Transcript VKL WIZDM

VOICE AND THE BODY
New Perspectives
Dory Rigopoulos Kafoure, M.A., CCC-SLP
September 26, 2011
Voice Training/Experience
• 31 years as SLP in Poway Unified School District
• Practitioner, LMRVT (Lessac Madsen Resonant Voice
Therapy)
• Practitioner, Lessac Voice and Body Work: Lessac
Institute
• LSVT Loud, Certified: Lee Silverman Voice Treatment
• Estill Voice Training
• Alexander Technique: private lessons
• Trained Singer
VKL WIZDM
Techniques from…
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LMRVT: Lessac Madsen Resonant Voice Therapy
Lessac Voice and Body Work
Estill Voice Training
Vocal Function Exercises
Accent Method Therapy
LSVT: Lee Silverman Voice Therapy
Development of Vocal Folds
• Infant has more hyaluronic acid (cushioning)
• Age 5 – denser fibers of vc
• Age 10 – more differentiation of superficial vs.
deep layers of lamina propia
• Age 17 – lamina propia is complete
* Phonotrauma occurs in 3-9% of the population
and in more boys than girls
Development of Respiration
• At 15 mo. oppositional movement between
ribs and abdomen for speech begins, before
that ribs/ab in synchrony .
• Over next 3 yrs. rib expansion for speech
increases & independent movement of
ribs/abdomen.
• Implication: With age increased capability to
generate increased air pressures and in turn
increasing VF impact stress.
Learning and Attitude
• Age 2-4: Magical thinking, focus on self, therapy
more parental – shaping behavior
• Age 5-7 : Magical, more directed therapy
• Age 7-11: Begins to think rationally, interested in
health
• Age 12-16: Uses problem solving, abstract
thinking, thinks in the ‘present’, self preservation,
peers/social, good voice is attractive
Therapy
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Minimize load: three goals
< age 5-10 (stories and voice care)
> 10 or 11 (treat as adult)
Look for the buy in: set goals
Need: 1) motivation, 2) remembering, and 3)
doing.
Vocal Hygiene
• Excessive coughing, laughing, crying, shouting,
animal/mechanical noises, clearing throat, loud
voice
• Spicy foods, caffeine, ice cream
• Lifting heavy objects/grunting
• Check hydration (less chance of injury)
• Talking/yelling in cold night air
• Smoking/second hand smoke
• Alcohol
• Check medications (drying)
Voice Issues in Children
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Phonotruma (most common)
Reflux/GERD
Paralyzed VC
Paradoxal vocal fold dysfunction
(PVFD)
Voice Issues in Adolescents
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Phonotrauma
Puberphonia
Reflux/GERD
Paralyzed vocal cord
Paradoxical VF Dysfunction (PVFD)
Goal is to balance…
• Respiration – breathing
• Phonation – how the vc are responding:
approximation, hard glottal attack
• Resonance – where the sound is directed
Breathing
• Chest/abdominal
• Smell the flower (feel side/back muscles expand), vary
what you smell (baking choc. chip cookies)
• Blow candle (watch posture)
• Blow candle ‘sh’ : short distance, long distance
• Sh: slow, steady, not forceful then let lungs fill naturally
• Amount of air will generate for the need OR
Breath adjusts to what it meets on the way out
Arthur Lessac and Dory
The Science behind RVT (LMRVT)
Arthur Lessac – Kittie Verdolini
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Vocal cords barely separated : .6 -.7 mm apart
Larger wave amplitude
Greater vocal economy with less effort
Easy voice/unload the larynx
Vibration transmits better on hard surface
Tissue mobilization: sim. to elec. toothbrush
Aiming for tissue change
Useful for phonotrauma, PVC, resonance
Resonant Voice Therapy
LMRVT
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Bone conduction
Feel the vibration: fingers/nose
Concentrate on the feel: m, n, ee
Hierarchy: syllables, words, sentences (hold out
m’s/n’s), later add voiced frontal consonants
(z,v,l,r), then alternate v con. with vl con (mapa)
Answer questions with “hm-m, right, y-yeah”
Label it: buzzy voice, old voice vs. new voice
Ask child, “Does voice feel good/easy?”
