Global Voice Therapy Model
(GVTM): Components and
Application
OSLHA Convention
Saturday, March 21, 2015 8:45am-12:00pm
Elizabeth Grillo, Ph.D., CCC-SLP Associate Professor
Department of Communication Sciences and Disorders West Chester University, West Chester, PA
Disclosure Statement
Financial
1. Employee of West
Chester University (WCU), West Chester, PA.
2
2. Pilot work funded by two WCU Faculty Professional Development Grants (2008-2009) and (2012-2013).
3. Royalty from NSS.
Non-financial
1. Inventor of GVTM
Intellectual Property
Information provided to you in this
course through PowerPoint
presentation is the intellectual property
of the instructor and may not be
reproduced without explicit permission
of the instructor.
Overview
Introduction
Components of the GVTM
Additional methods that augment and support the “new” voice
Stimulability testing Treatment hierarchy “New” vs “old” voice
Motor learning principles in the GVTM
Research related to the GVTM
Application of the GVTM 4
Learning Outcomes
Participants will…….
1. Describe the components of the GVTM. 2. Explain the motor learning principles applied
to the GVTM
3. Understand the research supporting the GVTM.
4. Apply the GVTM to clinical practice. 5. Identify appropriate use of the GVTM in
client examples and self-practice.
5
Introduction
Meet me……… Education Clinical Expertise Current Position 7Statistics
Voice disorders are the most common
communication disorder.
7.5 million people in the USA(NIDCD, 2014)
Across the lifespan, @30% of people
will experience a voice problem, far
greater than for other communication
disorders
(Roy et al., 2004)
8
Statistics
By their sheer volume, voice
disorders matter and deserve public
attention.
What’s the best way to improve voice
through voice therapy? What does
the literature say?
Voice Rehabilitation Literature
Voice production techniques for
immediate improvement of vocal output.
e.g., yawn-sigh (Boone & McFarland, 1993), twang (Estill, 2000; Lombard &Steinhauer, 2007), resonant voice (Stemple, 2000), increased airflow (Xu, Ikeda, & Komiyama, 1991), increased vocal fold adduction, loud voice, etc.)10
Voice Rehabilitation Literature
Clearly defined voice therapy models
that are based on a specific voice
production technique.
e.g., LSVT (Ramig et al., 1994), accent method (Smith & Thyme, 1976), resonant voice therapy (Stemple, 2000), LMRVT (Verdolini-Abbott, 2008)
11
Voice Rehabilitation Literature
What’s missing from the literature?
A model that promotes generalization and maintenance of the “new” voice to all spoken communication without relying on one specific voice production technique.
To Fill the Gap
My Global Voice Therapy Model
(GVTM)
Grillo, E.U. (2012). Clinical investigation of the Global Voice Therapy Model.
International Journal of Speech-Language
Pathology, 14(2), 156-164.
13
Components of
the GVTM
Components of the GVTM
Additional methods that augment and
support the “new” voice
Stimulability testing
Treatment hierarchy
Additional Methods
Vocal hygiene, vocal education,
respiration exercises, vocal function
exercises
(Stemple et al., 1994),circumlaryngeal massage
(Roy et al., 1997),etc.
Anything that augments the target
vocal output.
16
Stimulability Testing
Have the client produce different
techniques to see which one(s)
facilitate the best vocal output.
Grillo (2012) was the first and only study to address stimulability testing in voice.
17
Treatment Hierarchy
Bottom-up from smallest unit of
utterance up to the largest, while also
increasing cognitive complexity.
LSVT, LMRVT, accent method, and Stemple’s resonant voice therapy all have a treatment hierarchy.
Articulation and Fluency literature also support the use of a bottom-up tx hierarchy.
(Secord, 1989; Van Riper, 1978; Van Riper & Emerich, 1984)
“New” vs. “Old Voice
Client produces “new” and “old” voice
at all levels of the treatment
hierarchy.
On command by SLP
Independently, SLP must guess the correct voice
Grillo (2012) is the first and only study
to address “new” and “old” voice.
