1. ADVENTURES IN VOICE A Whole New Way of Doing Things for Kids! OVERVIEW OF PROGRAM K. Verdolini Abbott, Ph.D., CCC-SLP Rita Hersan, M.S., CCC-SLP David Hammer, M.A., CCC-SLP Jan Potter Reed, M.S., CCC-SLP September 2010

2. Which children are appropriate? Children with phonogenic voice problems (phonotrauma, MTD) Generally ages 4-11 Generally cognitively intact http://www.babyboomercaretaker.com/images/Who-Is-More-Important-Your-Own-Child-Or-Grandchild.jpg http://thebeautifulstruggler.com/wp-content/uploads/2010/04/black-girl-with-beautiful-eyes-horiz.jpg http://www.harrycutting.com/graphics/photos/children/african-american-girl-white-boy-FC5143-73.jpg http://www.saintbarnabas.com/hospitals/monmouth_medical/childrens_hospital/images/adolescent.jpg

3. Other children Program may be applicable with minor adaptations Generally children with voice problem who would benefit from a change in VF adduction Clinician’s discretion http://www.stammeringlife.com/Images/Vocal%20Folds%20(vf)%20Opening%20and%20Closi ng.JPG

4. Who may provide the program? SLP (CCC or otherwise licensed) Received 2-day training in AIV from Verdolini & associates Passing knowledge test receives additional certificate http://www.280group.com/ptgraphics/training.jpg

5. Fundamental framework “What” of training  “Easy vibrations voice” – Defined as easy voice produced with perceptible anterior oral vibrations – Likely corresponding with Barely ad/abducted vocal folds Large-amplitude, low- impact vocal fold oscillations Large AC flows, small DC flows, and small PL Relatively intense voice http://www.stammeringlife.com/Images/Vocal%20Folds%20(vf)%20Opening%20and%20Closi ng.JPG

6. Fundamental framework “How” of training  Motivation/remembering: – Setting the stage with elaborated stories Learning principles – Engage child’s active (cognitive and physical) participation in the therapy process. – Allow child to explore; don’t hover; provide feedback but not too much and not too quickly. – Direct child’s attention and active responses to sensations, perceptions related to output in self and others, not biomechanics. – Work on voice production as a whole, not component pieces. – Make goals for advancement in the program specific. – Mix up simple/complex tasks. – Provide opportunity for child to explore vocal target in numerous contexts relevant to the child. http://www.askrogerdrummer.com/healingherbs/wp-content/uploads/2010/02/children- being-active.jpg

7. Fundamental framework “If” of training  Numerous principles including – Engage the child – Involve the parent – Written/audio instructions – Accountability (follow-up monitoring) – Clinician presence http://www.thenaberhood.com/about/homework.gif

8. Sessions (competency based) SESSIONHygieneSet-UpBasicsBridgingLoudApplied *** SSThSMinis*** 1A1 2A2 3A3 4A4 5A5 6A6 7A7 8A8

9. Progression through program Competence should be shown for goals in each lesson before proceeding to the next session (~90%, i.e. “quite well”) If not, back up and re- do http://betalabs.nokia.com/files/blog/2008/12/steps.jpg

10. Program duration Depends on child and setting Created to be 8-12 sessions (weeks)

11. (In case you wonder) Relation to LMRVT – Adult LMRVT modified for children – Theory: Verdolini Abbott – Practice: Road testing and brainstorming Hersan, Hammer, Kessler However – Programs are sufficiently different one can no longer be trained in one and “invent” the other http://www.pluralpublishing.com/img/books//book_lmrvt.jpg

12. “Data” http://www- dse.ec.unipi.it/persone/ricercatori/Guerrazzi/Pictures/Data.jpg Uncontrolled Small N Retrospective From clinical practice using related program (Buzzy Child) (next p.)

13. PatientMPT (sec) pre MPT (sec) post Range (ST) pre Range (ST) post Voice Quality pre Voice Quality post Larynx pre Larynx post 014.08.4832G3G0BNn/a 023.06.0719G3G0BNNL 034.610.5820G2G0BNNL “Data” (from Kessler patients; representative; more forthcoming) (G3 worst rating; G0 best rating; BN bilateral nodules; NL normal larynx)