Posts tagged #nerdalert

Twang, Twang Into the Room: A Look Twang as a Therapy Technique

#researchtues and #bangbang

Resonant Voice Therapy might have let you hold its hand in school, but I'm gunna show you how to graduate...haha. I can't get that song off my radio!

When I came across the title to the research article I am featuring for this week's Research Tuesday, I wondered to myself about my own "twang" and how often it probably rises to the surface since I'm from Texas. I treat clients often who have a twang of their own and I smile when it is very apparent because it makes me proud to be a Texan and to call this great state my home.

You all may be familiar with Resonant Voice Therapy and its uses for unloading the vocal mechanism. You may not be familiar at all with "Twang Therapy Techniques." Joanna Lott defines it as, "an aryepiglottic narrowing to create a high intensity vocal quality while maintaining low vocal effort." This is narrowing the aryepiglottic sphincter, as evidenced in this video. Elpida Koutsoubaki, Voice Therapist (from Athens, Greece), is using this to review the patient’s progress. She had received 3 voice therapy sessions leading up to this. “She is one of many patients with bilateral vocal fold paralysis for whom twang therapy has mercifully delivered a fully rehabilitated and functional voice (and breath support),” Elpida says.

Still wondering how Twang sounds? Think Lois Griffin from Family Guy. Yanagisawa, Lombard & Steinhauer describe it similar to an oboe, banjo or duck quack. I'm thinking, 'Yeah I already have my patients try enough crazy sounds, what's one more animal sound-a-like?' It turns out, twanging, for lack of a better term (so as not to confuse others with Miley Cyrus and her antics) could really benefit a client in the therapy room.

Twang constricts the vocal tract in a way that clusters formants in an acoustically pleasing way because it complements the resonant frequency of the ear canal. Because it increases the perceived loudness levels for the listener, the client can increase volume without increasing effort. Pretty cool, huh?

And.....drumroll please....another guest appearance of, yes, wait for it..... INERTIVE REACTANCE. This is where the back pressure created by this "tube within a tube" eases the pressure and allows the vocal folds to self-sustain vibratory cycles with no excess effort for the patient or performer. (Just like Straw Phonation!)

But is there a danger of bad production habits? With any therapy technique, you must be knowledgeable about it going badly in order to keep your patients on the right side of the line. Aryepiglottic constriction has been found to be present in every-day vocal production, so it is safely utilized by the general public. Hyperfunction, on the other hand, is any false vocal fold medial constriction and is strictly prohibited because it recruits excess and unnecessary muscular effort to phonate. Make sure you are monitoring the difference carefully when utilizing this in the therapy room.

This can also treat the hypophonic voice, as a study by Lombard and Steinhauer proved in 2007. Vocal fold paralysis or atrophy can lead to a breathy, unsupported vocal quality. After receiving voice therapy sessions using twang intervention, all of the participants were very happy with the finished product and that they were increasing intensity without sacrificing effort or coming across like a country-music singer. I wonder how it would work with tandem with an LSVT approach?

When utilizingthis technique, it is important to know how to distinguish twang-y from nasal-y, as evidenced in this video. He is referencing Jo Estill's twang teaching, and educating on how to utilize your aryepiglottic folds when twanging. He explains about the soft palate movement nicely as well.

More studies are needed to determine the effects of twang therapy, so "get a ride in the engine that could...go..." and twang twang into the research scene!

 

-ATVC

References:

Joanna Lott; The Use of the Twang Technique in Voice Therapy. Perspect Voice Voice Dis 2014;24(3):119-123. doi: 10.1044/vvd24.3.119.

Also, Elpida has offered to answer questions re. application of Twang to bilateral vocal fold paralysis.
You can reach her at ivoicetherapy@gmail.com

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.

 

 

Voice Rx: Birth Control, Tylenol and Breath Support?

I was listening to a podcast from NATS (National Association of Teachers of Singing) this week and was surprised when I heard that Dr. Robert Sataloff was being interviewed. He is a special physician because he has his Doctor of Musical Arts in Vocal Performance from Combs College of Music in addition to being an otolaryngologist and a musician, which peaked my interest immediately. I am sure that others know of him already, but this was news to me and it made me excited. I couldn't wait to hear the questions that the NATS group had for him.

This chat was on the subject of performing arts medicine and care of the professional voice. The first question raised was in regards to PMS. I immediately thought back to voice changes that Moya Andrews talked about around "that time of the month" in one of her books. The doctor said to consider avoiding any diuretics or water-shedding pills when you are about to start your period. Why? Because during the pre-menstrual time, the vocal folds are swollen, like other muscles in your body, with a protein-bound edema fluid which will not be expelled by a diuretic. The only thing that taking these pills would do is strip the essential epithelial lubrication on your vocal folds and make them more susceptible to damage from overuse and misuse. The swelling remains until the woman's period has finished. His recommendation for the few days prior to your period beginning? Stay hydrated. I'm thinking, yeah....let's add more fluid to the mix....Mucinex will not compensate for the benefits of hydration, but it might help you thin secretions when they are too thick. You should avoid any bloating pills if you are a professional voice user. He also recommends in some extreme cases that birth control pills can help with avoiding that fluid overload altogether by hormone regulation.