19Quiz
20
Quiz
1)What are the components of the GVTM?
a.additional methods that augment and support
the new voice, stimulability testing, treatment hierarchy, and “new” vs. “old voice
b.stimulability testing and "new" vs. "old" voice
Quiz
2) What are some examples of additional
methods?
a.vocal hygiene
b.vocal education
c.posture work
d.relaxation exercises
e.all of the above
22
Quiz
3) Stimulability testing means that you always
use one voice production technique for every client. For example, you use only resonant voice.
a.true b.false
23
Quiz
4) The treatment hierarchy begins at
conversation.
a.true b.false
5) When facilitating the "new" vs. "old" voice
component, the client will produce both voices at each step of the treatment hierarchy.
a.true b.false
Motor Learning
Principles
Motor Learning Principles
Applied to GVTM
Basic skill is acquired before increasing
to a more complex pattern (bottom-up
Tx. hierarchy)
(Schmidt, 1975, 1976, 2003; Schmidt & Lee, 1999)
26
26
Motor Learning Principles
Applied to GVTM
Treatment hierarchy is necessary to
build from basic to complex utterances,
while increasing cognitive load.
Sentences
Memorized speech acts
Specific spontaneous speech acts
Motor Learning Principles
Applied to GVTM
Negative practice of both old and new
voice decreases likelihood that the
person will return to the old pattern
(Van Riper, 1978; Van Riper & Erickson, 1996)
Negative practice. Self-awareness of
both voices.
28
Motor Learning Principles
Applied to GVTM
Need for both blocked and random
practice schedules
(Lai & Shea, 1998; Lai et al., 2000; Shea et al., 2001; Wong et al., 2013)
29
29
Motor Learning Principles
Applied to GVTM
Blocked and random practice schedules
Blocked practice: “ma” 10 times in a row in the new voice, “me” 10 times in a row in the new voice
Random practice: “new” and “old” voice at each step
Do the blocked practice first. Client performs independently with 90% accuracy, then add random practice with old and new voice at the same level before advancing.
Motor Learning Principles
Applied to GVTM
Blocked: Say 10 words in new voice
Client independently meets goal at 90% accuracy.
Random: Same 10 words, but now client
produces them in either old or new voice
1) First on command by SLP &2) Then independently and the SLP has to guess the voice.
Client independently meets goal at 90% accuracy. 31
Motor Learning Principles
Applied to GVTM
Move up a step to phrases.
Blocked: Say 10 phrases in new voice
Client independently meets goal at 90% accuracy.
Random: Same 10 phrases, but now client
produces them in either old or new voice 1) First on command by SLP &
2) Then independently and the SLP has to guess the voice.
Client independently meets goal at 90% accuracy. 32
Motor Learning Principles
Applied to GVTM
Blocked practice allows for faster
acquisition of a new skill.
Random practice promotes better
generalization and maintenance to
untrained items
(Schmidt & Lee, 1999; Knock et al., 2000)
Motor Learning Principles
Applied to GVTM
Move up a step, etc. and so on
34
Motor Learning Principles
Applied to GVTM
Varying feedback depending upon the
practice schedule. Blocked less often.
Random more often
(Wulf, 1991, 1992; Wulf & Schmidt, 1996)
35
Motor Learning Principles
Applied to the GVTM
Frequency of Feedback
In blocked practice schedules, feedback after the 10thword.
In random practice schedules, feedback after every 2 or 3 words. This increased amount of feedback is necessary when first arriving at a step. As work proceeds at a step, amount of feedback may decrease.
Make every effort to ask what they think first to develop their self-awareness skills. Consider recorded feedback. Play it back and ask what they think before offering your two cents. 36
Motor Learning Principles
Applied to the GVTM
Pay attention to the effects of the mvt.
rather than the individual body parts
that form the movement.
