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Neurological Voice Disorders and Voice Therapy

What have you heard about voice therapy for neurological voice disorders? We may have heard things like, "it's a neurological voice disorder, don't bother with voice therapy" or "it can't be cured so there's no point in voice therapy".

There’s a strong belief that if a patient has a voice disorder of neurological origin then speech pathologists have no role. NOT true!!!

Why do professionals think this? I think sometimes professionals believe that because we can’t fix or cure the disorder that they have no role. But how many other disorders do we treat that we can’t cure or that have a neurological basis. Aphasia, primary progressive aphasia, voice changes due to Parkinson’s disease, dysarthria…

So why should neurological voice be any different?

Neurological voice disorders include spasmodic dysphonia, essential tremor of the voice, vocal fold paresis, and vocal fold paralysis. I can’t cure any of these. BUT I can certainly give a patient lots of tools and empowerment to feel even a little better. How?

  1. Education

  2. Tools to compensate for symptoms

  3. Validation

I have had a lot of success with voice therapy for patients with vocal fold paresis, spasmodic dysphonia, and vocal tremor. But it depends on how you define success. In my book (and many patients’ books) it’s an increase in vocal control, decrease in vocal strain, decline in vocal fatigue, increase in empowerment, decrease in psychosocial symptoms and increase in quality of life. Success does not have to mean complete resolution of a disorder, especially when that’s not possible.

Voice therapy may not work for some patients, very true. It won’t work to cure. It also won’t work if the treating SLP is not specialized or trained specifically in voice. And it definitely won’t work in sessions with SLPs who have the assumption at the start that it’s not going to be effective (If you don’t believe in what you’re doing in therapy, the patient certainly won’t and thus it won’t be successful)!

Sure, the voice therapy is harder than with someone without a neurological voice disorder. BUT can the patient be stimulable use more airflow to get a slightly smoother voice? Can they have an increase in forward vibration to provide a decrease in severity of roughness, tension or breaks? Can they use straw phonation before a phone call to help increase control of the voice and decrease frustration? Can they learn to use less effort and maladaptive compensatory techniques?

Can we validate what they’re going through? Can we provide education on why they’re feeling/hearing what they are and what is actually happening in the larynx?

Food for thought! Have you worked with neurological voice patients? What have you tried?

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