Posts tagged #Ingo Titze

Straw Phonation Takes Center Stage

Make Straw Phonation fun for your younger voice students. Click  Here !

Make Straw Phonation fun for your younger voice students. Click Here!


Try  Ellie Elephant  for Straw Phonation fun! 

Try Ellie Elephant for Straw Phonation fun! 

A light-hearted look at a Facebook group message that got over 64 comments. The funny group dynamic took it to boozy new heights and with a little science thrown in there, hopefully others learned about inertive reactance since Renee Fleming is already a fan.

I am a member of a classical singer forum on Facebook and never have I witnessed such a long winded comment section on a post until the other day. I wanted to share it with you all because I couldn't help but laugh out loud.

It began innocently enough with someone mentioning a recent master-class given by Renee Fleming. Ms. Fleming had been teaching singers to carry a straw with them at all times to warm up without disturbing others in close proximity with a full-out vocal blast to the ears. The comments began slyly rolling in about how straws should be saved for whiskey drinks, but others were intrigued. "Mind blown!" one said, "Great tip!" said another.

There were those who were confused, "How is it different than humming?" they wondered, "How is this straw supposed to work?" There were those who were gung-ho, "Is there a consensus among us that this works?" and, "Straw business is so hot right now."  (images of Hansel from Zoolander begin to swirl around in my head.) And there were those who were less than amused, "I hope she offered more than that." 

 

Folks were sneaking to fast food joints to grab a straw to try and experience this strange phenomenon and one woman even attempted with a turkey baster, to which her comrades replied that they hoped she removed the rubber part before attempting.

Some were defending this technique as if were their own flesh and blood, "It is not a sick joke! This was actually useful advice." One man even mentioned that a speech pathologist had taught him this trick and that he found it helpful. I smiled a bit there because straw phonation has been a shining star in my bag of tricks because of its ease of use. For easy to use diameters, try these. Narrow diameters produce more occlusive effect, like these. For the more environmentally conscious vocalist, these metal ones are great!

I chimed in with, "Straw phonation is a form of semi-occluded vocal tract exercises. Humming and lip trills and tongue trills and straw phonation are all semi-occluded vocal tract exercises. This allows for the singer to phonate with no excess glottic tension at the level of the vocal cords. It also elongates the vocal tract and narrows it, providing inertive reactance (back pressure) at the vocal cords. The vocal tract actually assists the vocal cords in vibration, easing their load."

One man thanked me for being scientific at this time of the morning and I provided video input from Ingo Titze's YouTube demonstration of straw phonation to aid quelling in any further confusion. The conversation soon turned to things I will not mention here on this blog, but in it somewhere were people mentioning Titze, tools, more alcohol, drunk tenorial overlords, and a woman carrying a straw since '82 and a commenter telling her she better change straws because that one is probably old. Ha.

When I speak to professional voice users about the many ways straw phonation can be used, I usually demonstrate how you can go from singing a line in a song, to straw phonating that line, to singing the line again to help improve your body's ability to reduce tension. You can access some materials for making this interesting and fun here.

Try this complete packet for making  straw phonation  fun.

Try this complete packet for making straw phonation fun.

 
Characters  for your straws!

Characters for your straws!

It helped me immensely to sing back and forth, with and without the straw to improve my own abilities and to cut back on vocal cracking and obtain a more easy and pleasant sound overall. No audience wants to watch a strained singer right? The audience likes to be enveloped in the artistic moment while watching a singer who produces notes and phrases as though it were syrup dripping right off the stage into the onlookers' laps.

Anyway, back to the Facebook hysterics, I tried to verbally explain this all to someone I hoped would find it as funny as I had, and he was not amused. Here's hoping the musician humor can be translated here.

-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.

 

Making Functional Aphonia Treatment Functional

Functional aphonia, conversional aphonia, psychogenic aphonia, acute sudden voice loss, hysterical aphonia....They all are names for the same disorder. In school, I learned that functional aphonia was when a person lost his or her voice and couldn't figure out how to speak again despite trying. In clinical experience, I have found that many factors can contribute to functional aphonia, not all clients are "malingerers" and it takes skill, patience and experience to separate these malingerers from those truly in need of voice therapy.