(Freedman et al., 2007; Lisman & Sadagopan, 2013; Wulf & Prinz, 2001)
37
Quiz
38
Quiz
1)What are the two steps in the treatment
hierarchy that are unique to the GVTM?
a.memorized speech acts and specific spontaneous
speech acts
b.phrases and sentences
Quiz
2) What is an example of a specific
spontaneous speech act?
a.tell me what you did over summer vacation
b.describe the outside of your house
c.recite the Pledge of Allegiance
40
Quiz
3) Producing the "new" voice at word level
across 10 trials is an example of blocked practice.
a.true b.false
4) Producing "new" and "old" voice at the
word level is an example of random practice.
a.true b.false
41
Quiz
5) It is recommended to do what practice first
to ensure acquisition of the new skill.
a.blocked
b.random
6)It is recommended to do what practice
schedule after the new skill has been acquired at a certain step of the treatment hierarchy.
a.blocked
b.random
Quiz
7) In blocked practice, you should provide
more or less feedback.
a.more b.less
8)In random practice, you should provide
more or less feedback.
a.more b.less
43
Quiz
9) When training the “new” voice, you should
focus on effects of the voice (e.g., what the new voice sounds like, what it feels like), rather than on the individual body parts that form the movement.
a.true b.false 44
Research
Supporting the
GVTM
Learner Objectives
You have met two of the Learner
Objectives,
1. Describe the components of the GVTM. 2. Explain the motor learning principles applied to
the GVTM
Well done!
Let’s move on……..
46
Learner Objectives
3. Understand the research supporting
the GVTM.
47
Question
Will the GVTM facilitate an
improvement in voice related measures
(i.e., acoustic, aerodynamic, perceptual,
and QOL) for 4 adult clients with voice
disorders?
(Grillo, 2012)
Methods
4 participants (i.e., 1 male and 3
females)
3 singers and 1 non-singer
Diagnosed voice disorders; MTD, VF
paresis, lesions (cyst and polyp)
Voice therapy with me using GVTM
once a week
Sessions were 40-50 minutes
Total number of sessions ranged from 4-5 49
Measures
Pre- and post-treatment data collected
Acoustic (Fo, perturbation measures) Aerodynamic (LR, Ps, airflow, MPT, s/z ratio) Self rating scales of vocal quality and vocal
fatigue VHI
50
Results
52Results
53Results
54Results
55
Summary
QOL improved post-tx as compared
to pre-tx (VHI)
Voice was more forward, facial, clear
(increased F
oand decreased NHR at
post)
Less effort with better movement of
air (MPT and flow increased at post)
Pre- and post video as example
#2 pre (:48-1:23) #2 post (:55-2:20)
56
Summary Continued
By 2
ndsession, even non-singer using
“new” voice in connected speech.
Why so fast?
New versus old at each step?
Future Directions
Investigate why the fast result?
Is it new versus old?
Larger participant number with varied
types of voice disorders
Introduce more control through a control
group or single-subject design with
multiple baselines.
Involve other clinicians to assess
generality of the GVTM
Compare GVTM to other Tx models
58Prevention
Prevention arm of Global Voice: Global
Voice Prevention Model
Same components
Focused right now on teachers,
physical education and vocal music
student teachers.
Past work (Grillo & Fugowski, 2011) Recent survey (Grillo, 2013) Pilot study of GVPM (Grillo, 2013)
59
Survey
Participants: 74 PE undergraduate seniors 29 women, 45 men (average age 23 years) Administered during the 12th week (i.e., November) of the fall semester 2012.
42 participants were student teaching
32 participants were finishing academic courses and had plans to begin student teaching spring semester 2013.
Survey
There appears to be a disconnect of understanding
Almost half said that teaching negatively effects voice, almost a third said they may develop a voice problem due to teaching, and only 17% thought a voice course/seminar was needed to learn strategies to prevent a problem.
Why?
61 61
Pilot Study
They need vocal education, hygiene, and
training presented through a voice disorders prevention model.
Thus, the GVPM
62 62
Pilot Study
Two participants (one male and one female)
completed the GVPM over 6 weekly 45-minute sessions.
2 sessions recorded pre- and post-data collection measures.
Pilot Study
64Pilot Study
65Pilot Study
66Pilot Study
Self-rating Scales Female
Pre=Voice feels fatigued before talking for the day (mild problem)
Pre=Overall, my voice is better after talking all day. 67 67
Pilot Study
Self-rating Scales FemalePost=No reports of fatigue
Post=Overall, my voice is better now than before doing the GVPM. 68 68
Pilot Study
Self-rating Scales MalePre, overall, no problems with quality, strain or fatigue
Post, overall no problems with quality, strain or fatigue
Overall, my voice is better now than before doing the GVPM
Pilot Study: Summary
Participants reported using his/her new voice during the week prior to the post-GVPM data collection
@85-90% of the time (female). @98-100% of the time (male).