Lip trills, tongue trills for forward vibration
LMRVT – Set the Stage
• Imagine 2 hands as vc’s: friends
• Gesture hands talking to each other
• Draw pictures to match behavior of VC: friends
get louder, hands rub/clap harder
• Use same concept: grating sound, cough
• Use stories: character development to align
with behavior, associative to healthy use of VC
• Therapy words: explore, discover, invite, do
Voila – Zee Therapy
Voice Stations
• Body Work: head (yes/no), side-side, I don’t know shrug,
strong man, rag doll, tight fists/jello, mouth yawn/lips purse, shoulder
rolls, tongue roll forward (like a ‘slide’), tongue stick out
• Sound: car: m-m/lip trill, v – airplane, z- bee, tongue trill – birds. Vary
loudness/pitch. Focus: front vibration/feeeeel it
• Yes/no: questions answered with ‘m-hm, n-no)
• Chant: build from one word to short phrases and sentences with
m,n,ng – ‘m-mean-nie’. Loud/soft, high/low. (handouts)
• Role Play: sports, home, favorite activities
• Breathing: smell the flower
• Pitch Exploration: build around forward sounds that connect with
meaning(whoah, whoops, oh, oo, m-m ‘tastes good’)
RVT- Stemple
• Molm …molm…molm..or meeenie….hm…eee..
Discover/feel vibrations, vary rate, small/short
sirening, chant on one note.
• Molm…slow,fast,slow/soft,loud,soft
• Molm in phrases like speech: vary rate, pitch and
loudness. Emphasize nasal. Connect ab to lips.
• Chant: Mary made me mad. (handout).
Overinflect as in speech. Change pitches.
• Read sentence, answer questions, conversation.
Estill Voice Method- Joan Estill
Kim Steinhauer & Mary Mcdonald Klimek
• Use of combined isolated vocal movements to promote
healthy voice use in speaking and singing: larynx, tvf, fvf,
velum, tongue, AES, lips, jaw) to combine for opera, twang,
belting.
• FVF: mildly constricted for speaking, slightly more constric.
affects breath flow/vibration, sounds pressed/strained.
• FVF: retract-laugh, constrict – lift, hold breath
• Velum: “hungee”, low-mid-high
• AES: aryepiglottic sphincter = twang (nasal) + FVF retract
Estill 2
Situations to trigger use of FVF
• Holding back breath at ends of phrases
• High vocal intensity-strenuous vocal activity
• Emotional challenges
• High/low notes
Effort Numbers
(Estill)
• Use numbers rather than words to make
judgments for degrees of effort…all #s
• Push forefinger and thumb together. Assign
the amount of push an effort number.
• Shake hands with a neighbor. Assign the grip
a number
• Use these numbers to describe ‘old misuse’ as
well as ‘new’ ways to measure volume, etc.
The Accent Method
Svend Smith
• Holistic therapy regime: respiration, phonation,
resonance, dev. In 1930’s. *Rhythm
• Three tempos: Largo (slow): 2-3 beats/ andante (fast):
4-5 beats/ allegro (very fast): 6 or more beats
• Start with only inhale/exhale rhythm. Sustain vl fric.
s,f,sh. Sustain unstressed vl fricative followed by longer
stressed fricative (s…..S….fade, sh, f). Same with voiced
fric (v...V…z…..Z), No!, Stop!, Fire!
• Bring attention: chg. in air/stress due to contraction of
abdomen, patient & therapist engage in ‘ping pong’
interchange of verbal syllables, words, etc.
Accent Method 2
• Vary stress, intonation, volume
/hey hey/, /hoy yoy/, /hey yey yey/, /hoy yoy yoy/
/hoy ooy ooy ooy/, /boy boy boy boy boy/
I won’t, you did, I couldn’t, he’s home
I don’t care, It isn’t fair
He came back home, a piece of cake
• Transition to speech
Automatic series, common phrases, rhymes
Reading (familiar/unfamiliar)
Monologue/speech/how to do a task
Dialogue with a buddy
Shouting the right way
• Accent Method: vary stress, intonation, volume.
• Lessac: ‘ The Call’: forward facial posture, reverse
megaphone (oo, oh)
• Begin small volume & increase. Discuss distance, take out
to the playground. Select words/phrases used in favorite
activities (sports)
-Hey, yo, hey Joe, hello, all aboard!
-Throw the ball, Get ‘em out
-Meet me Monday Those old boats don’t float.
-Hey Mike, No Mike, Me? Never! All aboard!
