset and maintenance
Incorporated into any approach requiring voice production
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| 18: Open Mouth | Voice produced with open mouth has better quality, louder, more resonant
Visual feedback is key
Vowel sounds are good stimuli
Used with Focus
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| 19: Pitch Inflections | Auditory feedback is important
Practice upward and downward pitch inflections
Once mastered at single-word level, progress through hierarchy
Often used with change of loudness
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| 20: Redirected phonation | Use vegetative voicing to establish phonation
Cough, gargle, hum, laugh, sing, trilling, um-hmm
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| 21: Relaxation | Establish total body relaxation
Mental imagery is important
Biofeedback helps
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| 22: Respiration Training | teach the concept of breathing as it relates to voice production
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| 23: Tongue protrusion | Helps to reduce laryngeal tension, protrude tongue comfortably and produced sustained /i/ at a higher pitch, eventually lower pitch
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| 24: Visual feedback | Self explanatory
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| 25: Yawn-sigh | Yawn and sigh are produced with maximum widening of supra glottis and gentle glottal attack
Model
Produce vowels preceded by /h/
Progress to natural voice production
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