Male commented that he has less strain in his voice when talking over background noise at a bar or restaurant.
Male’s girlfriend noticed a positive change in
his voice by the end of the GVPM. 70
Samples
Pre-Post Videos
Subject 1 voice attitudes (0:00-0:50) pre Subject 1 E Final Interview (0:00-1:35) post Subject 2 voice attitudes (0:00-0:30) pre Subject 2 Final Interview (0:00-1:45) post
New vs Old Voice
Session 3 (22:13-26:27) Healthy Yelling Training
Session 4 (20:00-21:46)
71 71
Quiz
Quiz
1)Was the GVTM successful in improving voice
related measures of four participants?
a.true b.false
2)What were the results?
a.VHI scores decreased at post-therapy
b.Foincreased at post-therapy
c.participants reported better movement of air at
post-therapy
d.all of the above
73
Application of
the GVTM
Learner Objective
You have met one of the Learner
Objectives,
3. Understand the research supporting the GVTM.
Well done!
Learner Objectives
4. Apply the GVTM to clinical practice.
76
Goals
We will apply each component of the
GVTM through goals with client
examples.
Long-term goal (medical setting) = Goal (educational setting)
Short-term goal (medical setting) = Objective (educational setting)
77
78
Long-Term Goal
Client will return the voice to a level of
adequacy that can be realistically
achieved and that will satisfy the client’s
occupational and social needs in all
spoken communication with 90%
accuracy.
FYI, you can substitute “occupational” with “educational” for children.
This goal should be achieved in 4-6 weekly
sessions.
79
Short-Term Goal #1
Vocal Education Goal
Client will demonstrate an
understanding of the 3 interactive
structures for voice production by
“verbal explanation to clinician with
90% accuracy.” (5 minutes in first
session)
OR “by answering 9/10 questions correctly.”
Short-term Goal #1
Rationale…….
Where would you put this goal in my
GVTM?
80Fundamentals of Voice
Therapy
Examples: #4 1:00-2:32, #2 00-2:49,Put it all together
Describe how you will achieve a better
voice based on power, source, and filter
interactions.
For example, atrophy vs. nodules
82
83
Short-Term Goal #2
Vocal hygiene goal
Client will utilize vocal hygiene strategies throughout his or her day in 9 out of 10 opportunities. (5-10 minutes first session)
OR
Client will demonstrate understanding of vocal hygiene strategies by answering 9/10 questions correctly.
Rationale…….
Hydration matters (Titze, 1988; Verdolini-Marston, Sandage, & Titze, 1994; Verdolini, Titze, & Fennel, 1994).
Need to create the best possible environment for phonation.
Short-term Goal #2
Tailor vocal hygiene strategies to meet
the needs of the client.
Where would you put this goal in my
GVTM?
85
Introduce Vocal Hygiene
Based on disorder
May be different for hyper versus hypofunctional
60-80 oz. of water a day Don’t clear throat (silent cough)
Decrease talking in loud background noise Use other methods to get someone’s attention
instead of yelling
Take reflux meds., elevate HOB
Last meal, three hours before you lay down
86
Introduce Vocal Hygiene
Continued
Stop smoking (decrease exposure)
Good posture Minimize caffeine Use microphone when
teaching
Use headset if on the telephone a lot Relax!!!
Warm-ups and cool-downs Healthy Yelling Strategies
Vocal Hygiene for Performers
Warm-up your voice before singing, acting
Limit alcohol before performing
If in a smoky bar, have tons of water with you.
Monitor speakers for singer in a band
Don’t have milk or chocolate before performing
88
How will the client monitor
vocal hygiene?
A diary or self-monitoring schedule
How many times a day are you filling up your water bottle?
A rubber band on wrist for throat clearing.
Decrease smoking this week by half a pack.
For every cup of caffeine, have a cup of water.
