Voice
Speech and language therapists who work with voice problems assist people whose voice does not work reliably, or has changed from its usual sound. Absence of voice (aphonia) or impairment (dysphonia) may be congenital or acquired. Adults and children with voice problems may have been seen by a laryngologist (in a hospital ENT department) before referral to a speech and language therapist, or referral to such a specialist may be made at a later date.
Recognised characteristics of voice problems:
- A persistent - if variable - change in the voice. This may affect pitch, volume, flexibility, or control.
- Possible throat discomfort during, or after, use of the voice.
- A voice that becomes croakier or unreliable with continued use. Rest may become increasingly necessary to refresh the voice.
- A loss of confidence that the voice will sound reliably clear when speaking in public.
- Problems linked to singing affecting the spoken voice.
- There may be a physical problem such as vocal cord nodules/polyps.
Speech and language therapy for adult voice problems often begins with an examination by an ENT doctor. This will determine whether the throat/larynx has any identifiable physical problem. A speech therapist may also view the larynx, and these views can be compared with ones taken later after any treatment - hopefully showing improvement! The therapist and client will then explore the underlying causes of the voice problem. These may arise from a number of sources such as work pressures, environmental irritants, or stress related issues.
The following may form part of therapy input for adults with voice problems:
- Raising awareness of which behaviours contribute to ongoing voice irritation.
- A focus on supportive breathing for the voice.
- Awareness of tight muscles in the larynx which hinder the production of free voice.
- Using the voice in various postures: seated, standing and moving.
- Massage of the muscles of the throat, by the therapist - and taught to the client.
- An element of counselling, if necessary.
Therapists who work with children with voice problems may be considering similar topics, but the approach in therapy has to be modified appropriately.
- Assessment of the general health and voice history of the child and current voice problem. Parents can inform the therapist of: any known medical problems that may be related to the voice issue; the outcome of reports from a doctor/laryngologist; the child's awareness of the problem.
- Explanation of how voice is produced.
- Strategies and exercises that parents and children can work on together. Teachers may also need to be involved.
- Advice on looking after the voice to maintain vocal health.
- Referral on to other specialists if appropriate.
Some points you may wish to discuss with any therapist you contact include:
- The therapist's specialist credentials in the specific area of voice problems. There are different training courses which provide approaches to the problems (e.g. Estill, Voicecraft techniques, the Accent method, laryngeal manipulation). The therapist may belong to the British Voice Association, the Voice Care Network UK, the British Association of Performing Arts and Medicine - BAPAM, or another specific multi-disciplinary voice group.
- If you are already involved in a special programme (e.g. Alexander Technique, specialist counselling, Yoga, or a strenuous form of exercise) you may wish to discuss this with your therapist.
- How much experience the therapist has with voice problems.
- Where the therapist sees people for assessment/therapy.
- How much the therapist charges for assessment and/or regular therapy.
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