With this diagnosis, many insurance companies deny at the hint of anything functional. They see "functional" and read it as the patient is "choosing" not to speak. It doesn't help that some patients receive secondary gain from this disorder and "milk it for all it is worth."  This may sometimes be the case, but for most functional aphonics, this disorder is something they cannot recover from without intervention. It usually occurs following an illness (such as an upper respiratory infection) or following a traumatic or emotional occurrence. It may even develop as a result of fear.

Before speech therapy was seen as an appropriate intervention technique, psychogenic aphonia was treated in very odd ways. One way was essentially "suffocating" the patient to evoke a vocal cry of alarm. Other treatments included using electricity, grabbing the tongue, water torture or cocaine applied to the laryngeal mucosa. Yikes...None of my therapy techniques include any of these thankfully.

The first functional aphonic patient I ever saw was by observation only. She was a young woman who had a child at home. Being a single mom, she worked at a very demanding job where she had to use her voice all day. She was receiving voice therapy fully paid for by her insurance company, and her job was giving her time off for short term disability. Each time she would come for a session, we made progress and she was able to find a wonderful and resonant target voice. The next time she would come in, the voice would be whispery and diminished again. It made me wonder if she was just using the time off for whatever personal reason, but the struggle in each session to achieve a normal sounding voice was all too real.

A memorable functional aphonia patient I saw was in a hospital where I worked. He had not been intubated, and I spend most of the evaluation trying to figure out if he was faking or not. Malingerers are out there... The more I found out about his family and the emotional trauma of what brought him to the hospital, the more I realized that the trauma itself had changed how this man functioned in every way, including how he spoke. It took 3 sessions before he even made a noise, but through semi-occluded vocal tract exercises with a straw in a cup of water, we were able to bring him into a complete and normal speaking voice in no time.

This population can be difficult to treat because, like most voice cases, no "one" treatment will work all the time. I have compiled a list of tricks and tips to help any SLP treating a functional aphonic achieve that "light bulb" moment.

  1. Bubbles in a cup. Begin with water in a cup, 1/3 of the way full or so. Have the patient place the straw in the water and blow air until bubbles are seen. This gives the patient visual feedback that air is indeed flowing. Next, have the patient begin to hum this way. Sometimes the distraction of the cup, the vibration of the bubbles and the noise made is all that is necessary to get phonation to occur again.

  2. Gargle. If the patient is appropriate and not an aspiration risk (i.e. not bedbound or on a ventilator), get some warm salt water, or plain water to gargle.

  3. Raspberries or tongue trills. These semi-occluded vocal tract exercises are based on the same scientific idea as straw phonation, but these easy productions may be the key for some patients.

  4. Laughing. Get out your joke book here. Sometimes all that is needed is good old-fashioned joking around. Some YouTube videos can be used as well. I like this old superbowl commercial about herding cats. It's hysterical.

  5. Being silly. Act out some lines from a play in ridiculous accents or at different tempos.

  6. Masking. If you have headphones with some white noise you want to use, great! If you are interested in a more budget friendly and quick trick, crinkle paper towels or plastic next to both ears while having the patient attempt to phonate.

  7. Technology. Use your phone or a small recording device to record the patient making these noises. Sometimes patients will not even believe it is really them in the recording, so videos are the next step here.

Laryngeal Reposturing (ideas from Nelson Roy) can also be helpful in these cases. The book, Exercises for Voice Rehabilitation, shows this nicely in detail, but it is best learned from a practicing clinician.

Make sure you are utilizing negative practice in your sessions because the quicker the patient regains the ability to reorganize his or her own kinesthetic framework for phonation, the quicker the patient can get back to a normal life.

-ATVC

 

References:

Kollbrunner, Juerg; Menet, Anne-Dorine; Seifert, Eberhard. Psychogenic aphonia: No fixation even after a lengthy period of aphonia. Swiss Med Weekly, 2010,; 140(1-2):12-17.

Stemple, Glaze & Klaben. Clinical Voice Pathology: Theory and Management, Fourth Edition. Plural Publishing, 2010.

 

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.

