The hardest thing right now for many students, CFYs and licensed SLPs and SLPAs is wondering how they will ever be able to train to treat voice patients adequately. They may have had a very difficulty time securing an in-person spot at a voice center to observe and try their skills, and COVID has made it nearly impossible to do what they had planned when they signed up to sharpen their skills for voice rehabilitation services.
Videos to go along with this blog! Hooray!
I thought today in my online sessions that I would highlight some of the ways I feel voice therapy is an art. In this video, you see many things happening as I introduce a new technique, and I wanted to break it down in hopes that you might be implementing some of these things in your sessions:
In the beginning, I am humming during resonant voice therapy training. Resonant voice therapy is a type of physiological voice technique that helps patients improve resonance and coordination of vocal subsystems by focusing the sound forward by producing tactile vibrations in the front of the face. I give the patient an example of the hum, and then let the patient try. I then pose a question. Putting the work in the patient’s hands is important because they begin to take ownership. I ask, “Where do you feel the vibration?” The patient answers, and I reassure them with a tactile cue is specific to them. Why? Because patients report multiple different sensations when completing a forward, buzzy hum, and I want to tailor the therapy for success with each patient in their own way.
Not Just Feeling
I then pose a question to the patient asking them what they hear. I give options so the patient can choose where they are headed, and put the ownership again on them to describe their own way how their hum sounds. This is important because when performing behavioral voice therapy, we need to make sure we give patients multiple tools to assess their own accuracy, especially since they practice the bulk of techniques on their own, without our feedback. If you don’t have a map, how can you find your way on your own?
If a patient messes up, excellent! This is a teaching moment and I wish it happened more often. Often patients feel a pressure to perform well, and messing up is taboo. I catch the patient here with my “OOOOH! What happened there?” I do not call them out for messing up or attempt to make them feel like they were bad, I ask them why they thought it wasn’t good. I let them explain, and then reinforce the things that were correct about their assumption AND I then offer a way for them to analyze why it wasn’t the best production that becomes a solution for the next trial they perform. “Take a deep breath” and “feeling coolness” are both things that the patient and I have discussed prior to this task, so bringing back self assessment is always helpful at giving the patient a path forward.
I hope it was helpful to see a play-by-play of a few of voice rehabilitations finer attributes, and something that you can’t read in a textbook. Let me know if you want to see more blogs like this.
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.
Also, if you want more tailored training, email The Confident Clinician Cooperative at firstname.lastname@example.org to join the first of its kind voice assessment and rehabilitation trainings that will include virtual drop-ins, coaching, live therapy, and brand-new webinars about everything voice. Or click the pic below to see about viewing webinars we already designed, and ask about tailored voice trainings.