Next he addressed pain killers. Ibuprofen and aspirin were discussed in detail in regards to the effects on the voice, but the consensus was that Tylenol or any acetaminophen was usually safe for the vocal performer. Ibuprofen (Advil and Motrin) thins your blood and puts you at risk for vocal fold bleeding for only about 24 hours. For the time the drug is still in your system, you should be careful not to strain or overuse your voice. Aspirin, he warned, is even more dangerous to the professional voice because its effects last 7-10 days after just popping one pill. It interferes with platelet function, so it increases the bleeding risk for a person. He also says that if your blood vessels are already dilated and delicate (ie you are about to begin a period or are sick with laryngitis or a cold) and then you consume ibuprofen or aspirin, you are at very high risk for hemorrhage of the vocal folds. Old types of birth control pills with high doses of hormones used to cause some consumers to lose part of the upper vocal register and when pills were ceased, the voice returned to normal. New BC pills, though lacking formal studies, don't seem to be having that dramatic of an effect on the voice because they contain much lower amounts of hormones. He warns women to be wary of birth control pills containing androgens (male hormones), as they may lower the pitch of the voice.

He discussed vocal fry with one listener. This is the way a Kardashian speaks, with a low, guttural creak at the end of almost every utterance. We categorize our voices within 3 registers or physiological frequency ranges: modal (normal)-- falsetto (high)-- and fry (lower). For modal register, the vocal fold vibratory cycle contains vocal folds spending an equal amount of time open as they spend closed. Falsetto produces sound with the vocal folds barely touching or not at all. Vocal fry is different. Vocal Fry produces sound with a very long vocal fold contact time. Here, the majority of the sound production time is spent with closed vocal folds. It is this constant contact in combination with the pressing that causes the vocal fold damage and makes this a vocally abusive behavior. Most of the time, Dr. Sataloff says, people are using poor breath support when they utilize the fry register. I know I find myself doing it when I'm lying in bed on the phone or when I'm tired.

When a person presses, he or she is squeezing the muscles of the larynx to make sound instead of letting the breath do the work. He reminds us that most of the time, using vocal fry is abusive to the vocal folds.

He also discussed the importance of diaphragmatic breathing and body awareness to treat MTD or Muscle Tension Dysphonia. He encouraged relaxation awareness to improve outcomes for professional voice users and even gave a "shout out" to Speech-Language Pathologists and singing voice specialists and our important role in treating this disorder in speakers and singers.

This was a nice breath of fresh air about voice and medicine and I am thankful this was shared on a twitter account I follow.

-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.

A Cure for Stage Fright? Can Blood Pressure Medication Help or Hurt?

In honor of #ResearchTuesday, I have chosen to blog about a study I was given to peruse this past week about a double-blind controlled trial about how stage fright affects the voice. Stage fright is an issue for many performers and public speakers, and has varying degrees of intensity. The study wanted to explore quantifying these effects of stage fright stress on the human voice.

In previous studies, fundamental frequency (your voice's pitch) is the constant here, as it is documented to increase with stress. Conflicting evidence on vocal intensity (loudness) and speaking rate exists, so I guess for some individuals experiencing stage fright, you might get louder with a faster rate of speech or quieter and slower....or a combination....My mind begins to wander back to middle school presentations I had to give. I stood there at the front of the class, shaking and flushed in the face. I can't remember what my voice did, so I'm was interested in the outcome of this study.

Some folks don't like the shaky, sweaty palms, nausea or diarrhea that stage fright brings upon a person...I wonder why? So, they take beta-adrenergic blockers. This is your basic medication to lower the blood pressure by blocking adrenaline and slowing the heart beat, but side effects are a danger.

So this study took individuals and induced stress upon them by putting them in a room with 200 IEP goals to formulate in 1 hour's time. No, I'm kidding. They used cold pressor testing, then gave one group a placebo and one group medication and tested Fo (fundamental frequency), voice onset time, speaking rate, jitter (cycle-to-cycle differences in frequency or pitch), shimmer (cycle-to-cycle differences in amplitude or loudness), and a few other measures. Cold pressor testing is your hand in ice water for one whole minute (aka how one tries to prepare for the pain of child labor...ha. Just keep breathing and imaging yourself on a sunny beach...)

Findings were an increase in blood pressure more in female participants than in male, but both the placebo group and the medication group showed an increase. Jitter increased following medication for stage fright, and speaking rate increased with no medication following the cold water test. I am pretty sure I would have the same reaction if you made me hold my hand in an ice cold glass of water. "Please let me take my hand out now thank you very much yadayadayada....." It would be like truth serum.

It was interesting to me that the researchers hypothesized that the voice parameters measured would all increase in a person with stage fright. They thought the changes in the lungs from the body's reaction to the cold water test would increase the airflow in the throat and therefore increase the vocal fold vibratory speed (making the person's pitch increase). They found that without medication to combat the stress, a person's pitch increased.  

Unfortunately, the only statistically significant finding from this study was that jitter increased after receiving medication for the stress. This means that there is no reason to pop some blood pressure meds before your huge opera debut or that presentation you have to give this week to keep your voice from going all wonky. In fact, this study actually suggests that professional voice users should avoid any medication of this type before singing or speaking because it might be counterproductive, as it increases the noise in your voice.

I guess we will all have to just rely on practice, practice and more practice to keep the "jitters" away during any performance or speaking engagement. Fake it 'till you make it, and by then you will have performed so many times, the stage fright should only come from a ghost light...

-ATVC

 

References:

Beta-Adrenergic Blockade and Voice: A Double-Blind, Placebo-Controlled Trial. Giddens, Cheryl L.; Baron, Kirk W.; Clark, Keith F.; Warde, William D. Journal of Voice , Volume 24 , Issue 4 , 477 - 489.

 

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.