 

 

Let's talk Larynx

If you are interested in voice and voice disorders, like me, you may have found that your interest in knowledge of voice anatomy did not peak until you were waist-deep in your graduate studies. Or maybe you have always been doodling posterior cricoarytenoid muscles in the corner of your MEAD spiral notebook pages. (WARNING: the previous link transports you to a very graphic video of an actual larynx...not for the weak) I studied and memorized all the muscle names for each test during school. It one day dawned on me that it was just easier to know the ins and outs of the laryngeal mechanism in order to better understand my craft. But, why didn't this occur to me years earlier? Like, perhaps, when I began singing? Or better yet, when I discovered the left true vocal fold cyst that plagued the beginning of my college vocal performance career.

I have found that the more I know about the larynx and its muscles, the better I am at explaining therapy techniques, lay-man's terms anatomy and vocal fold vibratory dynamics to my patients. This is great because when I first began my experience with voice patients in my internships, I was allowed to provide descriptive verbal anatomy to the patients. Man was I excited. I would practice my "spiel" on the way to and from the clinic. I would wait nervously during each videostroboscopy I was observing until it was my turn to give them the best anatomy lesson of all time!! But, I would get weird looks when I spoke of a thyrohyoid space or healthy looking thyroarytenoids. It was great that I knew the anatomy, but no one cared. They just wanted to understand why the physician had sent them and what magic we were going to prescribe. I had a patient's wife tell me recently that she was so thankful I had taken the time to actually talk to her and her husband about the exam in a way they could understand. I took this pat on the back and thought, "Maybe I finally am able to find a good mix between medical terminology and real-world explanations."

I am always finding a new and better way to explain things, and when one perfect way of describing something finds its way into my brain, I'm sure a few gems from a while back make their way out. It reminds me of a Married With Children Episode I watched a long time ago where Al puts Kelly on a trivia game show,  but for each new thing that she learns, a previously learned fact is forgotten. While I am glad that this is not real life, I went to a continuing education seminar this summer where I was able to take in succinctly presented information on vocal anatomy. While Kelly loses an old fact with each new one learned, I felt that I continued to fine tune my knowledge base and built upon what was already there. (Please visit the voiceboxvalhalla laryngeal anatomy website here. Thank you TCU.) It's a nice change of learning style when you can learn the fun things like pathologies after you already spent the time learning the dry names and functions. (Think late-night graduate study cram sessions where 3am rolls around, you are all batty from red-bull and lack of sleep, quizzing each other as if it were some sick-twisted endless Jeopardy episode.)

The larynx is such an amazing apparatus housing those vocal folds that are, as Ingo Titze says in his book (Fascinations with the Human Voice), "woefully undersized." With our dime sized vocal folds and our 7 inch vocal tract (epilarynx) we are able to completely mesmerize an auditorium full of audience members with no amplification whatsoever. Our larynx is made entirely of muscles and ligaments, with the hyoid as the only bone. Just as I fine tune my explanations, I work on keeping my larynx free from tension. This is a daily learning experience, which can be frustrating at times, but I feel I have a much more efficient practice technique with all the anatomical knowledge I know possess. And if I forget things, I won't be calling Kelly...

 

-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 October 13, 2014 .

Avatars, Tigers and Bears Oh My! (and straws)

Avatars, Tigers and Bears Oh My! (and straws)

by atempovoicecenter atempovoicecenter on 06/09/14

 

Voice rest recommendation got you down?

Well, fear no more. I wish to share with you an amazing speech generator that you can use for yourself or recommend for your patients. I mean, this thing is right out of an episode of 30 Rock. You can find a Jack Donaghy-sounding voice and make him talk for you so you can really get the voice rest your speech pathologist is recommending. It features an avatar of your choice and can even speak in different accents.

 

Need a louder voice?

Here is a link for a cell phone amplifier. It can amplify up to 40dB! On this website, serene innovations, you can find other useful products as well.

 

And for kicks, here is Ingo Titze's Straw Phonation video from YouTube. This is helpful to "unwind" your voice. Semi-occluded Vocal Tract Exercises, like this one, allow you to make sound without any glottal pressure. This can be helpful to start your day off right with good vocal production, or when you need to re-set your voice after some bad-habit talking. Titze has some great tips in this video.

-ATVC

Posted on September 30, 2014 .