I have had inquiries from multiple sources about how I track progress in voice rehabilitation sessions, so I thought it was high-time that I sat down to create a blog post about what types of goals I use in my sessions and how you can tweak them to make it workable for your specific clients. (Read up on Part 2 of this series on Long Term Voice Rehabilitation Goals.)
If you have recently been assigned a voice client, and don't even know where to start, check out Voice in a Jiff: Hospital, Clinic or SNF for Adult resources and Voice in a Jiff: Pediatric Edition for help with children. Both manuals can be downloaded quickly and ready to use in minutes, either from here or TeachersPayTeachers.
I divide my goals up into banks, one for Short Term and one for Long Term. I'll discuss Long Term goals in part 2 of this blog series. The Short Term goals are mostly appropriate for each patient, depending on if the patient has water intake restrictions.
(1) Patient/Client will demonstrate an understanding of voice production physiology and controlled voice utilization by describing/listing the phonation process and alternatives or modifications of current use in different environmental contexts with 90% accuracy within 4 weeks. (I measure this by education via video, picture and demonstration with biofeedback, to help the client better understand their own mechanism, so they have better control of their own ability to produce sound. This is also where I like to have the patient claim responsibility for the voice disorder, and stop referring to "the voice" in the third person, like it has power.)
(2) Patient will confirm implementation of hydration regimen in 3 consecutive sessions/weeks to decrease viscosity of reported throat mucus and irritation - as self-reported by patient with 100% accuracy. (There is not a published study about the specific amount of water best for the body, but a good rule of thumb is 8 glasses per day or 1/2 your body weight in ounces. Limiting alcohol and caffeine are also part of this goal, which you could technically create 2 separate goals for.)
(3) Patient will eliminate vocal overuse to improve health of vocal folds by reducing or eliminating trauma to vocal tissues within 4 weeks as evidenced by patient report and SLP observations with 100% accuracy. (This is a great one to help focus the patient on a better vocal atmosphere, and you can dovetail goal 1 into this one as well.)
(4) Patient will establish volitional control of respiration evidenced by utilization of diaphragmatic breathing during structured tasks within 4 weeks with 100% accuracy independently. (The basis of proper technique requires abdominal support, so this goal will be the one I work very diligently on during the first session and onward. The patient will have a challenging time if this goal is not mastered before beginning sound production.)
(5) Patient will coordinate vocal subsystems in hierarchical speech tasks by producing sound in an efficient manner yielding improved or normal voice quality and vocal endurance in the presence of existing laryngeal disorder with 90% accuracy independently. (This goal is very important, and the patient must reach this goal before number 7 can be achieved. Vocal Resonance, Flow Phonation and Semi-Occluded Vocal Tract Exercises can all be used to achieve this.)
(6) Patient will reduce vocal effort and fatigue by decreasing upper body tension as evidenced by a decrease in symptoms and lack of observable/palpable signs of hyperkinetic muscular behaviors. (I palpate my patients on the shoulders, neck, jaw, base of tongue and larynx to determine baseline tension and rate on a 0-3 scale with 3 begin severe tension. I monitor progress in these areas by what I feel and what I can see visually as the patient phonates or sits at rest.)
(7) Patient will implement generalization of goals with 80% accuracy independently to encourage the use of new vocal skills in varied speaking contexts. (This includes in sentences, paragraphs, conversation, with ambient background noise, while being masked with an audio source in headphones, on the phone, at the checkout counter.....Wherever the patient uses the voice, this goal applies. You can separate it out if you like, especially if your client is a child, but for adults this should take usually between 4-6 sessions.)
I hope this was helpful, and stay tuned for the blog post on Long-Term Goals for your Voice Rehabilitation clients! I'd love to hear how you are creating your voice goals, so feel free to comment below!
(Special thanks to SLP's Kim Coker 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.)
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.