Articulation assessment

1. TRADITIONAL APPROACHES
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2. .
Symptomatic Voice
Therapy
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PURPOSE
 Modification of the
deviant vocal
symptoms or
components.
POPULATION
 For symptoms like
breathiness, low
pitch, glottal fry
phonation, the use of
hard glottal attacks,
and so on.
 For causes like
functional misuse or
abuse of the voice
components
including pitch,
loudness, respiration,
PROCEDURE
 The misuses are
eliminated or
reduced through
voice therapy
FACILITATING
TECHNIQUES
 Boone’s(1971)
original facilitating
techniques include
20 such
techniques.
OUTCOMES
 Various facilitating
techniques are
used to stabilize
the voice when the
best voice is found.
 Symptomatic voice
therapy assumes
voice improvement
through direct
symptom
modification
( Stemple,1993)

3. Psychogenic voice
therapy
OUTCOME
 Voce pathologists must develop and
possess superior interview skills,
counselling skills, and the skill to know
when the emotional or psychosocial
problem is in need of more intensive
evaluation and therapy by other
professionals. (Stemple, 1993)
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PURPOSE
 Psychogenic voice
therapy is based on the
assumption of
underlying emotional
causes for the voice
disturbance.
POPULATION
 The voice disorder is a
manifestation of one
or more types of
psychological
disequilibrium- such as
anxiety, depression,
conversion reaction, or
personality disorder.
PROCEDURE
 Psychogenic voice therapy focuses on
identification and modification of the
emotional and psychosocial
disturbances associated with the
onset and maintenance of the voice
problem.

4. Etiologic voice therapy
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PURPOSE
 Etiologic voice therapy is based on the reasonable assumption that there is
always a cause for the presence of a voice disorder.
For e.g.: in case of vocal nodules, by modifying the shouting behavior, the
nodules are resolved and the voice improves without modification of the voice
components.
PROCEDURE
 Direct symptom
modification i.e.,
raising the pitch,
reducing breathiness,
and so on) is reserved
for the situations
where the
inappropriate use of a
voice component is
found to be the
primary etiologic
factor.
OUTCOME
 Once the cause is
identified, the cause
can be modified or
eliminated leading to
improved voice
production

5. Physiologic voice
therapy
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PURPOSE
 Physiologic voice
therapy is the
term used to
describe direct
voice therapies
which have been
devised to alter or
modify the
physiology of the
vocal mechanism.
 Physiologic voice
therapy
concentrates on
developing and
maintaining the
health of the
vocal fold cover.
POPULATION
 For disturbances
having in laryngeal
muscle strength,
tone, mass,
stiffness, flexibility,
and approximation.
 Disturbances may
be in respiratory
volume, power,
pressure, and flow.
PROCEDURE
 Physiologic voice
therapy strives to
balance the
physiology of
voice production
through direct
physical exercise
and
manipulations of
the laryngeal,
respiratory, and
resonatory
systems.
 Special care
should be taken
to account for the
health of the
vocal fold cover.

6. Eclectic voice therapy
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PURPOSE
Many patients share the same diagnosis, however, the
etiologies and personalities, vocal needs and emotional
reactions to their voice problems may be very different.
Because of this differences, the same pathologies may
require very different management approaches.
Therefore, the voice pathologist is advised not to adhere
to any one philosophical orientation of voice therapy, but
rather to learn a broad range of management
approaches.
Eclectic voice therapy is the combination of any and all
of the other orientations of voice therapy.

