Vocal Exercise andPerceptual-Motor Retraining

11/21/2011

Traditional voice therapy

• Facilitating techniques

• Trial and error

• Often informed by experience, not science

• Emphasis on voice conservation

The “what” of voice therapy

• Vocal hygiene

• Voice conservation (as it is really needed)• Biomechanical training of efficient voicing to

meet client’s functional needs

Biomechanical training of efficient voicing• Relationship between loud/strong voice and

clear voice

• Want to maximize acoustic output

• Want to minimize impact stress on TVFs

“Optimal Laryngeal Configuration” (OLC)• Barely ab/adducted TVFs

• Manipulating glottal width also affects:– Intensity of output (loudness)– Impact stress on TVFs– Subglottic pressure

• Similar objective to techniques trained in theater, classical singing

• Define target perceptually, not mechanically– Anterior vibrations– Ease of phonation– Not “put your arytenoid here”

• Link between perception and production

• Optimal laryngeal configuration (OLC) also has benefits for tissue recovery

• Many voice therapy/training approaches share this biomechanical target (“what”)

The “how” of voice therapy• How do people acquire new physical

behaviors?

– cognitive/neurologic mechanisms

– laws of practice

– implications for voice training

• Benefit for us: • by understanding principles of how people

learn, • we can be flexible in our application • and provide individualized, patient-centered

therapy programs

PERCEPTUAL-MOTOR LEARNING• “a set of processes• associated with practice or experience• leading to relatively permanent changes• in the capability for movement.”

(Schmidt, Lee 1999)

• Cannot observe learning, only performance

• Clinician (and client) observes change in client’s performance over time

• Learning can be indicated by average performance over time

PERFORMANCE ≠ LEARNING• Things we do in the clinic that improve client’s

immediate performance may detract from learning and retention

• Things we do in the clinic that mess up immediate performance may enhance long-term learning

• Client’s perception drives the bus.

Declarative vs. procedural learning

• Declarative: specific events, general facts; seen by (verbal) report

• Procedural: processes, skills; seen by performance changes following practice/exposure

• Involve different neurologic structures– E.g. declarative depends on hippocampus and

amygdala

• Evidence of distinction between declarative and procedural learning– Brain injury

• Procedural learning can happen with little or no conscious awareness

• Can improve without even knowing you have been exposed to the task!– Example from pop culture: The Karate Kid

• Implications for cueing in voice therapy?

• Thinking about something can disrupt doing it– Involve different neurologic pathways

• Investigate by observing, not by discussing

• Clients and clinicians may believe that verbal instructions are helpful

• they are…

• Locus of attention is key

• Internal vs. external locus of attention

• To promote learning, external > internal

• Pay attention to the effect of what you do, not the gesture itself– Where the ball goes, not what your arm did

• Implications for voice?

Don’t make it happen, just notice

• Visual images expand feedback loops to include extraneous stimuli

• Clients (and clinicians) may think that visual images and metaphors support learning (for voice)

• They are…

Conclusions• Verbal approach to training ↑’s verbal activity

in brain, leads to poor long-term learning

• Procedural approach ↑’s RH/perceptual activity in brain, leads to better long-term learning

• Awareness and attention to specific feedback is essential

• Train clients to trust their perception

• Minimize their dependence on your feedback

• Variable practice > nonvariable practice for generalization of new behaviors

• Modify tasks; place obstacles in path of learner

• Changing tasks just when client begins to succeed may frustrate short-term performance, but optimizes long-term generalization/retention

Some principles of exercise physiology

• Overload (duration/frequency/intensity)

• Specificity

• Progression/hierarchy

Some objectives of exercise

• strength

• flexibility

• endurance/consistency

• coordination and automaticity

Which one(s) are you targeting? Why?

• Progression– Unconsciously incompetent– Consciously incompetent– Consciously competent– Unconsciously competent

Speech hierarchies• Silence/breathing• Phonation• Phonemes• Syllables and syllable strings• Words and phrases• Sentences• Discourse• Challenge situations– loud noise, emotional topics, etc.

• Adjustments to airflow and breathing include

– Inspiratory checking

– Coordination of breathing with speech

• Adjustments to source include– Pitch– Loudness– Registration• fry• falsetto• Thin vs. thick folds (“chest”/TA vs. “head”/CT)

– Stability/periodicity

• Adjustments to filter

– False vocal fold retraction

– Laryngeal height

– Aryepiglottic narrowing (twang)

– nasality