Vocal Exercise and Perceptual-Motor Retraining

1. Vocal Exercise andPerceptual-Motor Retraining 11/21/2011

2. Traditional voice therapy • Facilitating techniques • Trial and error • Often informed by experience, not science • Emphasis on voice conservation

3. 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

4. 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

5. “Optimal Laryngeal Configuration” (OLC) • Barely ab/adducted TVFs • Manipulating glottal width also affects: • Intensity of output (loudness) • Impact stress on TVFs • Subglottic pressure

6. Similar objective to techniques trained in theater, classical singing • Define target perceptually, not mechanically • Anterior vibrations • Ease of phonation • Not “put your arytenoid here”

7. 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”)

8. The “how” of voice therapy • How do people acquire new physical behaviors? • cognitive/neurologic mechanisms • laws of practice • implications for voice training

9. Benefit for us: • by understanding principles of how people learn, • we can be flexible in our application • and provide individualized, patient-centered therapy programs

10. 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)

11. 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

12. 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

13. Client’s perception drives the bus.

14. Declarative vs. procedural learning • Declarative: specific events, general facts; seen by (verbal) report • Procedural: processes, skills; seen by performance changes following practice/exposure

15. Involve different neurologic structures • E.g. declarative depends on hippocampus and amygdala • Evidence of distinction between declarative and procedural learning • Brain injury

16. 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?

17. 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…

19. Locus of attention is key • Internal vs. external locus of attention

20. 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?

21. Don’t make it happen, just notice

22. 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…

24. 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

25. Awareness and attention to specific feedback is essential • Train clients to trust their perception • Minimize their dependence on your feedback

26. 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

27. Some principles of exercise physiology • Overload (duration/frequency/intensity) • Specificity • Progression/hierarchy

28. Some objectives of exercise • strength • flexibility • endurance/consistency • coordination and automaticity Which one(s) are you targeting? Why?

29. Progression • Unconsciously incompetent • Consciously incompetent • Consciously competent • Unconsciously competent

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

31. Adjustments to airflow and breathing include • Inspiratory checking • Coordination of breathing with speech

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

33. Adjustments to filter • False vocal fold retraction • Laryngeal height • Aryepiglottic narrowing (twang) • nasality