Vocal Hygiene STG
Example (#4 2:32-7:10) 1stsession
Quiz
Quiz
1)This is an appropriate long-term goal for
your client. "The client will use the "new" voice in words with 90% accuracy."
a.true b.false
2)In writing a long-term voice goal for a child
in a school setting, it is important to think about what?
a.academic/educational impact
b.occupational impact
91
Quiz
3) This is an appropriate vocal hygiene
short-term goal. "The client will use vocal hygiene strategies."
a.true b.false
92
Quiz
4) Vocal hygiene could include the following:
a.Hydration
b.stop or decrease smoking
c.treatment for reflux issues
d.strategies to conserve the voice throughout the
day
Quiz
5) This is an appropriate vocal education
short-term goal. "The client will understand how the voice works."
a.true b.false
6)Vocal education could include the following
EXCEPT:
a.hydration
b.how the "new" voice is produced c.how the "old" voice is produced
94
95
Short-Term Goal #3
Stimulability Goal
Client will participate in a stimulability
exercise to achieve the best possible
voice given the client’s anatomic,
physiologic, and psychological
capabilities. (5-10 minutes in first
session)
Short-term Goal #3
Rationale…….
Where would you put this goal in the
GVTM?
97
What techniques should we
use?
Try different techniques. What makes the voice sound the best????
Try techniques based on the client’s baseline phonation pattern.
Resonant voice, twang, increased vocal fold adduction, increased airflow, pitch variability, etc.
Stimulability example Disc 2 (1 of 2) 7:00-10:18
Voice Therapy Techniques
Head or facial resonance
Chest Resonance
Twang
Resistance (aka glottal attacks)
Loud voice
Increased airflow or yawn-sigh
Chanting or sing-song
Increased pitch variability
98
Voice Therapy Techniques
Coughing and throat clearing
Estill’s work
100
Combination of techniques
Some of the techniques are usually
combined in treatment.
For example, resonant voice with increased pitch variability and chanting.
101
Head or Facial Resonant Voice
Used with most hyperfunctional voicedisorders
Increase airflow and decrease muscle
Usually forward focus.
Decrease tension (laryngeal massage)
Minimizes vocal fold impact
Barely ab/aducted VFs
(Berry et al., 2001; Verdolini et al., 1998)
Minimum respiratory effort for phonation
102
Head or Facial Resonant Voice
Hummmmm….. (bring voice forward)
Feel buzz on lips
Feel sinuses vibrate
Can use singing to facilitate
When Humming, your VFs are getting a
massage
“youuuuuuu”
103
Head or Facial Resonant Voice
Humming into me,me,me,
More,more,more Maybe Monday
Is the client able to carry-over the new voice into these words?
Do you like the voice quality the client is achieving?
Resonant voice will combine with chanting or sing-song and pitch variability.
Can the client discriminate the old from the new voice?
104
Pitch variability and chanting or
sing-song
Pitch variability: opposite of monotone.
Why is this important for the health of the VFs?
Sing-song: opposite of hard glottal attacks
Words are connected to one another.
It is easier to maintain resonance with pitch variability and a sing-song quality.
Head or Facial Resonant Voice
106
Chest Resonance
Same benefits from Head or Facial Resonance, just not placed high in face.
Placed in chest, while still maintaining a forward focus.
Combine with pitch variability and sing-song. Use /h/ initial words, hello, how are you? Use humming
Can the client carry-over the new voice into single-words?
Can the client discriminate between the old and new voice?
Do you like the voice quality with the new voice?
107
Chest Resonance
Demonstration
108
Twang
Extreme form of oral or nasal resonance
Most successful with paralysis or paresis clients. I have used it with VF scar and cyst.
Creates a pocket of resonance above the vocal
folds by A-P squeeze.
(Lombard & Steinhauer, 2007)
Ask your client to cackle like a witch, tease like a kid
Place your voice in your mouth. Slam it against the back part of your face or mouth
109
Twang
Can the client transfer the voice to other words?
Can the client distinguish between the old and the new voice?
Do you like the voice quality?
Demonstration
110
Resistance Therapy (aka glottal
attacks)
(developed by Lori Lombard, Ph.D.)
