Fit Voices? The Rise of Vocal Injury in Fitness Instructors

The amount of fitness instructors who experience voice issues that continue to recur is 44-70%, according to Rumbach 2013. 78% report feeling a change in their voices after teaching just one class. And the very sad thing is that 80% of these folks regularly use microphones, but they constantly malfunction or the instructor has no idea how to use them efficiently. 

Posted on February 13, 2018 .

We've Partnered with MedBridge. Get Your Unlimited Discounted CEU's Here!

If you're like me, we have the disease of being busy. I have caseloads, business opportunities, blogs, family, taxes, billing, and as my head starts to spin, I could go on for days. In the past, I have waited for specific CEU's to roll around that I knew would be applicable to my patient demographic. Sometimes this would put me in a tough situation where I would have to spend money on airfare and hotels just to get certified in something that was voice or swallow related. 

MedBridge and I have partnered to offer quality CEU's at a very discounted rate so you can afford to educate yourself in the areas of knowledge specific to what you treat. MedBridge has observed that dealing with overpriced CEUs is a constant issue with SLPs (among other disciplines) and they have created a website that offers online continuing education and patient engagement tools. These video courses are accredited and contain excellent research based approaches. 

No longer do you have to travel to get CEU's (unless you want to, of course) and no longer do you have to shell out big bucks to do so! Since running my own business, all my CEU courses have been my financial responsiblity, and last year I spent over $1,000 for a course I attended in person. The year before that, it was a little less than $600 for an online certification in my area of specialty. NO MORE! Medbridge is offering a special pricing discount so you can earn your CEU's anywhere at anytime. (PJ's and coffee encouraged!) 

MedBridge has hundreds of CEU courses, live webinars and is an ASHA Approved CE provider. Use Promo Code: atempoVOICECENTER or click here to get your own discounted annual subscription to MedBridge for only $95! That's saving you $175 right away. 

You also get exclusive access to the home exercise program builder (HEP) which allows you to customize exercise programs specifically for your patients with over 5,000 video exercises. HEP's can be easily printed, texted or shared online. This means your patient is more likely to adhere to your home program, know what is expected and make progress. That's really what it's all about. 

Students? It's even better for you! If you use the student promo code: ATEMPOVOICECENTERstudent you will have a yearly subscription at only $75! Remember, you must sign up with your email address ending in ".edu" for this to be honored. You still get everything in the yearly regular SLP membership, except for CEU credit, because you aren't eligible to earn until you have your license. 

The best part is that huge names in the voice community have recorded webinars that are available to you 24/7! This means voice gurus like Joseph Stemple, Edie Hapner, Mary Sandage, Robert Grider, Sarah Schneider, and even Julie Barkmeier-Kraemer sharing valuable and applicable knowledge. If you are a Many Hats SLP, you can expand your knowledge in many other areas. Plus MedBridge is adding more every day.

I hope you'll take advantage of this fantastic offer, because you shouldn't feel like you are just getting CEU's to fill your quota. You should have affordable options to learn about areas specific to you. This benefits you as a clinician and most of all, your patients. 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

 

Posted on September 21, 2017 .

A Day in the Life of a Voice SLP

Working for yourself is not an easy out. It takes dedication and learning how to sift through the murky waters to pull through to the sun above. You can enjoy, but you have to keep trying to get ahead. If you want a 9-5 where you leave it all at work, I would encourage you to re-think working your own business. As for me, I couldn't imagine it any other way....

Posted on August 16, 2017 .

But Your Swallow Study is Fine.....What is Muscle Tension Dysphagia?

As a graduate student in Speech-Language Pathology, there are so many names to learn about with regard to terms coined, rehabilitation techniques researched and therapy approaches we don't even use anymore. As a patient, you just want answers. Terminology is important, and Christina Kang, Joseph Hentz, and Dr. David Lott have pioneered a term to describe symptoms for dysphagia that does not show up routine swallow studies.

Kang and team took a retrospective look at folks who came into their clinic for swallow and laryngeal studies including VFSS and flexible laryngoscopy. VFSS stands for Videofluroscopic Swallow Study, or Modified Barium Swallow Study, which looks at the swallow function under x-ray with the patient drinking and eating barium. The important thing here is that no swallow weakness or organic pathology was observed in these tests. This means there was no structural cause for the patient complaints. 97% of the patients chosen for this study that were complaining of swallow issues, also had abnormal laryngeal muscle tension. 82 percent had laryngeal hyperresponsiveness. This means that the larynx would respond to stimuli even when it wasn't present, like in refractory chronic cough, paradoxical vocal fold motion and globus sensation. Inflammation, or swelling and irritation, was also found in 52% of these people. 

 Credit: Kang et al 2016 article.

Credit: Kang et al 2016 article.

Kang thought, what if we targeted muscle tension in the larynx through voice rehabilitation, to see if these symptoms resolved? So, 13 of the initial 67 attended voice therapy sessions that specifically focused on unloading muscle tension. Treatments consisted of a combination of Resonant Voice Therapy, Semi-occluded vocal tract exercises, diaphragmatic/low breathing and cirumlaryngeal massage. 

