A speech language pathologist (also nicknamed SLP) or speech therapist, is an individual who focuses on rehabilitation of speech and language. Some speech pathologists focus on working with children. Some work just with adults, but in rehabilitation settings (i..e treating individuals with speech and language disorders due to stroke, neurological diseases or neurological insults). See post titled “What is a Speech Language Pathologist” for more details.
Voice is included in the umbrella under “speech”. You may also come across the terms voice therapist, or clinical voice specialist, or voice clinician. These names simply mean that the speech language pathologist is further specialized in the area of treating voice disorders.
Why would I need to see a voice therapist?
A voice therapist can be helpful in several areas. First, in diagnosis of a voice or upper airway impairment. The SLP is able to do different diagnosis tasks than the ENT/otolaryngologist (i.e. measures that look at objective measures of the acoustic (sound) properties of your voice, how much effort you’re using to make voice, assessing different perceived qualities in the sound of your voice, and perhaps, most importantly, assessing how your voice is impacting your quality of life or day to day functioning). An SLP can provide strategies for either treatment or better management of the voice impairment, depending on severity and disorder.
Voice therapy and Spasmodic Dysphonia
Is voice therapy helpful for my spasmodic dysphonia?
There has been much debate about this question. It is well recognized that voice therapy cannot cure SD. But what about compensating for it? As a speech language pathologist I treat other chronic “non-curable” disorders in the same way- I’ve worked even with many individuals with progressive neurological disorders (obviously understanding that my therapy would not cure but instead would help the individual to compensate for current or expected declines in communication). For stuttering, again, we don’t cure stuttering with our speech therapy treatment and that is never a goal. But we help individuals who stutter cope with the negative thought patterns, the avoidance behaviors, the emotional effects of the speech disorder that are further inhibiting effective communication, and we give the person strategies to make the speech easier, more fluid, and less effortful, even though the stuttering will still be there. I similarly treat chronic neurological voice disorders in the same way (i.e. vocal fold paralysis, paresis, vocal tremor). And that includes spasmodic dysphnonia. Even several sessions of voice therapy could be beneficial for some patients depending on what his/her needs are and depending on how “stimulable” they are for changing his or her voice. If the individual receives Botox and that gives them a functional voice without issues, that is great! Same for surgery. However, if an individual chooses not to get one of the current medical treatment options, wants a conservative approach, or feels that these options do not provide enough relief of symptoms alone, voice therapy can come into play.
Again, the goal is not to cure, but the SLP/voice therapist can provide: Education and counseling on the chronic voice disorder, education on voice production in general for the patient to understand the physiological mechanisms that are producing their symptoms, education on maintaining adequate vocal health, counseling surrounding use of Botox and continued Botox treatment, education on treatment options, voice therapy for compensating for the SD more efficiently and education on “tricks” to manage different speaking contexts (phones, ordering coffee at Starbucks, using voice in meetings, loud environments, presentations etc). Voice therapy can be helpful to reduce the effort it takes for you to get words out, can give you techniques and tools to make the voice smoother, and can help to rebalance and recoordinate your speech subsystems. Your voice therapist can also offer support in acknowledging the psychosocial effects of the disorder and in validating these feelings.
Can I just see any speech language pathologist?
The best course of action would be to seek an SLP who is specialized in assessing and treating voice disorders. He/she should specify this either in his/her title (i.e. voice specialist, voice therapist, voice clinician) or in his/her bio. You definitely want to make sure if you decide to go forward with a voice assessment or voice treatment with an SLP that he or she is specialized in voice treatment and that voice disorders make up the majority if not all of what he/she does. You also want to make sure he/she is familiar with spasmodic dysphonia or whichever voice disorder you have.
How do I go about finding a speech language pathologist/specialized voice therapist?
There are several ways to find a voice therapist who will provide voice therapy. Voice therapists can often be found working side by side otolaryngologists who treat SD. Often times both the otolaryngologist and SLP/voice therapist will work together in a Voice Center or Voice Program. Most major hospitals and some smaller hospitals have these. You can find a list of providers on the NSDA website here. There are also private practice providers, like Speaking Boldly. These speech language pathologists work in a private setting (outside of a hospital) and do similar functions but work in a slightly different setting to provide services. There are benefits and drawbacks to each. A big hospital will provide coverage usually covered by your insurance and well coordinated care with an otolaryngologist but perhaps less flexibility, while private services may or may not be covered (depending on several factors) but may offer more flexible scheduling, personalized support and most importantly often very specialized care.