-Make mine macaroons, Meet me mom, Me money
Vocal Function Exercises
Joseph Stemple
• Holistic voice treatment: Resp, Phon, Res. Used for a
wide range of hyper/hypo functional voice disorders.
• /i/- engage voice: extreme forward focus-almost nasal,
coordinated abdominal breathing with voice
• ‘whoo, knoll’, lip/tongue trill- start at comfortable pitch
and glide up. Make sure lips are forward, ½ yawn. Vib.
• ‘knoll,boom’, lip/tongue trill- start at MCL and glide
down
• ‘knoll’, sustain notes c/d/e/f/g as long as possible with
open pharynx, engage res. Voice vibration at the lips.
Lee Silverman Voice Therapy
• Originally created for Parkinsons’ patients
• Voice decline is one of first symptoms
• “Do what I do…say “ah” for as long and loud as
you can. Do at MCL, then higher/lower
• Only LSVT if done 60min. for 4da/wk otherwise
considered voice therapy
• Collecting data on use with CP/neurological dis.
Voice Evaluation
Should include:
• History/medical: reflux, allergies, asthma, Tonsils/adenoids,
mouth breather, cleft palate repair, oral exam
• S/Z ratio: time duration of ‘s’, ‘z’, should be 1:1, if > 1.4 may
indicate vibratory dysfunction of vf
• Observations during conversation/play
• ENT DX and rec: for speech
• Describe: quality, volume, pitch (pitch variation), breathing,
sing ‘Happy Birthday’, count 1-50 (breathe when needed –
observe breathing)
• Change in voice beginning/end of day or after recess
Voice Evaluation 2
• Behavior: home/school, personality
• Start of problem/what child notices
• Does child have frequent burping or complain of
tickling/choking sensation (reflux?)
• Repeat sentences: Where are you going? (v),
Hope he is here (v/vl), My mama makes lemon
muffins (v/vl)
• Do you think problem lies with: respiration,
phonation, resonance? The key is to balance.
BODY WIZDM
Inner/Outer Environment
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Outside stimuli/chaos
Auditory/Visual/Tactile
‘Feeling’: pre-intellectual
Sensory: feeling with awareness
You CAN control your inner environment
Feel – right brain, analyze – left brain
Don’t analyze, feel !
Psychosomatic Learning
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What it feels like to do it right instinctively
Children: play, do things instinctive
Familiar events: natural, familiar
Organic vs. nonorganic
organic – natural, instinctive
inorganic – a command to the body (conflict) wears down the body vs. discovering/playing
Body Energies
• Buoyancy: oxygen charged: lighter than air:
feather floating, dough rising, air-filled balloon
• Potency: chemically charged: strength, powerful,
confident
• Radiancy: impulse charged, body spark: shaking
with joy, eagerness, curiosity, cat stalking mouse,
clown, puppet, child’s eagerness/opening
present/anticipation, quivering/nervous
Relaxer-Energizers
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Inhale/exhale
Swallowing
Facial Forward Yawn
Back Yawn
Muscle Yawn
Humming
Sighing
**do these several times a
day
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Shaking
Singing
Laughing
Smiling
Dancing
How to use it
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Before a meeting
During a meeting
After a meeting
At the end of the day
• Okay….. so there’s wine.
How to use it
• Relaxer-energizers
• Body energies: What is yours? Change it.
Change anxiety/nervousness into useful NRG/
strategy for self-control
• Play: regears the body to function differently
• Rhythm – relieves sense of strain/’hard work’
YOUR GOAL
• Make it to Retirement mentally and physically
in tact
References
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Lessac Madsen Resonant Voice Therapy (workshop materials)
Body Wisdom: the use and training of the human body by Arthur Lessac
The Use and Training of the Human Voice by Arthur Lessac, 3rd. Edition
Estill Voice Training: Levels 1 &2 (workshop workbooks)
The Source for Childrens’ Voice Disorders by Nancy Swigert
(Linguisystems)
• The Source for Voice Disorders Adolescent & Adults by Sandra Kasper
Schwartz (Linguisystems)
• Voice Therapy, Clinical Case Studies, Third Edition by Joseph C. Stemple
(Plural Publishing)
• Vocal Health and Pedagogy, Advanced Assessment and Treatment, Vol.
II, Second Edition edited by Robert T. Sataloff (Plural Publishing)