7. • SPECIFIC APPROACHES FOR
SPECIAL DISORDERED
POPULATION
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8. Management for puberphonia
(William, 2012)
The voice therapy treatment protocol included therapy techniques
commonly applied for achieving lowering of pitch. Some techniques which
were commonly used were as follows:
 Humming while gliding down the pitch scale, i.e., humming while
gliding from a higher note to a lower note
 Phonation of vowel sounds with a glottal attack, i.e., forceful initiation
of voice during production of vowels
 Use of vegetative sounds like cough or throat clear to initiate voicing
 Production of glottal fry (i.e., lowest possible pitch which the patient
can produce)
 Digital manipulation of thyroid cartilage during vowel production-
patient is taught to apply a gentle inward push on the anterior aspect
of the thyroid cartilage while sustaining a vowel.
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9. (Thorton, 2008)
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AREA TRANSFEMAL
E
METHOD TRANSMALE
Pitch
and
intonation
 Increased
pitch to at
least
‘neutral
range’
145-165Hz
(Oates,
1997)
 Therapy
pre and
post pitch
changing
surgery to
maximise
surgical
results.
 Manipulation of vocal tract
length by altering laryngeal
height whilst keeping an open
and relaxed internal laryngeal
posture allows the individual to
focus on a reduced, more
gender-specific pitch range.
 Encouraging gentle onset and
finishing of phrases/utterances
in Transwomen and a narrower,
though not monotone, pitch in
transmen.
 In trans women, this helps to
eradicate the perceptually
aggressive style of the “male
speakers” which may be
characterized by a sharp drop in
intonation at the ends of the
phrases.
Stabilisation of post
Hormonal voice

10. AREA TRANSFEMALE METHOD TRANSMALE
Resonance
 Dynamic
pitch
contours with
gentle
onset and
ending of
Utterance.
 More head
resonance,
increasing the 3rd
formant to produce
a lighter voice.
 Lifting the voice in
association with
obtaining tactile
sensation from the
chest and face, altering
lips and tongue
placement
are often sufficient to
achieve a redistribution
in resonance and an
increase in the formant
frequency values, (in
trans women)
More chest resonance
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11. Vocal cord paralysis
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12. PRESCRIPTION OF VOICE THERAPY
• DIAGNOSIS: MODERATE BREATHINESS WITH UNILATERAL VOCAL CORD PALSY
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DOSAGE- 8REPETITIONS/5 TIMES A DAYFOR 2 WEEKS
• STRAW PHONATION WITH THICK STRAW
• CIRCUMLARYNGEAL MASSAGE
• PUSH-PULL EXERCISE
• SUCCESSIVE INCREASE OF LOUDNESS OF 1-5 COUNTING
• CIRCUMLARYNGEAL MASSAGE (SOS)
8REPETITIONS/3 TIMES A DAY FOR 2 WEEKS
• LIP AND TONGUE TRILL
• PUSH PULL EXERCISE
• VOICED CONSONANT PRODUCTIONWORDSPHRASESSENTENCES
WITH LOWER LAYNGEAL POSITIONING FOR 2 WEEKS
• GENERALISATION
TERMINATION OF THERAPY
• PATIENT ACHIEVED 80% OF TARGET  STOP REGULAR THERAPY
• MAINTENANCE OF THERAPY (F/U AFTER 15 DAYS 1 MONTH3
MONTHS6 MONTHS ANNUAL CHECK UP

13. Neuromuscular electrical stimulation (NMES) is a popular
rehabilitative modality, induces contraction of neuromuscular
system by applying electrical current.
Rushton,1997; Powell et al., 1999
In the field of rehabilitation, NMES has long been used to
improve motor function of the muscles of extremities and trunk,
and the working mechanisms have been suggested as
improvement of muscle strength, decrease of spasticity of
antagonist muscles, increased range of motion, improvement of
voluntary motor control and recovery of functional movement.
Maddocks et al., 2013; De
Oliveira Melo et al., 2013
NMES refers to the electrical stimulation of an intact lower
motor neuron (LMN) to activate paralyzed or paretic muscles.
Sheffler and Chae, 2007
NMES(NEUROMUSCULAR ELECTRICAL S
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14. TYPES OF
NMES
THERAPEUTICS NMES:-
Use of repetitive
stimulation of activation
of paralyzed muscle to
minimize specific
impairments like:-
1.Motor weakness
2.Spasticity
3.Cardiovascular
de-conditioning
FUNCTIONAL NMES:-
Use of NMES to activate
paralyzed muscle at a
précised sequence to
assist in the
performance of ADLs or
to provide stability to a
joint or maintain
biochemical integrity
and therefore function.
Sheffler , 2008
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