1. Vocal Exercise and Perceptual-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