5 Tips for Keeping Voice Safe During Teletherapy

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Here we are, with seemingly no end in sight to COVID-19 and school, outpatient clinic, and work obligation cancellations. We are staying home, we are physically/socially distancing, we are trying our best to flatten the curve. During this sudden switch to teletherapy, many of us without warning began experiencing new vocal fatigue and maybe didn’t put 2 and 2 together.


If you have been trying to keep your head above water, you are not alone. Laryngeal fatigue is a very real thing and if you are like Rebecca Reinking from Adventures in Speech Language Pathology, you may have even lost your voice for a few days and had to hold off on providing therapy. So, here are 5 easy things you can do today to lessen the chance you’ll succumb to vocal fatigue or voice loss while you’re trying to keep making a difference in the lives of your patients.


When we cannot hear clear feedback for our own vocal output, we put ourselves at risk. The Lombard Effect, explains Dr. Joel Portnoy, Laryngologist, is where we “automatically increase our own volume when we do not hear ourselves well such as when we are speaking over noise in loud environments.” Putting you and your client directly into your ears, with no room for any other acoustic input, reduces that effect. This should lessen strain on your voice. I chatted about this on my Instagram Stories the other day, and got so much feedback from this that I made it a long video for the IG Feed. Watch it Below…



Another super tip to help you balance your vocal subsystems (breath, vocalization, resonance) before or after your sessions are resonant sounds. Resonant Voice has been studied by numerous leaders in our field of vocology, and was popularized in the LMRVT approach by Kittie Verdolini Abbott. It is based on creating hums or vibratory sounds like /v/ and /z/ in the front of the face, and uses principles from Ingo Titze’s research on semi-occluded vocal tract exercises. Making select sounds in this way helps lessen collision forces on the vocal folds/cords, and helps encourage more balanced phonation when you speak. (The video above also goes over a quick demonstration for this.)


While it’s not imperative that you drink constantly, you should be aware of your intake of hydrating fluids while you’re at your computer. If you have back-to-back sessions where you barely get up to use the restroom, you might not think to grab something to drink either. I like to have a large vessel to put my water in so I can sip on it throughout my sessions, and I have no excuse. You also have the option of a cool-mist humidifier to moisturize the mouth and throat, or nebulizing 0.9% isotonic saline to hydrate your vocal folds (research from Kristine Tanner and her colleagues).

“Many of us, without warning, began experiencing new vocal fatigue and didn’t put 2 and 2 together”


When our brains are working so hard on making communication during these tele practice sessions, we forget that we can use visual cues. We need to harness the power of these because if the patient is sustaining phonation, we cannot stop them or cue them during their utterance because they cannot hear us on their end. Instead, work with your client to determine easy visual or written cues you can show when you need to communicate during a production on their end. This lessens the chance you will yell or try and talk over your client.


Sara Lobegeiger de Rodriguez talks a lot about the power of the pause on Voice Science. What she discusses is that communication is not always in constant, quick speech. Communication can take place within the lack of speech as well. Zoom, Hi-Talk, Doxy and other online platforms for teletherapy result in timing issues when there is no clear opportunity for conversational turn-taking. Both parties talk at once, both parties realize this has happened, and then they are silent until someone tries to speak again. Even with this unfortunate result of videoconferencing for your sessions, you can still allow the client to take responsibility (as Melanie Tapson says) and ownership for implementing your strategies and reporting what they feel and hear.

“When our brains are working so hard on making communication during these tele practice sessions, we forget that we can use visual cues.”



And with the help of my friends and colleagues from The Confident Clinician, Aaron and Cara, we created a LIVE webinar on April 4, 2020, that was recorded and will soon be available for download and viewing. This webinar talks about how to optimize your online clinic environment, troubleshooting ethics, billing/reimbursement, as well as actual live voice therapy to watch. Melanie Tapson consults with us during this webinar about optimizing your own vocal health as well.

Phonotrauma Prevention Handouts Here

Phonotrauma Prevention Handouts Here

Vocal Wellness, Warm Ups, Hydration Handouts Here

Vocal Wellness, Warm Ups, Hydration Handouts Here

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 voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway 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.


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