Used with hypofunctional voice disorders
Decrease airflow and increase muscle
Focus is back bottom of throat Uh, uh, uh, uh: Try and limit to just VFs Cue client to relax tongue, drop jaw
Facilitator phrases are ones with hard onsets (over and over, on and on, up and down, always and always)
Can use throat clear or cough
Resistance Therapy
Can the client carry-over the new voice to other phrases?
Again, new versus old voice?
Do you like the new voice quality?
112
Loud Voice
Loud Voice is the technique used in LSVT. Developed for people with Parkinson’s Disease (PD) (Ramig et al., 1994).
Think LOUD
Daily variables practiced 3 times a day.
Repetition and calibration are the most important aspect of LSVT.
Use Loud Voice as a technique, but apply to the GVTM.
I have used loud voice with PD and other types of neurological disorders.
Demonstration
113
Increased Airflow or Yawn-Sigh
Used with Hyper-Functional
Drops larynx and widens the glottal opening during voice
(Boone & McFarland, 1993)
Incorporate this into resonant voice therapy or relaxation therapy
114
Chanting or Sing-song
Eliminates hard glottal attacks, reduces vocal fold impact stress
Try on one pitch at first, then move to varying the pitch
115
Increased pitch variability
Incorporate with other techniques
Helps client to stay out of glottal fry zone
ROM for the VFs
116
Coughing and Throat Clearing
Used for hypo-function, specifically puberphonia, psychogenic (MTA).
Facilitate a cough into a vowel
Facilitate a cough into a lip trill
Lip trill on a pitch (will get voice)
Estill’s work
Quiz
118
Quiz
1)Head or facial resonance facilitates what
a.barely ab/adducted vocal folds
b.hard glottal attacks
c.more muscle effort and less airflow
2)Resistance therapy (aka glottal attacks)
facilitates what?
a.more muscle, less airflow
b.better vocal fold adduction during phonation
c.all of the above
119
Quiz
3) Twang facilitates what?
a.better resonance by narrowing the epilarynx in
an anterior-posterior configuration
b.better respiratory support for phonation
Quiz
4) When choosing the techniques for
stimulability, you must have an understanding of the physiology of the client's baseline phonation pattern and how the "new" voice technique will improve upon that pattern.
a.true b.false
121
Something works, now
what?
Short-Term Goal #4
Client will produce the new voice in syllables, words, phrases, sentences, memorized speech acts, specific spontaneous speech acts, monologue, and conversation with 90% accuracy. (the rest of the first session and into the 2nd, 3rd,
and 4thsessions)
124
Short-Term Goal #4
Where does this goal fit in my GVTM?
Example: #4 25:27-26:05 1stsession Disc3 3 of 6 (0:00 – 3:25)
Short-Term Goal #5
Client will produce the new and the old voice in syllables, words, phrases, sentences, memorized speech acts, specific spontaneous speech acts, monologue, and conversation with 90% accuracy. (the rest of the first session and into the 2nd, 3rd,
and 4thsessions)
125
126
Short-Term Goal #5
Rationale: Negative practice may facilitate faster generalization and maintenance, which allows for quick movement through the hierarchy.
Random practice
How? Because self-awareness of voice is
happening through auditory & kinesthetic feedback. And it offers random practice
(Grillo et al., 2010)
Where does this goal fit in my GVTM?
Example: (#4 32:53-36:20) 1stsession Disc3 4 of 6 (whole track 3:50)
127
Methods for spontaneous
speech
Self-monitoring schedule, taped conversations Think about the new voice before you pick up
the phone, sign on desk
Role play on phone and in conference hall Role play with children in therapy room, but
move out to other settings in school or home Observe child in classroom, hallways, lunch, etc.
Short-Term Goal #6
Client will maintain the new voice over a 2-week break period from voice therapy with 90% accuracy.
Rationale: Let’s see how they do away from you for 2 weeks before cutting the cord.
If not good, then keep them.
If good, then client met Long-Term Goal No further concerns, d/c from Tx.