Guess What? ALL 13 reported a complete resolution of dysphagia symptoms! Why is this so exciting? I don't know about you, but these patients seem to get pushed to the side if VFSS shows nothing abnormal, but the patient still feels symptoms. The most common symptom sometimes during my week at the clinic is, "I feel like something is stuck in my throat." Having complaints seemingly dismissed after a diagnostic test that shows no problems can make the patient upset, feel like it's "all in my head" and lead to continued and unnecessary testing and physician visits. Kang and team are proposing Muscle Tension Dysphagia or "MTDg" to describe a certain group of patients with functional dysphagia. 

The important and amazing thing here is that these patients improved! There is a possible solution to the problems that brought them to the doctor in the first place. We no longer have to send these patients away with no option for treatment.

Of course further testing is needed in this area, but what a great treatment option to offer patients who normally just get sent home and told to "stop worrying about choking, you'll be fine."

 

Reference: Kang, C.H.; Hentz, J.G.; Lott, D.G. Muscle Tension Dysphagia: Symptomology and Theoretical Framework. June 28, 2016. 

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

 

 

Posted on July 13, 2017 .

Resonant Voice Exercise is Better than Vocal Rest?

What Kittie Verdolini Abbott likes to call the "Scream Study" shows just that. She and her cohorts (including Ryan Branski and Clark Rosen) took a group of 9 folks and subjected them all to the same task to "tax" their vocal fold tissue (talking loudly for 1 hour, with a few small breaks in between). Then, they separated them into 3 groups.

But What About Voice Rehabilitation Goals? Part 2: Long Term

I've enjoyed hearing feedback from you all about short term goals and how they work for you. Many of you are more specific in creation, but are focused on the same end goal. If you have no idea what I'm talking about, check out Part I of this series about Short Term voice rehabilitation goals. 

Let's get to chatting about goals for the Long Term. Perhaps you abandoned some goals in the Short Term that were no longer appropriate. Maybe your patient has met all the Short Term goals and has a dramatically improved quality of life. This may be the perfect time to complete final acoustic measures, possibly a re-videostroboscopy, and a Vocal Handicap Index.

Long Term

(1) Patient will demonstrate voice production abilities which meet the needs for activities of daily living while maintaining health of true vocal folds within 12 weeks as evidenced by patient report and SLP observations. (I have 12 weeks, because I always guess that 9-12 weeks is long enough for a patient to come to 4-6 sessions, with illness, no-shows and cancellations. Is your patient able to talk for work? Is the fatigue or throat pain lowered or eradicated completely?)

(2) Patient will decrease or eliminate pathology while improving overall health of true vocal folds by eliminating vocal misuse within 12 weeks as evidenced by patient report and SLP observations. (Misuse is not only throat clears, coughs and yelling, but pressed talking, or talking for long periods of time with no break. Singing, and especially voice use after the show, is another area of misuse that should have been addressed and fixed before this goal is met.)

(3) Patient will maximize efficiency of the vocal mechanism relative to existing laryngeal disorder through coordinating subsystems of voice within 12 weeks as evidenced by patient report and SLP observations. (This is an expansion of STG #5, and this target voice should be present across your patient's speaking patterns. Diagnosis is important here, as it can sometimes be appropriate to have LTG 2 & 3 for a patient, but sometimes it's one or the other. For example, if a patient has vocal nodules, LTG 2 only would be appropriate. If the patient has Muscle Tension Dysphonia in response to a vocal cyst, both may be appropriate because you want to decrease or eliminate the MTD, but the patient may or may not be a surgical candidate for the cyst to be removed, so that disorder would remain existing. And sometimes, you get lucky and the excrescence goes away with voice rehabilitation alone!)

(4) Patient will achieve improved/normal voice assessed with perceptual scales, acoustic and/or aerodynamic measures within 12 weeks. (Using the CAPE-V, AVQI, VHI, Cepstral Peak Prominence, you can track progress for your patient and also help back up your data for insurance reimbursement. I mean, who doesn't like to see tangible progress that is quantitative? By the way, Cepstral Peak Prominence (CPP) is considered the most promising and robust way of determining severity of a dysphonia....that's right, more than Jitter...more than Shimmer......)

(5) Patient will return to vocal activities of daily living with reduction and/or elimination of complaints regarding vocal production within 12 weeks as evidenced by patient report and SLP observations. (Your patient sometimes will come in and meet this goal, without having met all the short term goals, and you have no choice but to say hooray for you, and you never see that person again. It know it's hard, since you didn't finish your plan of care as you initially indicated, but this was the outcome we were looking for! The patient is happy, you shouldn't just keep them on case to fill boxes.)

(6) Patient will acquire vocalization skills to meet personal and professional needs while maintaining and improving health of true vocal folds as evidenced by patient report, as measured by improvement in acoustic measures, and as assessed through videostroboscopy and through perceptual analysis. (You may delete this or combine it with #5, but it could stand on its own as well. Patient report and your skilled clinical assessment are both important factors here.)

(Special thanks to SLP's Kim Coker, Chis Watts and Shelby Diviney, as I drew from their teachings and materials to formulate the Short and Long term goals listed in this blog series. Thanks to them both for being my mentors and guiding me in being the clinician I strive to be.)

-ATVC

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

Posted on March 30, 2017 .