128
Quiz
1)This is an appropriate short-term goal for
blocked practice in the treatment hierarchy. "The client will produce "new" and "old" voice in memorized speech acts with 90% accuracy."
a.true b.false
130
Quiz
2) What are the steps in the treatment
hierarchy?
a.technique level, words, phrases
b.technique level, words, phrases, sentences
c.technique level, words, phrases, sentences,
memorized speech acts, specific spontaneous speech acts, monologue, and conversation
131
Quiz
3) This is an appropriate short-term goal for
the "new" vs. "old voice component with random practice. "Client will produce "new" and "old" voice in words with 90% accuracy."
a.true b.false
Quiz
4) What component has blocked practice built
in?
a.treatment hierarchy
b.“new" vs. "old" voice
5)What component has random practice built
in?
a.treatment hierarchy
b.“new" vs. "old" voice
133
Client Examples
and Self-practice
Learner Objective
You have met one of the Learner
Objectives,
4. Apply the GVTM to clinical practice.
Well done!
Learner Objective
5. Identify appropriate use of the
GVTM in client examples and
self-practice.
136
137
Case #1,
What’s the long-term goal?
What are the short-term goals?
What techniques will you try? Disc 1, Track 12 of 12 (0:00-1:40)
2ndsession Disc 3 1 of 6, (0:00-4:10) This is what he sounded like when he walked in to the 2ndsession. What do you think?
Self-Practice
From the STGs that you will address
in that first session, what types of
methods will you use to target the
goal?
Vocal hygiene methods for children and adults. How will you ensure mastery or use of the methods?
Vocal education methods for children and adults. How will you ensure mastery?
138
Self-Practice
By the way, in what component of the
GVTM can we find vocal hygiene and
education?
139
139
Self-Practice
Stimulability Exercise
In what component of the GVTM can
you find stimulability?
Your turn.
Pick a partner and try different voice production techniques, resonant voice, yawn-sigh, glottal attacks, loud voice, twang, etc. Can you get carry-over of the “new” voice into
phrases?
140
140
Self-Practice
Now, that you found a technique that
you want to use, let’s do treatment
hierarchy and “new” vs. “old” voice.
142
Case Studies
What goals am I addressing and why?
Disc 1 5of12 (4:00 to the end) Disc 1 6of12 (0:00 to 5:10)
Your client: Disc 1 1of12 (0:00-1:10) (old voice)
What would you do for stimulability?
This is the new voice Disc 1 2of12 (3:40-to the end)
143
Your client
Sally, 40 y/o female, has been diagnosed with a vocal fold paresis. Her average airflow is 300 ml/sec. She complains that she can’t project her voice and it is too breathy.
What are you going to do? Use the GVTM.
State your goals and why. What techniques for stimulability?
Your client
Michael is a 12 y/o male. In school, kids are teasing him because of his voice. His pitch is too high. Teachers are having trouble hearing or understanding him because of his voice. Michael is not participating in class because he is ashamed of his voice. His parents took him to a laryngologist and she diagnosed puberphonia. Voice therapy was recommended.
What are you going to do? Use the GVTM.
State your goals and why.
Your client
Mary, 40 y/o female, with bilateral vocal fold nodules. She is a teacher. Her voice is hoarse, runs out on her by the end of the day.
What are you going to do? Use the GVTM.
State your goals and why. What techniques for stimulability?
145
145
Your client
Jessica, 6 y/o female, in 1stgrade. Voice
is negatively affecting her academic performance. Teachers can’t understand her when she talks because of
hoarseness. Kids are teasing her. She speaks less and less during school. Diagnosed with bilateral vocal fold cysts. Parents reported that she has always sounded like this. Mom sounds the same.
What are you going to do? Use the
GVTM. State your goals and why.
What techniques for stimulability? 146146
Learner Objective
Congratulations! You met the final Learner Objective:
5. Identify appropriate use of the GVTM in client examples and self-practice.
To Recap……
Look at all that you achieved! You can now:
1. Describe the components of the GVTM.
2. Explain the motor learning principles applied to the GVTM
3. Understand the research supporting the GVTM.
4. Apply the GVTM to clinical practice. 5. Identify appropriate use of the GVTM in
client examples and self-practice.
148
148
Thank You for Your
Participation!
149
References
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1116 1161 116
References
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